The neural correlates of deficient error awareness in attention-deficit hyperactivity disorder (ADHD)

Response Inhibition in Tic Disorders: Waiting to Respond Is Harder When ADHD Is Present

OBJECTIVE

Tic disorders such as Gilles-de-la-Tourette syndrome (TS) are associated with difficulties in withholding movements and sometimes inappropriate actions. The present study examined whether these disorders lead to a specific difficulty in withholding preprogrammed voluntary movements irrespective of decisions on whether or not to move.

METHOD

Children with TS with or without attention-deficit hyperactivity disorder (ADHD) and controls performed a fast-paced simple reaction time task involving responses to a target in a rapid letter stream (9 letters/s, average foreperiod 332 ms) with feedback on response speed.

RESULTS

The ADHD group showed more premature responses and more variable response time than other groups, whether the timing of the target was predictable or not.

CONCLUSION

The data indicate that in tic disorders, the presence of ADHD is associated with difficulties in waiting to initiate preprogrammed movements independently of response selection or response timing difficulties.

The Representation of Objects in Apraxia: From Action Execution to Error Awareness

Apraxia is a well-known syndrome characterized by the sufferer's inability to perform routine gestures. In an attempt to understand the syndrome better, various different theories have been developed and a number of classifications of different subtypes have been proposed. In this article review, we will address these theories with a specific focus on how the use of objects helps us to better understand upper limb apraxia. With this aim, we will consider transitive vs. intransitive action dissociation as well as less frequent types of apraxia involving objects, i.e., constructive apraxia and magnetic apraxia. Pantomime and the imitation of objects in use are also considered with a view to dissociating the various different components involved in upper limb apraxia. Finally, we discuss the evidence relating to action recognition and awareness of errors in the execution of actions. Various different components concerning the use of objects emerge from our analysis and the results show that knowledge of an object and sensory-motor representations are supported by other functions such as spatial and body representations, executive functions and monitoring systems.

Movement Scaling in Children With ADHD-Combined Type

OBJECTIVE

The aim of the study was to investigate motor performance in children with ADHD using a size-scaling handwriting task.

METHOD

In all, 14 male children with ADHD and 14 typically developing (TD) children (age 7-15) wrote 10-mm and 40-mm cursive letter "l."

RESULTS

Children with ADHD were unable to maintain their writing accurately at 40 mm, falling short by several millimeters; this was not evident in the TD children. Children with ADHD also had slightly faster and more fluent writing than TD children.

CONCLUSION

It was concluded that children with ADHD have difficulties scaling handwriting movement in the larger 40-mm condition that may reflect poor planning and modulation of movement, despite having faster and more fluent movements.

A meta-analysis of decision-making and attention in adults with ADHD

OBJECTIVE

Deficient reward processing has gained attention as an important aspect of ADHD, but little is known about reward-based decision-making (DM) in adults with ADHD. This article summarizes research on DM in adult ADHD and contextualizes DM deficits by comparing them to attention deficits.

METHOD

Meta-analytic methods were used to calculate average effect sizes for different DM domains and continuous performance task (CPT) measures.

RESULTS

None of the 59 included studies (DM: 12 studies; CPT: 43; both: 4) had indications of publication bias. DM and CPT measures showed robust, small to medium effects. Large effect sizes were found for a drift diffusion model analysis of the CPT.

CONCLUSION

The results support the existence of DM deficits in adults with ADHD, which are of similar magnitude as attention deficits. These findings warrant further examination of DM in adults with ADHD to improve the understanding of underlying neurocognitive mechanisms.

Error-related brain activity in the age of RDoC: A review of the literature

The ability to detect and respond to errors is critical to successful adaptation to a changing environment. The error-related negativity (ERN), an event-related potential (ERP) component, is a well-validated neural response to errors and reflects the error monitoring activity of the anterior cingulate cortex (ACC). Additionally, the ERN is implicated in several processes key to adaptive functioning. Abnormalities in error-related brain activity have been linked to multiple forms of psychopathology and individual differences. As such, the component is likely to be useful in NIMH's Research Domain Criteria (RDoC) initiative to establish biologically-meaningful dimensions of psychological dysfunction, and currently appears as a unit of measurement in three RDoC domains: Positive Valence Systems, Negative Valence Systems, and Cognitive Systems. In this review paper, we introduce the ERN and discuss evidence related to its psychometric properties, as well as important task differences. Following this, we discuss evidence linking the ERN to clinically diverse forms of psychopathology, as well as the implications of one unit of measurement appearing in multiple RDoC dimensions. And finally, we discuss important future directions, as well as research pathways by which the ERN might be leveraged to track the ways in which dysfunctions in multiple neural systems interact to influence psychological well-being.

Reduced neural error signaling in left inferior prefrontal cortex in young adults with ADHD

OBJECTIVE

The neural network involved in inhibition of inappropriate response tendencies shares commonalities with the error-processing network, signaling failure of inhibition. Most studies on error processing in ADHD have been conducted in children using electrophysiological methods.

METHOD

Using event-related functional magnetic resonance imaging, the authors studied 14 adults with ADHD and 12 group-matched healthy control participants while performing a modified version of a combined Eriksen Flanker-Go/NoGo-task.

