The ecological validity of laboratory and analogue assessment methods of ADHD symptoms

Clinical and Experimental Factors Influencing the Efficacy of Neurofeedback in ADHD: A Meta-Analysis

Meta-analyses have been extensively used to evaluate the efficacy of neurofeedback (NFB) treatment for Attention Deficit/Hyperactivity Disorder (ADHD) in children and adolescents. However, each meta-analysis published in the past decade has contradicted the methods and results from the previous one, thus making it difficult to determine a consensus of opinion on the effectiveness of NFB. This works brings continuity to the field by extending and discussing the last and much controversial meta-analysis by Cortese et al. (1). The extension comprises an update of that work including the latest control trials, which have since been published and, most importantly, offers a novel methodology. Specifically, NFB literature is characterized by a high technical and methodological heterogeneity, which partly explains the current lack of consensus on the efficacy of NFB. This work takes advantage of this by performing a Systematic Analysis of Biases (SAOB) in studies included in the previous meta-analysis. Our extended meta-analysis (k = 16 studies) confirmed the previously obtained results of effect sizes in favor of NFB efficacy as being significant when clinical scales of ADHD are rated by parents (non-blind, p-value = 0.0014), but not when they are rated by teachers (probably blind, p-value = 0.27). The effect size is significant according to both raters for the subset of studies meeting the definition of "standard NFB protocols" (parents' p-value = 0.0054; teachers' p-value = 0.043, k = 4). Following this, the SAOB performed on k = 33 trials identified three main factors that have an impact on NFB efficacy: first, a more intensive treatment, but not treatment duration, is associated with higher efficacy; second, teachers report a lower improvement compared to parents; third, using high-quality EEG equipment improves the effectiveness of the NFB treatment. The identification of biases relating to an appropriate technical implementation of NFB certainly supports the efficacy of NFB as an intervention. The data presented also suggest that the probably blind assessment of teachers may not be considered a good proxy for blind assessments, therefore stressing the need for studies with placebo-controlled intervention as well as carefully reported neuromarker changes in relation to clinical response.

Executive functioning in adolescent anorexia nervosa: Neuropsychology versus self- and parental-report

There is limited research concerning the relationship between neuropsychological assessment and self-report of executive functioning in adolescent anorexia nervosa (AN); available studies demonstrate only low to moderate correlations. Therefore, this study examines the association between neuropsychological test performance and self-report in AN. Forty adolescent inpatients with AN completed an extensive neuropsychological assessment, including set-shifting, central coherence, and questionnaires assessing executive functioning in daily life (BRIEF-SR). Their parents filled out an analog version (BRIEF-PF). Statistical analyses revealed low to medium positive and negative correlations between neuropsychological measures and BRIEF subscales. Similarly, self- and parental ratings were only slightly positively correlated, with patients scoring significantly higher than their parents on two subscales. The results support previous findings of modest correlations between self-report and performance-based testing and emphasize the importance of a multiple format assessment of executive functioning in adolescent AN.

Mobility may impact attention abilities in healthy term or prematurely born children at 7-years of age: protocol for an intervention controlled trial

BACKGROUND

Seven years of age is a milestone for learning basic knowledge that is strongly related to attention abilities such as Alerting, Orienting, and Inhibition function, allowing for appropriate adaptation to primary school. These attention abilities are also influenced by gestational age at birth in a complex manner, indicating an area of weakness in prematurely born children. Furthermore, recent studies suggest that allowing children to have freedom of movement during learning may improve their attention level and school performance. The purpose of the present study is to determine the influence of mobility on the attentional components that may impact learning abilities in children aged 7-years who were born at term and prematurely.

METHODS

This prospective, randomized, controlled trial will focus on psychometric testing of attentional abilities assessed with the Attention Network Test for Child (Child ANT) and involves a mixed measurement design. Forty-eight children aged 7-years, half of whom were premature at birth and in their expected grade without learning difficulties will be included after parental consent. They will be equipped with a head-mounted display in which the Child ANT will be presented. The association of different flankers and pre-cues will allow the measurement of the development level of Alerting, Orienting, and Inhibition function. The task will be composed of one experimental block of trials randomly performed per posture: seated, standing, or free.

DISCUSSION

This study will assess the contribution of mobility in specific attentional contexts that are usually present during fundamental learning in children. New pedagogical formats of teaching could consider these findings, and new pedagogical tools enabling free spontaneous child mobility might be designed. Moreover, a small percentage of children integrating into the educational system are born prematurely. These children, often considered immature and hyperactive, could benefit from educational innovations that enhance their attention abilities, thereby improving their adaptation to primary school.

TRIAL REGISTRATION

This trial is registered at ClinicalTrials.gov ( NCT03125447 ).

A Review of the Clinical Utility of Systematic Behavioral Observations in Attention Deficit Hyperactivity Disorder (ADHD)

This review evaluates the clinical utility of tools for systematic behavioral observation in different settings for children and adolescents with ADHD. A comprehensive search yielded 135 relevant results since 1990. Observations from naturalistic settings were grouped into observations of classroom behavior (n = 58) and of social interactions (n = 25). Laboratory observations were subdivided into four contexts: independent play (n = 9), test session (n = 27), parent interaction (n = 11), and peer interaction (n = 5). Clinically relevant aspects of reliability and validity of employed instruments are reviewed. The results confirm the usefulness of systematic observations. However, no procedure can be recommended as a stand-alone diagnostic method. Psychometric properties are often unsatisfactory, which reduces the validity of observational methods, particularly for measuring treatment outcome. Further efforts are needed to improve the specificity of observational methods with regard to the discrimination of comorbidities and other disorders.