RESULTS

Patients with ADHD demonstrated significantly reduced error signaling in the left inferior frontal gyrus bordering the anterior insular cortex (BA 47), computed from the contrast of unsuccessful minus successful inhibition trials.

CONCLUSION

Hypoactivation of the left inferior frontal cortex during error signaling might represent a neurofunctional marker of a crucial prerequisite for error processing in adults with ADHD. This possibly indicates a dysfunction of the neural system that operates task-set related representations and monitoring of erroneous performances in service of ensuing posterror processing.

Network connectivity abnormality profile supports a categorical-dimensional hybrid model of ADHD

Attention-deficit/hyperactivity disorder (ADHD) is characterized by inattention, hyperactivity, and impulsivity, but there is no consensus regarding whether ADHD exists on the extreme end of a continuum of normal behavior or represents a discrete disorder. In this study, we sought to characterize both the categorical and dimensional variations in network functional connectivity in order to identify neural connectivity mechanisms of ADHD. Functional connectivity analyses of resting-state fMRI data from 155 children with ADHD and 145 typically developing children (TDC) defined the dorsal attention network (DA), default mode network (DM), salience processing network (SAL) and executive control network (CON). Regional alterations in connectivity associated with categorical diagnoses and dimensional symptom measures (inattention and hyperactivity/impulsivity) as well as their interaction were systematically characterized. Dimensional relationships between symptom severity measures and functional connectivity that did not differ between TDC and children with ADHD were observed for each network, supporting a dimensional characterization of ADHD. However, categorical differences in functional connectivity magnitude between TDC and children with ADHD were detected after accounting for dimensional relationships, indicating the existence of categorical mechanisms independent of dimensional effects. Additionally, differential dimensional relationships for TDC versus ADHD children demonstrated categorical differences in brain-behavior relationships. The patterns of network functional organization associated with categorical versus dimensional measures of ADHD accentuate the complexity of this disorder and support a dual characterization of ADHD etiology featuring both dimensional and categorical mechanisms.

Executive dysfunction and reward dysregulation: a high-density electrical mapping study in cocaine abusers

Executive function deficits and reward dysregulation, which mainly manifests as anhedonia, are well documented in drug abusers. We investigated specific aspects of executive function (inhibitory control and cognitive control), as well as anhedonia, in a cohort of current cocaine abusers in order to ascertain to what extent these factors are associated with more severe drug dependence. Participants filled out questionnaires relating to anhedonia and their addiction history. Participants also performed a response inhibition task while high-density event-related potentials (ERPs) were recorded. Electrophysiological responses to successful inhibitions (N2/P3 components) and to commission errors (ERN/Pe components) were compared between 23 current users of cocaine and 27 non-using controls. A regression model was performed to determine the association of our measures of reward dysregulation and executive function with addiction severity. As expected, cocaine users performed more poorly than controls on the inhibitory control task and showed significant electrophysiological differences. They were also generally more anhedonic than controls. Higher levels of anhedonia were associated with more severe substance use, whereas the level of executive dysfunction was not associated with more severe substance use. However, N2 amplitude was associated with duration of drug use. Further, inhibitory control and anhedonia were correlated, but only in controls. These data suggest that while executive dysfunction characterizes drug abuse, it is anhedonia, independent of executive dysfunction, that is most strongly associated with more severe use.

Transcranial direct current stimulation over right dorsolateral prefrontal cortex enhances error awareness in older age

The ability to detect errors during cognitive performance is compromised in older age and in a range of clinical populations. This study was designed to assess the effects of transcranial direct current stimulation (tDCS) on error awareness in healthy older human adults. tDCS was applied over DLPFC while subjects performed a computerized test of error awareness. The influence of current polarity (anodal vs cathodal) and electrode location (left vs right hemisphere) was tested in a series of separate single-blind, Sham-controlled crossover trials, each including 24 healthy older adults (age 65-86 years). Anodal tDCS over right DLPFC was associated with a significant increase in the proportion of performance errors that were consciously detected, and this result was recapitulated in a separate replication experiment. No such improvements were observed when the homologous contralateral area was stimulated. The present study provides novel evidence for a causal role of right DLPFC regions in subserving error awareness and marks an important step toward developing tDCS as a tool for remediating the performance-monitoring deficits that afflict a broad range of populations.

Topological organization of the "small-world" visual attention network in children with attention deficit/hyperactivity disorder (ADHD)

Background: Attention-deficit/hyperactivity disorder (ADHD) is the most commonly diagnosed childhood psychiatric disorder. Disrupted sustained attention is one of the most significant behavioral impairments in this disorder. We mapped systems-level topological properties of the neural network responsible for sustained attention during a visual sustained task, on the premise that strong associations between anomalies in network features and clinical measures of ADHD would emerge.

Methods: Graph theoretic techniques (GTT) and bivariate network-based statistics (NBS) were applied to fMRI data from 22 children with ADHD combined-type and 22 age-matched neurotypicals, to evaluate the topological and nodal-pairing features in the functional brain networks. Correlation testing for relationships between network properties and clinical measures were then performed.

Results: The visual attention network showed significantly reduced local-efficiency and nodal-efficiency in frontal and occipital regions in ADHD. Measures of degree and between-centrality pointed to hyper-functioning in anterior cingulate cortex and hypo-functioning in orbito-frontal, middle-occipital, superior-temporal, supra-central, and supra-marginal gyri in ADHD. NBS demonstrated significantly reduced pair-wise connectivity in an inner-network, encompassing right parietal and temporal lobes and left occipital lobe, in the ADHD group.