Transcranial direct current brain stimulation decreases impulsivity in ADHD

BACKGROUND

Impulsivity is a core deficit in attention deficit hyperactivity disorder (ADHD). Transcranial direct current stimulation (tDCS) of the dorsolateral prefrontal cortex (DLPFC) has been shown to modulate cognitive control circuits and could enhance DLPFC activity, leading to improved impulse control in ADHD.

OBJECTIVE

Hypothesis: We predicted 2.0 mA anodal stimulation (tDCS) versus sham stimulation applied over the left DLPFC would improve Conners Continuous Performance Task (CPT) scores. Our secondary hypothesis predicted that stop signal task (SST) reaction time (SSRT) would decrease with tDCS (versus sham).

METHODS

Thirty-seven participants completed two periods of three tDCS (or sham) sessions two weeks apart in a within-subject, double-blind, counterbalanced order. Participants performed a fractal N-back training task concurrent with tDCS (or sham) stimulation. Participants completed the CPT and SST at the beginning of treatment (baseline), at the end of the treatment, and at a 3-day post-stimulation follow-up.

RESULTS

There was a significant stimulation condition by session interaction for CPT false positive scores (χ² = 15.44, p < 0.001) driven by a decrease in false positive errors from baseline to end of treatment in the tDCS group (β = -0.36, 95% Confidence Interval (CI) -0.54 to -0.18, p < 0.001). This effect did not persist at follow-up (β = -0.13, p > 0.05). There was no significant stimulation condition by session interaction effect on CPT true positive errors or response time (ps > 0.05). No significant change in SSRT performance was observed (p > 0.05).

CONCLUSION

These findings suggest that stimulation of the left DLPFC with tDCS can improve impulsivity symptoms in ADHD, supporting the therapeutic potential for tDCS in adult ADHD patients.

Study protocol for a self-controlled cluster randomised trial of the Alert Program to improve self-regulation and executive function in Australian Aboriginal children with fetal alcohol spectrum disorder

INTRODUCTION

While research highlights the benefits of early diagnosis and intervention for children with fetal alcohol spectrum disorders (FASD), there are limited data documenting effective interventions for Australian children living in remote communities.

METHODS AND ANALYSIS

This self-controlled cluster randomised trial is evaluating the effectiveness of an 8-week Alert Program school curriculum for improving self-regulation and executive function in children living in remote Australian Aboriginal communities. Children in grades 1-6 attending any of the eight participating schools across the Fitzroy Valley in remote North-West Australia (N ≈ 363) were invited to participate. Each school was assigned to one of four clusters with clusters randomly assigned to receive the intervention at one of four time points. Clusters two, three and four had extended control conditions where students received regular schooling before later receiving the intervention. Trained classroom teachers delivered the Alert Program to students in discrete, weekly, 1-hour lessons. Student outcomes were assessed at three time points. For the intervention condition, data collection occurred 2 weeks immediately before and after the intervention, with a follow-up 8 weeks later. For control conditions in clusters two to four, the control data collection matched that of the data collection for the intervention condition in the preceding cluster. The primary outcome is change in self-regulation. FASD diagnoses will be determined via medical record review after the completion of data collection. The results will be analysed using generalised linear mixed modelling and reported in accordance with Consolidated Standards of Reporting Trials (CONSORT) guidelines.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the University of Western Australia (WA) (RA/4/1/7234), WA Aboriginal Health Ethics Committee (601) and WA Country Health Service (2015:04). The Kimberley Aboriginal Health Planning Forum Research Sub-Committee and WA Department of Education also provided approval. The results will be disseminated through peer-reviewed journals, conference presentations, the media and at forums.

TRIAL REGISTRATION NUMBER

ACTRN12615000733572; Pre-results.

Hyperactivity in mice lacking one allele of the glutamic acid decarboxylase 67 gene

GABAergic interneuron loss, maturational delay or imbalance of glutamatergic to GABAergic signaling has been implicated in several neuropsychiatric disorders including Tourette syndrome and attention-deficit/hyperactivity disorder (ADHD). In schizophrenia, decreases in parvalbumin (PV), somatostatin (Sst) and glutamic acid decarboxylase (GAD) RNA have been observed and seem to indicate a failure in maturation in PV and Sst neurons. In Tourette syndrome, which has a high level of comorbid ADHD, reduced numbers of parvalbumin expressing neurons have been observed in the basal ganglia of affected patients. In addition, polymorphisms in the GAD1 gene that codes for GAD67 protein have been associated with ADHD. We have examined whether mice with a disrupted Gad67 allele, the Gad67 GFP knock-in mice (Gad67-GFP^+/-), display abnormal locomotor behavior or altered anxiety behavior on the elevated plus maze. We found that Gad67-GFP^+/- mice displayed a mild hyperactivity compared to control littermates.

A Pilot Trial of Mindfulness Meditation Training for ADHD in Adulthood: Impact on Core Symptoms, Executive Functioning, and Emotion Dysregulation

OBJECTIVE

Mindfulness meditation training is garnering increasing empirical interest as an intervention for ADHD in adulthood, although no studies of mindfulness as a standalone treatment have included a sample composed entirely of adults with ADHD or a comparison group. The aim of this study was to assess the feasibility, acceptability, and preliminary efficacy of mindfulness meditation for ADHD, executive functioning (EF), and emotion dysregulation symptoms in an adult ADHD sample.

METHOD

Adults with ADHD were stratified by ADHD medication status and otherwise randomized into an 8-week group-based mindfulness treatment ( n = 11) or waitlist group ( n = 9).

RESULTS

Treatment feasibility and acceptability were positive. In addition, self-reported ADHD and EF symptoms (assessed in the laboratory and ecological momentary assessment), clinician ratings of ADHD and EF symptoms, and self-reported emotion dysregulation improved for the treatment group relative to the waitlist group over time with large effect sizes. Improvement was not observed for EF tasks.

CONCLUSION

Findings support preliminary treatment efficacy, though require larger trials.

Evidence for deficient motor planning in ADHD

We compare motor planning mechanisms of ADHD and control subjects based on their effect on later observed kinematic characteristics. We monitor hand movement following planning conditions that differ in preparation time, and evaluate the differences across conditions and participants with/without ADHD. Our findings show that when there is sufficient planning time, people without ADHD seem to have a motor plan ready, and immediately initiate a planned movement after a ‘GO’ cue, with a bell shaped velocity profile. When planning time is not sufficient, they start the movement in a delayed time, possibly indicating that they needed to complete a movement plan. However, people with ADHD, did not start movement immediately after the cue, even when provided with a long preparation time, possibly indicating that even for this planning interval they did not have a motion plan ready. The movement was not only delayed, its velocity profile was not bell shaped and had several peaks. We further found differences between control and ADHD participants in the velocity profile, variability and jitter of movements. Our results suggest that ADHD motion characteristics, are associated with an immature motor plan. Based on the results we propose a paradigm to evaluate deficiencies in motor planning.

Cognitive functions in adults with β-thalassemia major: before and after blood transfusion and comparison with healthy controls

While β-thalassemia major (β-TM)-related physiological complications have been well established, less is known about implications for neuropsychological and cognitive function. The few existing studies have focused almost exclusively on children. We evaluated cognitive function in adult β-TM patients compared to healthy controls (study 1) and in β-TM patients before and after blood transfusion (study 2). Performance intelligence quotient (IQ) was evaluated with four subtests from the Wechsler Adult Intelligence Scale (WAIS-III). Attention functions were evaluated using the online continuous performance test (OCPT). The results of study 1 revealed poorer performance of β-TM patients on three of the four intelligence subtests, with significantly lower total performance IQ scores compared with controls. The percentage of participants with abnormal performance IQ (<85) was almost five times higher in the β-TM group (58%) than in the control group (12%). In study 2, significant differences were found in OCPT performance as a function of blood transfusion. Before transfusion, patients had higher rates of omission and commission errors, slower response times (RTs), and lower RT consistency than after transfusion. As β-TM patients' life expectancy is increasing, assessment and treatment of neurocognitive functions should become an integral part of appropriate follow-up to improve patients' quality of life.

[Formula: see text]Cognitive and behavioral rating measures of executive function as predictors of academic outcomes in children

Interrelations of two measurement methods (cognitive versus behavioral ratings) for executive function (EF) were examined and related to reading comprehension and math calculations in fourth and fifth grade students (n = 93) in the context of a diverse urban student population. Relations among measures within four EF processes (working memory, planning, inhibition and shifting) were modest; relations to academics were stronger. EF measures contributed to both academic outcomes even in the context of relevant covariates (age, language and educational program). Working memory was particularly important for reading comprehension across measurement type. Cognitive measures from all EF processes, particularly inhibition and planning, and behavioral ratings of working memory were important for math.

Attention-Deficit Hyperactivity Disorder-Like Traits and Distractibility in the Visual Periphery

We examined the performance of nonclinical subjects with high and low levels of self-reported attention-deficit hyperactivity disorder (ADHD)-like traits in a novel distractibility paradigm with far peripheral visual distractors, the likely origin of many distractors in everyday life. Subjects were tested on a Sustained Attention to Response Task with distractors appearing before some of the target or nontarget stimuli. When the distractors appeared 80 ms before the targets or nontargets, participants with high levels of ADHD-like traits were less affected in their reaction times than those with lower levels. Reducing the distractor-target or nontarget interval to 10 ms removed the reaction time advantage for the high group. We suggest that at 80 ms, the distractors were cueing the arrival of the target or nontarget, and that those with high levels of ADHD-like traits were more sensitive to the cues. Increased sensitivity to stimuli in the visual periphery is consistent with hyperresponsiveness at the level of the superior colliculus.

Auditory and Visual Continuous Performance Tests

Elementary school children in three grade groups (Grades K/1, 3, and 5/6) completed either the auditory or the visual 1/9 vigilance task from the Gordon Diagnostic System (GDS) as well as subtests from the Wechsler Intelligence Scale for Children–Third Edition and auditory or visual processing subtests from the Woodcock-Johnson Tests of Cognitive Ability–Revised (WJ-R). Teachers rated the children's classroom attentional and self-control behaviors on the Child Behavior Checklist (CBCL) and the Self-Control Observation Scale (SCOS). Although performance on both auditory and visual continuous performance tests (CPTs) improved with age, gender effects were small and limited to the visual CPT. Neither auditory nor visual CPT scores were related to IQ scores. However, auditory CPT scores were related to classroom behaviors as reported by teachers whereas visual CPT scores were related to visual processing.

Ecological Validity of the Conners' Continuous Performance Test II in a School-Based Sample

The ecological validity of the Conners' Continuous Performance Test II (CPT-II) was examined using a sample of 206 first- and second-grade children. Children's CPT-II scores were correlated with observations of inattentive/hyperactive behavior during CPT-II administration, observations of children's behavior during analogue academic task, classroom observations, and parent/teacher reports. CPT-II scores showed moderate correlations with test session behavior but low correlations with external measures of inattention/hyperactivity. On the other hand, test session observations, analogue task observations, classroom observations, and teacher reports showed moderate and significant intercorrelations. Furthermore, test session observations predicted a significant amount of variance in children's classroom behavior above and beyond CPT-II scores alone. Results suggest that psychologists should supplement CPT-II scores with observational data to estimate children's functioning outside the test setting.

Relationships Between Continuous Performance Task Scores and Other Cognitive Measures: Causality or Commonality?