Conclusions: These data suggest that atypical topological features of the visual attention network contribute to classic ADHD symptomatology, and may underlie the inattentiveness and hyperactivity/impulsivity that are characteristics of this syndrome.

Monoaminergic modulation of behavioural and electrophysiological indices of error processing

RATIONALE

Error processing is a critical executive function that is impaired in a large number of clinical populations. Although the neural underpinnings of this function have been investigated for decades and critical error-related components in the human electroencephalogram (EEG), such as the error-related negativity (ERN) and the error positivity (Pe), have been characterised, our understanding of the relative contributions of key neurotransmitters to the generation of these components remains limited.

OBJECTIVES

The current study sought to determine the effects of pharmacological manipulation of the dopamine, noradrenaline and serotonin neurotransmitter systems on key behavioural and event-related potential correlates of error processing.

METHODS

A randomised, double-blinded, placebo-controlled, crossover design was employed. Monoamine levels were manipulated using the clinically relevant drugs methylphenidate, atomoxetine and citalopram, in comparison to placebo. Under each of the four drug conditions, participants underwent EEG recording while performing a flanker task.

RESULTS

Only methylphenidate produced significant improvement in performance accuracy, which was without concomitant slowing of reaction time. Methylphenidate also increased the amplitude of an early electrophysiological index of error processing, the ERN. Citalopram increased the amplitude of the correct-response negativity, another component associated with response processing.

CONCLUSIONS

The effects of methylphenidate in this study are consistent with theoretical accounts positing catecholamine modulation of error monitoring. Our data suggest that enhancing catecholamine function has the potential to remediate the error-monitoring deficits that are seen in a wide range of psychiatric conditions.

The balanced mind: the variability of task-unrelated thoughts predicts error monitoring

Self-generated thoughts unrelated to ongoing activities, also known as "mind-wandering," make up a substantial portion of our daily lives. Reports of such task-unrelated thoughts (TUTs) predict both poor performance on demanding cognitive tasks and blood-oxygen-level-dependent (BOLD) activity in the default mode network (DMN). However, recent findings suggest that TUTs and the DMN can also facilitate metacognitive abilities and related behaviors. To further understand these relationships, we examined the influence of subjective intensity, ruminative quality, and variability of mind-wandering on response inhibition and monitoring, using the Error Awareness Task (EAT). We expected to replicate links between TUT and reduced inhibition, and explored whether variance in TUT would predict improved error monitoring, reflecting a capacity to balance between internal and external cognition. By analyzing BOLD responses to subjective probes and the EAT, we dissociated contributions of the DMN, executive, and salience networks to task performance. While both response inhibition and online TUT ratings modulated BOLD activity in the medial prefrontal cortex (mPFC) of the DMN, the former recruited a more dorsal area implying functional segregation. We further found that individual differences in mean TUTs strongly predicted EAT stop accuracy, while TUT variability specifically predicted levels of error awareness. Interestingly, we also observed co-activation of salience and default mode regions during error awareness, supporting a link between monitoring and TUTs. Altogether our results suggest that although TUT is detrimental to task performance, fluctuations in attention between self-generated and external task-related thought is a characteristic of individuals with greater metacognitive monitoring capacity. Achieving a balance between internally and externally oriented thought may thus aid individuals in optimizing their task performance.

Association of genetic risk severity with ADHD clinical characteristics

This study sought to examine the association between the cumulative risk severity conferred by the total number of attention-deficit/hyperactivity disorder (ADHD) risk alleles of the DAT1 3'UTR variable number tandem repeat (VNTR), DRD4 Exon 3 VNTR, and 5-HTTLPR with ADHD characteristics, clinical correlates, and functional outcomes in a pediatric sample. Participants were derived from case-control family studies of boys and girls diagnosed with ADHD, a genetic linkage study of families with children with ADHD, and a family genetic study of pediatric bipolar disorder. Caucasian children 18 and younger with and without ADHD and with available genetic data were included in this analysis (N = 591). The association of genetic risk severity with sociodemographic, clinical characteristics, neuropsychological, emotional, and behavioral correlates was examined in the entire sample, in the sample with ADHD, and in the sample without ADHD, respectively. Greater genetic risk severity was significantly associated with the presence of disruptive behavior disorders in the entire sample and oppositional defiant disorder in participants with ADHD. Greater genetic risk severity was also associated with the absence of anxiety disorders, specifically with the absence of agoraphobia in the context of ADHD. Additionally, one ADHD symptom was significantly associated with greater genetic risk severity. Genetic risk severity is significantly associated with ADHD clinical characteristics and co-morbid disorders, and the nature of these associations may vary on the type (externalizing vs. internalizing) of the disorder.

Is there any electrophysiological evidence for subliminal error processing?