Relationships among continuous performance test, IQ, achievement, and memory/learning scores were explored in a clinical sample of 1,280 children ( M age = 9.4 years, M grade = 3.9). Intercorrelations among CPT measures were significant, but modest. Correlations between CPT measures and IQ, achievement, and memory/learning scores were also significant, but again generally weak. The CPT number correct scores were more strongly related to other cognitive measures than were commission (i.e., responding to incorrect stimuli) scores. The breadth and extent of associations among the CPT measures and the various cognitive/academic tasks suggest that all, to some extent, require attention and inhibition. The importance of routinely assessing attention and disinhibition in psychological testing is discussed.

The Validity of the ADHD Section of the Diagnostic Interview Schedule for Children

The purpose of this study was to assess the concurrent criterion validity of the attention-deficit/hyperactivity disorder (ADHD) portion of the National Institute of Mental Health Diagnostic Interview Schedule for Children–IV (NIMHDISC-IV). Fifty-seven adolescent participants were divided into three groups on the basis of whether participants met criteria for ADHD on caretaker and adolescent responses on the DISC: (a) 18 participants for whom both the caretakers and adolescents endorsed ADHD, (b) 17 participants for whom the caretakers but not the youth endorsed ADHD, and (c) a clinical control group with no ADHD diagnosis ( n = 22). These three groups were compared across parent, teacher, and adolescent checklists; clinician diagnosis; and three objective measures of behavior (continuous performance task, actigraphy monitoring, and a structured observation). Findings lend partial support to the concurrent criterion validity of the ADHD section of DISC.

Virtual-reality-based attention assessment of ADHD: ClinicaVR: Classroom-CPT versus a traditional continuous performance test

Virtual-reality-based assessment may be a good alternative to classical or computerized neuropsychological assessment due to increased ecological validity. ClinicaVR: Classroom-CPT (VC) is a neuropsychological test embedded in virtual reality that is designed to assess attention deficits in children with attention deficit hyperactivity disorder (ADHD) or other conditions associated with impaired attention. The present study aimed to (1) investigate the diagnostic validity of VC in comparison to a traditional continuous performance test (CPT), (2) explore the task difficulty of VC, (3) address the effect of distractors on the performance of ADHD participants and typically-developing (TD) controls, and (4) compare the two measures on cognitive absorption. A total of 33 children diagnosed with ADHD and 42 TD children, aged between 7 and 13 years, participated in the study and were tested with a traditional CPT or with VC, along with several cognitive measures and an adapted version of the Cognitive Absorption Scale. A mixed multivariate analysis of covariance (MANCOVA) revealed that the children with ADHD performed worse on correct responses had more commissions and omissions errors than the TD children, as well as slower target reaction times . The results showed significant differences between performance in the virtual environment and the traditional computerized one, with longer reaction times in virtual reality. The data analysis highlighted the negative influence of auditory distractors on attention performance in the case of the children with ADHD, but not for the TD children. Finally, the two measures did not differ on the cognitive absorption perceived by the children.

Components of Motor Deficiencies in ADHD and Possible Interventions

There is a growing body of evidence pointing at several types of motor abnormalities found in attention-deficit/hyperactivity disorder (ADHD). In this article we review findings stemming from different paradigms, and suggest an interweaving approach to the different stages involved in the motor regulation process. We start by reviewing various aspects of motor abnormalities found in ADHD and related brain mechanisms. Then, we classify reported motor impairments associated with ADHD, into four classes of motor stages: Attention to the task, motion preparation, motion execution and motion monitoring. Motor abnormalities and corresponding neural activations are analyzed in the context of each of the four identified motor patterns, along with the interactions among them and with other systems. Given the specifications and models of the role of the four motor impairments in ADHD, we ask what treatments correspond to the identified motor impairments. We analyze therapeutic interventions targeting motor difficulties most commonly experienced among individuals with ADHD; first, Neurofeedback training and EMG-biofeedback. As some of the identified components of attention, planning and monitoring have been shown to be linked to abnormal oscillation patterns in the brain, we examine neurofeedback interventions aimed to address these types of oscillations: Theta/beta frequency training and SCP neurofeedback targeted at elevating the CNV component. Additionally we discuss EMG-Biofeedback interventions targeted at feedback on motor activity. Further we review physical activity and motor interventions aimed at improving motor difficulties, associated with ADHD. These kinds of interventions are shown to be helpful not only in aspects of physical ability, but also in enhancing cognition and executive functioning.

Iron Status Is Associated with Performance on Executive Functioning Tasks in Nonanemic Young Women

BACKGROUND

Iron deficiency (ID) is prevalent, particularly among women of reproductive age (WRA). How mild ID without anemia relates to cognition is poorly understood. Executive functioning (EF) has emerged as potentially being affected by mild ID in WRA.

OBJECTIVE

We sought to examine how iron markers relate to performance on EF tasks in nonanemic WRA.

METHODS

Participants included 127 females aged 18-35 y. Hematological indicators included hemoglobin, RBC distribution width, transferrin saturation (TSAT), ferritin, transferrin receptor (TfR), and total body iron (TBI). EF was assessed using 5 tasks. Associations between EF outcomes and iron status were examined using continuous iron predictors and group comparisons.

RESULTS

Better iron status was associated with better attention [faster reaction time (RT) with lower TfR (P = 0.028) and higher TSAT (P = 0.013)], inhibitory control [lower RT variability with higher TSAT (P = 0.042) and planning ability (faster planning time and a smaller planning time increase with increasing difficulty with higher ferritin; P = 0.010)]. No associations with iron status were found for several EF outcomes, possibly due to performance ceilings. Paradoxically, worse performance on a working memory task was related to better iron status, which may reflect hippocampal-frontal interference [lower capacity with lower TfR (P = 0.034) and higher TBI (P = 0.043) and a larger accuracy change with increasing difficulty with higher TBI (P = 0.016)]. Longer RTs on a working memory task were observed among those with positive TBI (iron surplus; P = 0.021) and <2 abnormal iron markers (P = 0.013) compared with those with negative TBI (iron deficit) and ≥2 abnormal markers, respectively.