The role of error awareness in executive control and modification of behavior is not fully understood. In line with many recent studies showing that conscious awareness is unnecessary for numerous high-level processes such as strategic adjustments and decision making, it was suggested that error detection can also take place unconsciously. The Error Negativity (Ne) component, long established as a robust error-related component that differentiates between correct responses and errors, was a fine candidate to test this notion: if an Ne is elicited also by errors which are not consciously detected, it would imply a subliminal process involved in error monitoring that does not necessarily lead to conscious awareness of the error. Indeed, for the past decade, the repeated finding of a similar Ne for errors which became aware and errors that did not achieve awareness, compared to the smaller negativity elicited by correct responses (Correct Response Negativity; CRN), has lent the Ne the prestigious status of an index of subliminal error processing. However, there were several notable exceptions to these findings. The study in the focus of this review (Shalgi and Deouell, 2012) sheds new light on both types of previous results. We found that error detection as reflected by the Ne is correlated with subjective awareness: when awareness (or more importantly lack thereof) is more strictly determined using the wagering paradigm, no Ne is elicited without awareness. This result effectively resolves the issue of why there are many conflicting findings regarding the Ne and error awareness. The average Ne amplitude appears to be influenced by individual criteria for error reporting and therefore, studies containing different mixtures of participants who are more confident of their own performance or less confident, or paradigms that either encourage or don't encourage reporting low confidence errors will show different results. Based on this evidence, it is no longer possible to unquestioningly uphold the notion that the amplitude of the Ne is unrelated to subjective awareness, and therefore, that errors are detected without conscious awareness.

Attention-deficit hyperactivity disorder (ADHD) stimulant medications as cognitive enhancers

Recent increases in attention deficit hyperactivity disorder (ADHD) diagnoses, and the escalation of stimulant prescriptions, has raised concern about diversion and abuse of stimulants, as well as the ethics of using these drugs as “cognitive enhancers.”Such concern appears misplaced in the face of substantial evidence that stimulant drugs do not improve the academic performance of ADHD-diagnosed students. Moreover, numerous studies have found little or no benefit of stimulants on neuropsychological tests of ADHD-diagnosed as well as normal, individuals. This paper examines the apparent paradox: why don't drugs that improve “attention,” produce better academic outcomes in ADHD-diagnosed students? We found that stimulant drugs significantly improved impairment of episodic memory in ADHD-diagnosed undergraduate students. Nevertheless, we also found consistent academic deficits between ADHD students and their non-ADHD counterparts, regardless of whether or not they used stimulant medications. We reviewed the current literature on the behavioral effects of stimulants, to try to find an explanation for these conflicting phenomena. Across a variety of behavioral tasks, stimulants have been shown to reduce emotional reactions to frustration, improve the ability to detect errors, and increase effortful behavior. However, all of these effects would presumably enhance academic performance. On the other hand, the drugs were also found to promote “risky behavior” and to increase susceptibility to environmental distraction. Such negative effects, including the use of drugs to promote wakefulness for last minute study, might explain the lack of academic benefit in the “real world,” despite their cognitive potential. Like many drugs, stimulants influence behavior in multiple ways, depending on the environmental contingencies. Depending on the circumstances, stimulants may, or may not, enhance cognition.

When the rules are reversed: action-monitoring consequences of reversing stimulus-response mappings

How does switching tasks affect our ability to monitor and adapt our behavior? Largely independent lines of research have examined how individuals monitor their actions and adjust to errors, on the one hand, and how they are able to switch between two or more tasks, on the other. Few studies, however, have explored how these two aspects of cognitive-behavioral flexibility interact. That is, how individuals monitor their actions when task rules are switched remains unknown. The present study sought to address this question by examining the action-monitoring consequences of response switching-a form of task switching that involves switching the response that is associated with a particular stimulus. We recorded event-related brain potentials (ERPs) while participants performed a modified letter flanker task in which the stimulus-response (S-R) mappings were reversed between blocks. Specifically, we examined three ERPs-the N2, the error-related negativity (ERN), and the error positivity (Pe)-that have been closely associated with action monitoring. The findings revealed that S-R reversal blocks were associated with dynamic alterations of action-monitoring brain activity: the N2 and ERN were enhanced, whereas the Pe was reduced. Moreover, participants were less likely to adapt their posterror behavior in S-R reversal blocks. Taken together, these data suggest that response switching results in early enhancements of effortful control mechanisms (N2 and ERN) at the expense of reductions in later response evaluation processes (Pe). Thus, when rules change, our attempts at control are accompanied by less attention to our actions.

Preliminary evidence for reduced posterror reaction time slowing in hyperactive/inattentive preschool children

BACKGROUND

Attention deficit/hyperactivity disorder (ADHD) has been associated with deficits in self-regulatory cognitive processes, some of which are thought to lie at the heart of the disorder. Slowing of reaction times (RTs) for correct responses following errors made during decision tasks has been interpreted as an indication of intact self-regulatory functioning and has been shown to be attenuated in school-aged children with ADHD. This study attempted to examine whether ADHD symptoms are associated with an early-emerging deficit in posterror slowing.

METHOD

A computerized two-choice RT task was administered to an ethnically diverse sample of preschool-aged children classified as either "control" (n = 120) or "hyperactive/inattentive" (HI; n = 148) using parent- and teacher-rated ADHD symptoms. Analyses were conducted to determine whether HI preschoolers exhibit a deficit in this self-regulatory ability.

RESULTS

HI children exhibited reduced posterror slowing relative to controls on the trials selected for analysis. Supplementary analyses indicated that this may have been due to a reduced proportion of trials following errors on which HI children slowed rather than due to a reduction in the absolute magnitude of slowing on all trials following errors.