CONCLUSIONS

These findings suggest cognitive ramifications of mild ID in otherwise healthy WRA and have implications for daily well-being. Future investigators should explore how brain system interactions change according to iron availability.

Behavioral Assessment of Core ADHD Symptoms Using the QbTest

OBJECTIVE

Hyperactivity, one of the core symptoms of ADHD, has been mostly neglected in neuropsychological assessment of childhood ADHD. The neuropsychological Quantified behavior Test (QbTest) separately assesses all three core symptoms of ADHD on a behavioral level. Factor structure of the QbTest and its concurrent and discriminant validity are presented.

METHOD

An exploratory factor analysis (n = 828 children) was performed. In a second sample (n = 102 children) a Multi-Trait-Multi-Method (MTMM) approach was used for validity analyses.

RESULTS

A three factorial model explained 76 % of the total variance, with the resulting QbTest factors significantly influenced by age and gender. The MTMM approach yielded promising results for discriminant, yet inconsistent findings for concurrent validity between the QbTest and another attention test as well as for Conners' Parent and Teacher Rating Scales.

CONCLUSION

Results indicate that the QbTest may be helpful for the behavioral assessment of childhood ADHD, yet further studies on its psychometric quality and clinical utility are needed.

Developmental trajectories of aggression, prosocial behavior, and social-cognitive problem solving in emerging adolescents with clinically elevated attention-deficit/hyperactivity disorder symptoms

Middle school is a critical yet understudied period of social behavioral risks and opportunities that may be particularly difficult for emerging adolescents with attention-deficit/hyperactivity disorder (ADHD) given their childhood social difficulties. Relatively few ADHD studies have examined social behavior and social-cognitive problem solving beyond the elementary years, or examined aspects of positive (prosocial) behavior. The current study examined how middle school students with clinically elevated ADHD symptoms differ from their non-ADHD peers on baseline (6th grade) and age-related changes in prosocial and aggressive behavior, and the extent to which social-cognitive problem solving strategies mediate these relations. Emerging adolescents with (n = 178) and without (n = 3,806) clinically elevated, teacher-reported ADHD-combined symptoms were compared longitudinally across 6th through 8th grades using parallel process latent growth curve modeling, accounting for student demographic characteristics, oppositional-defiant disorder (ODD) symptoms, deviant peer association, school climate, and parental monitoring. Sixth graders with elevated ADHD symptoms engaged in somewhat fewer prosocial behaviors (d = -0.44) and more aggressive behavior (d = 0.20) relative to their peers. These small social behavioral deficits decreased but were not normalized across the middle school years. Contrary to hypotheses, social-cognitive problem solving was not impaired in the ADHD group after accounting for co-occurring ODD symptoms and did not mediate the association between ADHD and social behavior during the middle school years. ADHD and social-cognitive problem solving contributed independently to social behavior, both in 6th grade and across the middle school years; the influence of social-cognitive problem solving on social behavior was highly similar for the ADHD and non-ADHD groups.

Motor impulsivity during childhood and adolescence: a longitudinal biometric analysis of the go/no-go task in 9- to 18-year-old twins

In the present study, we investigated genetic and environmental effects on motor impulsivity from childhood to late adolescence using a longitudinal sample of twins from ages 9 to 18 years. Motor impulsivity was assessed using errors of commission (no-go errors) in a visual go/no-go task at 4 time points: ages 9-10, 11-13, 14-15, and 16-18 years. Significant genetic and nonshared environmental effects on motor impulsivity were found at each of the 4 waves of assessment with genetic factors explaining 22%-41% of the variance within each of the 4 waves. Phenotypically, children's average performance improved across age (i.e., fewer no-go errors during later assessments). Multivariate biometric analyses revealed that common genetic factors influenced 12%-40% of the variance in motor impulsivity across development, whereas nonshared environmental factors common to all time points contributed to 2%-52% of the variance. Nonshared environmental influences specific to each time point also significantly influenced motor impulsivity. Overall, results demonstrated that although genetic factors were critical to motor impulsivity across development, both common and specific nonshared environmental factors played a strong role in the development of motor impulsivity across age. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

Community perceptions of developmental and behavioral problems experienced by children living with epilepsy on the Kenyan coast: A qualitative study

Childhood epilepsy is common in Africa. However, there are little data on the developmental and behavioral problems experienced by children living with epilepsy, especially qualitative data that capture community perceptions of the challenges faced by these children. Identifying these perceptions using qualitative approaches is important not only to help design appropriate interventions but also to help adapt behavioral tools that are culturally appropriate. We documented the description of these problems as perceived by parents and teachers of children with or without epilepsy. The study involved 70 participants. Data were collected using in-depth interviews and focus group discussions and were analyzed using NVIVO to identify major themes. Our analysis identified four major areas that are perceived to be adversely affected among children with epilepsy. These included internalizing and externalizing problems such as aggression, temper tantrums, and excessive crying. Additionally, developmental delay, especially cognitive deficits and academic underachievement, was also identified as a major problematic area. There is a need to supplement these findings with quantitative estimates and to develop psychosocial and educational interventions to rehabilitate children with epilepsy who have these difficulties.

Cross-fostering differentially affects ADHD-related behaviors in spontaneously hypertensive rats

Although both genetic and non-genetic factors are known to contribute to the occurrence of Attention-Deficit Hyperactivity/Disorder (ADHD), little is known about how they impact specific symptoms. We used a cross-fostering approach with an established animal model of ADHD, the Spontaneously Hypertensive Rat strain (SHR), to test the influence of genotype and maternal behavior on ADHD-related behaviors. SHRs and their normo-active genetic relative, Wistar Kyoto rats (WKY), were cross-fostered to an unfamiliar dam of either the same or different strain. Behavioral testing took place when the rats reached adulthood. Locomotor hyperactivity was completely dependent on the strain of the offspring. In contrast, social behavior was primarily determined by the strain of the mother, while attentional orienting behavior was influenced by both the strain of the offspring and the strain of the dam. Anxiety-related behavior was influenced by an interaction between offspring and dam strain.

Relations between response trajectories on the continuous performance test and teacher-rated problem behaviors in preschoolers

Although both the continuous performance test (CPT) and behavior rating scales are used in both practice and research to assess inattentive and hyperactive/impulsive behaviors, the correlations between performance on the CPT and teachers' ratings are typically only small-to-moderate. This study examined trajectories of performance on a low target-frequency visual CPT in a sample of preschool children and how these trajectories were associated with teacher-ratings of problem behaviors (i.e., inattention, hyperactivity/impulsivity [H/I], and oppositional/defiant behavior). Participants included 399 preschool children (mean age = 56 months; 49.4% female; 73.7% White/Caucasian). An attention deficit/hyperactivity disorder (ADHD) rating scale was completed by teachers, and the CPT was completed by the preschoolers. Results showed that children's performance across 4 temporal blocks on the CPT was not stable across the duration of the task, with error rates generally increasing from initial to later blocks. The predictive relations of teacher-rated problem behaviors to performance trajectories on the CPT were examined using growth curve models. Higher rates of teacher-reported inattention and H/I were uniquely associated with higher rates of initial omission errors and initial commission errors, respectively. Higher rates of teacher-reported overall problem behaviors were associated with increasing rates of omission but not commission errors during the CPT; however, the relation was not specific to 1 type of problem behavior. The results of this study indicate that the pattern of errors on the CPT in preschool samples is complex and may be determined by multiple behavioral factors. These findings have implications for the interpretation of CPT performance in young children.

Reliable ratings or reading tea leaves: can parent, teacher, and clinician behavioral ratings of preschoolers predict ADHD at age six?

To assess the relative ability of parent, teacher, and clinician behavioral ratings of preschoolers to predict ADHD severity and diagnosis at 6 years of age. Hyperactive/inattentive preschoolers [N = 104, 75 % boys, Mean (SD) age = 4.37 (0.47) years] were followed over 2 years (mean = 26.44 months, SD = 5.66). At baseline (BL), parents and teachers completed the ADHD-RS-IV and clinicians completed the Behavioral Rating Inventory for Children following a psychological testing session. At age 6, [Mean (SD) age = 6.62 (0.35) years], parents were interviewed with the K-SADS-PL; teachers completed the ADHD-RS-IV; and laboratory measures of hyperactivity, impulsivity, and inattention were obtained from children. Hierarchical logistic and linear regression analyses examined which combination of BL ratings best predicted 6-year-old ADHD diagnosis and severity, respectively. At age 6, 56 (53.8 %) children met DSM-IV criteria for a diagnosis of ADHD. BL ratings from parent/teacher/clinician, parent/teacher and parent/clinician combinations significantly predicted children who had an ADHD diagnosis at age 6. Parent and clinician, but not teacher, behavior ratings were significant independent predictors of ADHD diagnosis and severity at 6-years-old. However, only clinician reports of preschoolers' behaviors predicted laboratory measures of over-activity and inattention at follow-up. Cross-situationality is important for a diagnosis of ADHD during the preschool years. Among parents, teachers and clinicians, positive endorsements from all three informants, parent/teacher or parent/clinician appear to have prognostic value. Clinicians' ratings of preschoolers' inattention, impulsivity and hyperactivity are valid sources of information for predicting ADHD diagnosis and severity over time.

"Together at school"--a school-based intervention program to promote socio-emotional skills and mental health in children: study protocol for a cluster randomized controlled trial

Background

Schools provide a natural context to promote children’s mental health. However, there is a need for more evidence-based, high quality school intervention programs combined with an accurate evaluation of their general effectiveness and effectiveness of specific intervention methods. The aim of this paper is to present a study protocol of a cluster randomized controlled trial evaluating the “Together at School” intervention program. The intervention program is designed to promote social-emotional skills and mental health by utilizing whole-school approach and focuses on classroom curriculum, work environment of school staff, and parent-teacher collaboration methods.

Methods/Design

The evaluation study examines the effects of the intervention on children’s socio-emotional skills and mental health in a cluster randomized controlled trial design with 1) an intervention group and 2) an active control group. Altogether 79 primary school participated at baseline. A multi-informant setting involves the children themselves, their parents, and teachers. The primary outcomes are measured using parent and teacher ratings of children’s socio-emotional skills and psychological problems measured by the Strengths and Difficulties Questionnaire and the Multisource Assessment of Social Competence Scale. Secondary outcomes for the children include emotional understanding, altruistic behavior, and executive functions (e.g. working memory, planning, and inhibition). Secondary outcomes for the teachers include ratings of e.g. school environment, teaching style and well-being. Secondary outcomes for both teachers and parents include e.g. emotional self-efficacy, child rearing practices, and teacher-parent collaboration. The data was collected at baseline (autumn 2013), 6 months after baseline, and will be collected also 18 months after baseline from the same participants.

Discussion

This study protocol outlines a trial which aims to add to the current state of intervention programs by presenting and studying a contextually developed and carefully tested intervention program which is tailored to fit a national school system. Identification of effective intervention elements to promote children’s mental health in early school years is crucial for optimal later development.

Trial registration

ClinicalTrials.gov register: NCT02178332.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2458-14-1042) contains supplementary material, which is available to authorized users.