CONCLUSIONS

High levels of ADHD symptoms in preschoolers may be associated with a deficit in error processing as indicated by posterror slowing. The results of supplementary analyses suggest that this deficit is perhaps more a result of failures to perceive errors than of difficulties with executive control.

Error awareness and the insula: links to neurological and psychiatric diseases

Becoming aware of errors that one has committed might be crucial for strategic behavioral and neuronal adjustments to avoid similar errors in the future. This review addresses conscious error perception ("error awareness") in healthy subjects as well as the relationship between error awareness and neurological and psychiatric diseases. We first discuss the main findings on error awareness in healthy subjects. A brain region, that appears consistently involved in error awareness processes, is the insula, which also provides a link to the clinical conditions reviewed here. Then we focus on a neurological condition whose core element is an impaired awareness for neurological consequences of a disease: anosognosia for hemiplegia (AHP). The insular cortex has been implicated in both error awareness and AHP, with anterior insular regions being involved in conscious error processing and more posterior areas being related to AHP. In addition to cytoarchitectonic and connectivity data, this reflects a functional and structural gradient within the insula from anterior to posterior. Furthermore, studies dealing with error awareness and lack of insight in a number of psychiatric diseases are reported. Especially in schizophrenia, attention-deficit hyperactivity disorder, (ADHD) and autism spectrum disorders (ASD) the performance monitoring system seems impaired, thus conscious error perception might be altered.

Impact of five SNPs in dopamine-related genes on executive function

OBJECTIVES

Dopamine neurotransmission is a critical factor for executive function, which is controlled by the prefrontal cortex in humans. Although the contribution of genetic factors to the regulation of brain dopaminergic activity is widely acknowledged, identification of a genotype-phenotype association has not yet been clearly established. In this study, we therefore evaluated the effects of five functional single-nucleotide polymorphisms (SNPs) in specific genes related to dopamine neurotransmission on executive function in a general population.

MATERIALS AND METHODS

Participants of the health examination at the Shimane Institute of Health Science were recruited for this study (n = 964). To evaluate executive function, the Frontal Assessment Battery (FAB) was administered. SNPs were genotyped using the TaqMan method.

RESULTS

A significant association was found between an SNP in the catechol-O-methyltransferase (COMT) gene (rs4680) encoding the low-activity Met allele and FAB score (P = 0.003). Of note, the flexibility subset of the FAB was associated with the SNP in COMT (P = 0.003) after adjustment for confounding factors. The generalized multifactor dimensionality reduction method identified that the combination of two SNPs in the COMT gene (rs4680) and the dopamine D4 receptor gene (rs1800955) had a significant effect on FAB score.

CONCLUSIONS

Our study indicates a contribution of rs4680 in the COMT gene to the variability in executive function, as assessed by the FAB. In addition, we have indicated that a complex gene-gene interaction between SNPs in the genes related to dopamine neurotransmission may influence executive function in a general population.

Noradrenergic versus dopaminergic modulation of impulsivity, attention and monitoring behaviour in rats performing the stop-signal task: possible relevance to ADHD

RATIONALE

Deficient response inhibition is a prominent feature of many pathological conditions characterised by impulsive and compulsive behaviour. Clinically effective doses of catecholamine reuptake inhibitors are able to improve such inhibitory deficits as measured by the stop-signal task (SST) in humans and other animals. However, the precise therapeutic mode of action of these compounds in terms of their relative effects on dopamine (DA) and noradrenaline (NA) systems in prefrontal cortical and striatal regions mediating attention and cognitive control remains unclear.

OBJECTIVES

We sought to fractionate the effects of global catecholaminergic manipulations on SST performance by using receptor-specific compounds for NA or DA. The results are described in terms of the effects of modulating specific receptor subtypes on various behavioural measures such as response inhibition, perseveration, sustained attention, error monitoring and motivation.

RESULTS

Blockade of α2-adrenoceptors improved sustained attention and response inhibition, whereas α1 and β1/2 adrenergic receptor antagonists disrupted go performance and sustained attention, respectively. No relevant effects were obtained after targeting DA D1, D2 or D4 receptors, while both a D3 receptor agonist and antagonist improved post-error slowing and compulsive nose-poke behaviour, though generally impairing other task measures.

CONCLUSIONS

Our results suggest that the use of specific pharmacological agents targeting α2 and β noradrenergic receptors may improve existing treatments for attentional deficits and impulsivity, whereas DA D3 receptors may modulate error monitoring and perseverative behaviour.

In the zone or zoning out? Tracking behavioral and neural fluctuations during sustained attention

Despite growing recognition that attention fluctuates from moment-to-moment during sustained performance, prevailing analysis strategies involve averaging data across multiple trials or time points, treating these fluctuations as noise. Here, using alternative approaches, we clarify the relationship between ongoing brain activity and performance fluctuations during sustained attention. We introduce a novel task (the gradual onset continuous performance task), along with innovative analysis procedures that probe the relationships between reaction time (RT) variability, attention lapses, and intrinsic brain activity. Our results highlight 2 attentional states-a stable, less error-prone state ("in the zone"), characterized by higher default mode network (DMN) activity but during which subjects are at risk of erring if DMN activity rises beyond intermediate levels, and a more effortful mode of processing ("out of the zone"), that is less optimal for sustained performance and relies on activity in dorsal attention network (DAN) regions. These findings motivate a new view of DMN and DAN functioning capable of integrating seemingly disparate reports of their role in goal-directed behavior. Further, they hold potential to reconcile conflicting theories of sustained attention, and represent an important step forward in linking intrinsic brain activity to behavioral phenomena.

Error awareness and salience processing in the oddball task: shared neural mechanisms

A body of work suggests similarities in the way we become aware of an error and process motivationally salient events. Yet, evidence for a shared neural mechanism has not been provided. A within subject investigation of the brain regions involved in error awareness and salience processing has not been reported. While the neural response to motivationally salient events is classically studied during target detection after longer target-to-target intervals in an oddball task and engages a widespread insula-thalamo-cortical brain network, error awareness has recently been linked to, most prominently, anterior insula cortex. Here we explore whether the anterior insula activation for error awareness is related to salience processing, by testing for activation overlap in subjects undergoing two different task settings. Using a within subjects design, we show activation overlap in six major brain areas during aware errors in an antisaccade task and during target detection after longer target-to-target intervals in an oddball task: anterior insula, anterior cingulate, supplementary motor area, thalamus, brainstem, and parietal lobe. Within subject analyses shows that the insula is engaged in both error awareness and the processing of salience, and that the anterior insula is more involved in both processes than the posterior insula. The results of a fine-grained spatial pattern overlap analysis between active clusters in the same subjects indicates that even if the anterior insula is activated for both error awareness and salience processing, the two types of processes might tend to activate non-identical neural ensembles on a finer-grained spatial level. Together, these outcomes suggest a similar functional phenomenon in the two different task settings. Error awareness and salience processing share a functional anatomy, with a tendency toward subregional dorsal and ventral specialization within the anterior insula.

Electrophysiological indices of error monitoring in juvenile and adult attention deficit hyperactivity disorder (ADHD)--a meta-analytic appraisal

Attempts to identify the central disturbed processes explaining the overt symptoms of juvenile and adult ADHD rely heavily on the concept of deficient error monitoring processes. A number of studies have investigated event-related potentials (ERPs) and behavioral performance in tasks traditionally used to probe the interference control and inhibition of motor responses. The inspection of the error negativity (Ne/ERN) and error positivity (Pe) components evoked in these tasks has produced conflicting results with respect to the nature and extent of an error monitoring deficit in ADHD. A meta-analytic aggregation of these single studies should help develop a reliable appraisal of the evidence for the compromised performance monitoring processes in ADHD. Our meta-analysis was confined to studies of adult and juvenile ADHD participants examined in GoNogo and Flanker task studies that also reported the Ne/ERN and Pe ERP components. Only seven studies were suited for the meta-analysis, but their aggregation nevertheless led to clear results: Ne was attenuated in adult and adolescent ADHD participants for both tasks, and Pe was attenuated only in the GoNogo tasks. The ADHD participants made more errors than the controls in both tasks but responded slower only in the Flanker task. To our knowledge, this meta-analysis is the first to compare electrophysiological and behavioral indices of error monitoring in adult and juvenile ADHD patients and healthy controls. Admittedly, the data available for this comparison were sparse and heterogeneous; nevertheless, this meta-analysis produced salient results that indicate a monitoring deficit as a central feature of the ADHD syndrome.

Error-related anterior cingulate cortex activity and the prediction of conscious error awareness

Research examining the neural mechanisms associated with error awareness has consistently identified dorsal anterior cingulate cortex (ACC) activity as necessary but not predictive of conscious error detection. Two recent studies (Steinhauser and Yeung, 2010; Wessel et al., 2011) have found a contrary pattern of greater dorsal ACC (dACC) activity [in the form of the error-related negativity (ERN)] during detected errors, but suggested that the greater activity may instead reflect task influences (e.g., response conflict, error probability) and or individual variability (e.g., statistical power). We re-analyzed fMRI BOLD data from 56 healthy participants who had previously been administered the Error Awareness Task (EAT), a motor Go/No-go response inhibition task in which subjects make errors of commission of which they are aware (Aware errors), or unaware (Unaware errors). Consistent with previous data, the activity in a number of cortical regions was predictive of error awareness, including bilateral inferior parietal and insula cortices, however, in contrast to previous studies, including our own smaller sample studies using the same task, error-related dACC activity was significantly greater during aware errors when compared to unaware errors. While the significantly faster RT for aware errors (compared to unaware) was consistent with the hypothesis of higher response conflict increasing ACC activity, we could find no relationship between dACC activity and the error RT difference. The data suggests that error awareness is associated with error-related dACC activity but that the role of this activity is probably best understood in relation to the activity in other regions. Activity in the dACC may be important to conscious error detection, but it remains unclear what task and individual factors influence error awareness.

Is any awareness necessary for an Ne?