Neuropharmacological effect of atomoxetine on attention network in children with attention deficit hyperactivity disorder during oddball paradigms as assessed using functional near-infrared spectroscopy

The current study aimed to explore the neural substrate for atomoxetine effects on attentional control in school-aged children with attention deficit hyperactivity disorder (ADHD) using functional near-infrared spectroscopy (fNIRS), which can be applied to young children with ADHD more easily than conventional neuroimaging modalities. Using fNIRS, we monitored the oxy-hemoglobin signal changes of 15 ADHD children (6 to 14 years old) performing an oddball task before and 1.5 h after atomoxetine or placebo administration, in a randomized, double-blind, placebo-controlled, crossover design. Fifteen age-, gender-, and intelligence quotient-matched normal controls without atomoxetine administration were also monitored. In the control subjects, the oddball task recruited the right prefrontal and inferior parietal cortices. The right prefrontal and parietal activation was normalized after atomoxetine administration in ADHD children. This was in contrast to our previous study using a similar protocol showing methylphenidate-induced normalization of only the right prefrontal function. fNIRS allows the detection of differential neuropharmacological profiles of both substances in the attentional network: the neuropharmacological effects of atomoxetine to upregulate the noradrenergic system reflected in the right prefrontal and inferior parietal activations and those of methylphenidate to upregulate the dopamine system reflected in the prefrontal cortex activation.

Variations on the bilingual advantage? Links of Chinese and English proficiency to Chinese American children's self-regulation

The present study examined whether bilingualism-related advantages in self-regulation could be observed: (a) among Chinese American immigrant children with varying levels of Chinese and English proficiencies, and (b) across different domains of self-regulation in laboratory, home, and classroom contexts. A socioeconomically diverse sample of first- and second-generation Chinese American immigrant children between ages 7 and 10 (n = 223) was administered assessments of Chinese and English language proficiencies and a multi-method, multi-informant battery of self-regulation measures. Multiple regression analyses suggested that controlling for covariates (child age, gender, and SES), children's bilingualism-related advantages were limited to higher performance only on computerized tasks of cognitive flexibility, and only among children with higher degrees of fluency in both Chinese and English. By contrast, proficiencies in one language (either Chinese or English) were uniquely and positively associated with other domains of self-regulation, including parent and teacher-reported effortful control. These results suggest that the bilingual advantage for self-regulation may be observed as a continuous variable among immigrant children with varying levels of bilingual fluency; however, this advantage may not extend across all domains and contexts of self-regulation.

Relationships between computer-based testing and behavioral ratings in the assessment of attention and activity in a pediatric ADHD stimulant crossover trial

This study investigated the relationships between computer-based testing and behavioral ratings in the assessment of stimulant-induced changes in attention and activity in a pediatric ADHD crossover trial with methylphenidate, dextroamphetamine, and a placebo. Here 36 children between 9 and 14 years old were randomly and evenly assigned to each of six counterbalanced drug orders. A computer-based continuous performance test combined with a motion-tracking system (cb-CPT-MTS) and an ADHD questionnaire rated by teachers constituted the outcome measures. All outcome measures responded to stimulants in a comparable way at the group level, as shown by significant treatment effects of similar size for the two stimulants compared with a placebo. Computer-based and rating-based measures were unrelated in the assessment of stimulant-induced changes in attention and activity in individual children; no significant correlations between these measures in the assessment of change from placebo to stimulant conditions across the sample were detected. Results suggest that computer-based testing and behavioral ratings cannot be considered equivalent in the assessment of stimulant-induced changes in attention and activity among ADHD children.

Reliability and validity of the Online Continuous Performance Test among children

OBJECTIVE

The study assesses the reliability and validity of a new Online Continuous Performance Test (OCPT) for measuring sustained attention, response inhibition, and response time consistency among children.

METHOD

The study sample comprised 73 children (6-13 years), 47 children with attention deficit hyperactivity disorder and 24 in the control group. The Diagnostic Interview Schedule for Children was administered to participants' parents to confirm group allocation. Children completed the OCPT in a laboratory setting, and a week later completed the OCPT at home.

RESULTS

Split-half correlation coefficients reflected high levels of reliability in the laboratory and at home. Significant correlations were found between the laboratory- and home-based OCPT scores. Significant differences in OCPT performance were found between children with and without attention deficit hyperactivity disorder on the OCPT in the two settings.

CONCLUSIONS

These results support the reliability and validity of the OCPT and suggest that it may serve as an effective tool for the assessment of children's attention function in naturalistic settings.

Long-term temporal stability of measured inattention and impulsivity in typical and referred children

OBJECTIVE

This study investigates the stability of measured inattention and impulsivity in children.

METHOD

The Gordon Diagnostic System (GDS) assesses inattention and impulsivity and has been administered in the same manner since its 1983 publication. GDS scores were compared between the 1983 standardization sample and a recent typical sample of 445 children, 562 children with ADHD-Combined (ADHD-C) type, 235 with ADHD-Inattentive (ADHD-I) type, and 231 with autism.

RESULTS

Typical children earned a GDS composite standard score of 100, consistent with the normal mean of 100 in the 1983 standardization sample. Means for children with ADHD-C, ADHD-I, and autism were 70, 78, and 76, respectively, approximately two standard deviations below the normal mean.

CONCLUSION

As measured by the GDS, children are no more or less inattentive and impulsive today than in 1983, suggesting that inattention and impulsivity are stable neurobiological traits largely unaffected by cultural, educational, and environmental factors.

Using environmental distractors in the diagnosis of ADHD

This study examined the effect of the incorporation of environmental distractors in computerized continuous performance test (CPT) on the ability of the test in distinguishing ADHD from non-ADHD children. It was hypothesized that children with ADHD would display more distractibility than controls while performing CPT as measured by omission errors in the presence of pure visual, pure auditory, and a combination of visual and auditory distracting stimuli. Participants were 663 children aged 7–12 years, of them 345 diagnosed with ADHD and 318 without ADHD. Results showed that ADHD children demonstrated more omission errors than their healthy peers in all CPT conditions (no distractors, pure visual or auditory distractors and combined distractors). However, ADHD and non-ADHD children differed in their reaction to distracting stimuli; while all types of distracting stimuli increased the rate of omission errors in ADHD children, only combined visual and auditory distractors increased it in non-ADHD children. Given the low ecological validity of many CPT, these findings suggest that incorporating distractors in CPT improves the ability to distinguish ADHD from non-ADHD children.