The Error-Related Negativity (Ne or ERN) is a reliable electrophysiological index of error processing, which has been found to be independent of whether a subject is aware of an error or not. A large Ne was equally seen after errors that were consciously detected (Aware errors) and those that were not (Unaware errors), compared to a small negativity for correct responses (CRN). This suggests a dissociation between an automatic, preconscious error processing mechanism and subjective evaluation. A common concern regarding this finding is that subjects could have been somewhat aware of their errors, but did not report them due to lack of confidence. Here we tested this possibility directly using a betting paradigm which allowed us to separate occasions in which the subjects were confident of their response and trials in which they were unsure. In a choice reaction time task, subjects directly judged the accuracy of each response (correct or error) and then bet on this judgment using a high, medium, or low amount of money. The bets were used to determine the level of confidence the subjects had of their response. The average across all subjects regardless of confidence (betting) measure replicated the reported finding of an equal Ne for Aware and Unaware errors which was larger than the CRN. However, when Ne measurement was confined to high confidence (high bet) trials in confident subjects, a prominent Ne was seen only for Aware errors, while confident Unaware errors (i.e., error trials on which subjects made high bets that they were correct) elicited a response that did not differ from the CRN elicited by truly correct answers. In contrast, for low confidence trials in unconfident subjects, an intermediate and equal Ne/CRN was elicited by Correct responses, Aware and Unaware errors. These results provide direct evidence that the Ne is related to error awareness, and suggest the amplitude of the Ne/CRN depends on individual differences in error reporting and confidence.

Error awareness and the error-related negativity: evaluating the first decade of evidence

From its discovery in the early 1990s until this day, the error-related negativity (ERN) remains the most widely investigated electrophysiological index of cortical error processing. When researchers began addressing the electrophysiology of subjective error awareness more than a decade ago, the role of the ERN, alongside the subsequently occurring error positivity (Pe), was an obvious locus of attention. However, the first two studies explicitly addressing the role of error-related event-related brain potentials (ERPs) would already set the tone for what still remains a controversy today: in contrast to the clear-cut findings that link the amplitude of the Pe to error awareness, the association between ERN amplitude and error awareness is vastly unclear. An initial study reported significant differences in ERN amplitude with respect to subjective error awareness, whereas the second failed to report this result, leading to a myriad of follow-up studies that seemed to back up or contradict either view. Here, I review those studies that explicitly dealt with the role of the error-related ERPs in subjective error awareness, and try to explain the differences in reported effects of error awareness on ERN amplitude. From the point of view presented here, different findings between studies can be explained by disparities in experimental design and data analysis, specifically with respect to the quantification of subjective error awareness. Based on the review of these results, I will then try to embed the error-related negativity into a widely known model of the implementation of access consciousness in the brain, the global neuronal workspace (GNW) model, and speculate as the ERN's potential role in such a framework. At last, I will outline future challenges in the investigation of the cortical electrophysiology of error awareness, and offer some suggestions on how they could potentially be addressed.

Neurochemical enhancement of conscious error awareness

How the brain monitors ongoing behavior for performance errors is a central question of cognitive neuroscience. Diminished awareness of performance errors limits the extent to which humans engage in corrective behavior and has been linked to loss of insight in a number of psychiatric syndromes (e.g., attention deficit hyperactivity disorder, drug addiction). These conditions share alterations in monoamine signaling that may influence the neural mechanisms underlying error processing, but our understanding of the neurochemical drivers of these processes is limited. We conducted a randomized, double-blind, placebo-controlled, cross-over design of the influence of methylphenidate, atomoxetine, and citalopram on error awareness in 27 healthy participants. The error awareness task, a go/no-go response inhibition paradigm, was administered to assess the influence of monoaminergic agents on performance errors during fMRI data acquisition. A single dose of methylphenidate, but not atomoxetine or citalopram, significantly improved the ability of healthy volunteers to consciously detect performance errors. Furthermore, this behavioral effect was associated with a strengthening of activation differences in the dorsal anterior cingulate cortex and inferior parietal lobe during the methylphenidate condition for errors made with versus without awareness. Our results have implications for the understanding of the neurochemical underpinnings of performance monitoring and for the pharmacological treatment of a range of disparate clinical conditions that are marked by poor awareness of errors.

An electrophysiological signal that precisely tracks the emergence of error awareness

Recent electrophysiological research has sought to elucidate the neural mechanisms necessary for the conscious awareness of action errors. Much of this work has focused on the error positivity (Pe), a neural signal that is specifically elicited by errors that have been consciously perceived. While awareness appears to be an essential prerequisite for eliciting the Pe, the precise functional role of this component has not been identified. Twenty-nine participants performed a novel variant of the Go/No-go Error Awareness Task (EAT) in which awareness of commission errors was indicated via a separate speeded manual response. Independent component analysis (ICA) was used to isolate the Pe from other stimulus- and response-evoked signals. Single-trial analysis revealed that Pe peak latency was highly correlated with the latency at which awareness was indicated. Furthermore, the Pe was more closely related to the timing of awareness than it was to the initial erroneous response. This finding was confirmed in a separate study which derived IC weights from a control condition in which no indication of awareness was required, thus ruling out motor confounds. A receiver-operating-characteristic (ROC) curve analysis showed that the Pe could reliably predict whether an error would be consciously perceived up to 400 ms before the average awareness response. Finally, Pe latency and amplitude were found to be significantly correlated with overall error awareness levels between subjects. Our data show for the first time that the temporal dynamics of the Pe trace the emergence of error awareness. These findings have important implications for interpreting the results of clinical EEG studies of error processing.