The effect of environmental distractors incorporation into a CPT on sustained attention and ADHD diagnosis among adolescents

BACKGROUND

Diagnosis of ADHD in adolescents involves specific challenges. Conventional CPT's may fail to consistently distinguish ADHD from non-ADHD due to insufficient cognitive demands. The aim of this study was to explore whether the incorporation of environmental distractors into a CPT would increase its ability to distinguish ADHD from non-ADHD adolescents.

NEW METHOD

Using the rate of omission errors as a measure of difficulty in sustained attention, this study examined whether ADHD adolescents are more distracted than controls and which type of distractors is more effective in terms of ADHD diagnosis. The study employed the MOXO-CPT version which includes visual and auditory stimuli serving as distractors. Participants were 176 adolescents aged 13-18 years, 133 diagnosed with ADHD and 43 without ADHD.

RESULTS AND COMPARISON WITH EXISTING METHODS

Results showed that ADHD adolescents produced significantly more omission errors in the presence of pure visual distractors and the combination of visual and auditory distractors than in no-distractors conditions. Distracting stimuli had no effect on CPT performance of non-ADHD adolescents. ROC analysis further demonstrated that the mere presence of distractors improved the utility of the test.

CONCLUSIONS

This study provides evidence that incorporation of environmental distractors into a CPT is useful in term of ADHD diagnosis. ADHD adolescents were more distracted than controls by all types of environmental distractors. ADHD adolescents were more distracted by pure visual distractors and by the combination of distractors than by pure auditory ones.

Maturational delay in ADHD: evidence from CPT

While data from behavioral, neuropsychological, and brain studies suggested that Attention-Deficit/Hyperactivity Disorder (ADHD) is related to a developmental lag that reduces with age, other studies have proposed that ADHD represents a deviant brain function. The present study used a cross-sectional approach to examine whether ADHD children show a developmental delay in cognitive performance measured by continuous performance test (CPT). We thus, compared six age groups of ADHD children (N = 559) and their unaffected peers (N = 365), aged 6–11, in four parameters of MOXO-CPT performance: Attention, Timing, Hyperactivity and Impulsivity. Results have shown that despite improvement in CPT performance with age, ADHD children continued to demonstrate impaired performance as compared to controls. In most parameters, CPT performance of ADHD children matched that of 1–3 years younger normal controls, with a delay most prominent in older children. However, in the Hyperactivity parameter, ADHD children's performance resembled that of much younger healthy children, with almost no evidence for a developmental catch up. This study suggests that while some cognitive functions develop slower but normally, other functions (e.g., inhibitory control) show a different trajectory.

Do programs designed to train working memory, other executive functions, and attention benefit children with ADHD? A meta-analytic review of cognitive, academic, and behavioral outcomes

Children with ADHD are characterized frequently as possessing underdeveloped executive functions and sustained attentional abilities, and recent commercial claims suggest that computer-based cognitive training can remediate these impairments and provide significant and lasting improvement in their attention, impulse control, social functioning, academic performance, and complex reasoning skills. The present review critically evaluates these claims through meta-analysis of 25 studies of facilitative intervention training (i.e., cognitive training) for children with ADHD. Random effects models corrected for publication bias and sampling error revealed that studies training short-term memory alone resulted in moderate magnitude improvements in short-term memory (d=0.63), whereas training attention did not significantly improve attention and training mixed executive functions did not significantly improve the targeted executive functions (both nonsignificant: 95% confidence intervals include 0.0). Far transfer effects of cognitive training on academic functioning, blinded ratings of behavior (both nonsignificant), and cognitive tests (d=0.14) were nonsignificant or negligible. Unblinded raters (d=0.48) reported significantly larger benefits relative to blinded raters and objective tests (both p<.05), indicating the likelihood of Hawthorne effects. Critical examination of training targets revealed incongruence with empirical evidence regarding the specific executive functions that are (a) most impaired in ADHD, and (b) functionally related to the behavioral and academic outcomes these training programs are intended to ameliorate. Collectively, meta-analytic results indicate that claims regarding the academic, behavioral, and cognitive benefits associated with extant cognitive training programs are unsupported in ADHD. The methodological limitations of the current evidence base, however, leave open the possibility that cognitive training techniques designed to improve empirically documented executive function deficits may benefit children with ADHD.

Stroop/reverse-Stroop interference in typical development and its relation to symptoms of ADHD

This study examined prepotent response inhibition among 376 children and young adults divided into five age groups: 23 5-6-year-olds, 80 7-8-year-olds, 72 9-10-year-olds, 98 11-12-year-olds, and 70 young adults (19-24-year-olds). The Stroop/reverse-Stroop test was administered with a manual response. This test measured Stroop interference, which occurred when naming the ink color of the incongruent color word stimuli (for instance the word red printed in blue ink), and the reverse-Stroop interference, which occurred when reading the stimuli. This study also examined the relation between performance on the Stroop/reverse-Stroop test and scores on the ADHD Rating Scale-IV. Results indicated that the Stroop interference decreased with age, whereas the reverse-Stroop interference increased with age. Results also showed that all three scores in the ADHD Rating Scale-IV, two subscale scores of inattentive and hyperactive-impulsive symptoms and a total score, correlated with the Stroop interference, but not with the reverse-Stroop interference in typically developing children. These results indicated the difference in mechanism between the Stroop interference and the reverse-Stoop interference, and suggested that the Stroop interference is strongly correlated with ADHD symptoms in typically developing children.