Neural correlates of inhibitory control in adult attention deficit/hyperactivity disorder: evidence from the Milwaukee longitudinal sample

Only a few studies have investigated the neural substrate of response inhibition in adult attention deficit hyperactivity disorder (ADHD) using Stop-Signal and Go/No-Go tasks. Inconsistencies and methodological limitations in the existing literature have resulted in limited conclusions regarding underlying pathophysiology. We examined the neural basis of response inhibition in a group of adults diagnosed with ADHD in childhood and who continue to meet criteria for ADHD. Adults with ADHD (n=12) and controls (n=12) were recruited from an ongoing longitudinal study and were matched for age, IQ, and education. Individuals with comorbid conditions were excluded. Functional magnetic resonance imaging (fMRI) was used to identify and compare the brain activation patterns during correct trials of a response-inhibition task (Go/No-Go). Our results showed that the control group recruited a more extensive network of brain regions than the ADHD group during correct inhibition trials. Adults with ADHD showed reduced brain activation in the right frontal eye field, pre-supplementary motor area, left precentral gyrus, and the inferior parietal lobe bilaterally. During successful inhibition of an inappropriate response, adults with ADHD display reduced activation in fronto-parietal networks previously implicated in working memory, goal-oriented attention, and response selection. This profile of brain activation may be specifically associated with ADHD in adulthood.

An asymmetric stroop/reverse-stroop interference phenomenon in ADHD

OBJECTIVE

To examine whether participants with ADHD showed a deficit in Stroop/reverse-Stroop interference by comparing them to non-ADHD participants.

METHOD

A group with ADHD, primarily inattentive type (n = 15), and a paired non-ADHD group (n = 15) completed the group version of the Stroop/reverse-Stroop test.

RESULTS

Asymmetric interference was observed between the Stroop test and the reverse-Stroop test in ADHD participants, presenting evidence contrary to Barkley's behavioral inhibition model of ADHD in which response inhibition deficits pertained only to the ADHD-C subtype.

CONCLUSION

Participants with ADHD showed a control deficit in reverse-Stroop interference but not in Stroop interference.

May posterror performance be a critical factor for behavioral deficits in attention-deficit/hyperactivity disorder?

BACKGROUND

Although the performance of children with attention-deficit/hyperactivity disorder (ADHD) is impaired in a variety of cognitive tasks, the specific capacity of strategic readaptation after errors as a source of behavioral deficits is not sufficiently understood. This study used an extended and refined behavioral parameterization to assess performance monitoring and posterror adaptation in children with ADHD.

METHODS

Twenty-eight healthy control subjects and 47 ADHD patients (7-16 years of age, all males, matched for age and IQ) performed a visual flanker task in which targets were congruent or incongruent with preceding flankers. Posterror adaptation was measured for response speed (posterror slowing), accuracy, and variability by using normalized individual rates of change. Markers of error detection and general performance were also analyzed.

RESULTS

Postcorrect response speed and accuracy did not differ between the groups, in contrast to posterror behaviors. Whereas posterror slowing was not evident in any of the groups, the error rate and performance instability (reaction time variance) substantially increased after errors only in ADHD patients, not in control subjects. No reliable between-group differences were found for error detection and global performance.

CONCLUSIONS

In healthy children, posterror adaptation preserves performance at its ongoing level. No such adaptation was evident in ADHD, leading to consecutive errors and increased behavioral instability. Performance deficits in ADHD were only present after error but not after correct behaviors, which shapes the general profile of performance impairment in ADHD. The findings have practical implications for strategic designs of behavioral therapy in ADHD.

Independent oscillatory patterns determine performance fluctuations in children with attention deficit/hyperactivity disorder

The maintenance of stable goal-directed behaviour is a hallmark of conscious executive control in humans. Notably, both correct and error human actions may have a subconscious activation-based determination. One possible source of subconscious interference may be the default mode network that, in contrast to attentional network, manifests intrinsic oscillations at very low (<0.1 Hz) frequencies. In the present study, we analyse the time dynamics of performance accuracy to search for multisecond periodic fluctuations of error occurrence. Attentional lapses in attention deficit/hyperactivity disorder are proposed to originate from interferences from intrinsically oscillating networks. Identifying periodic error fluctuations with a frequency<0.1 Hz in patients with attention deficit/hyperactivity disorder would provide a behavioural evidence for such interferences. Performance was monitored during a visual flanker task in 92 children (7- to 16-year olds), 47 with attention deficit/hyperactivity disorder, combined type and 45 healthy controls. Using an original approach, the time distribution of error occurrence was analysed in the frequency and time-frequency domains in order to detect rhythmic periodicity. Major results demonstrate that in both patients and controls, error behaviour was characterized by multisecond rhythmic fluctuations with a period of ∼12 s, appearing with a delay after transition to task. Only in attention deficit/hyperactivity disorder, was there an additional 'pathological' oscillation of error generation, which determined periodic drops of performance accuracy each 20-30 s. Thus, in patients, periodic error fluctuations were modulated by two independent oscillatory patterns. The findings demonstrate that: (i) attentive behaviour of children is determined by multisecond regularities; and (ii) a unique additional periodicity guides performance fluctuations in patients. These observations may re-conceptualize the understanding of attentive behaviour beyond the executive top-down control and may reveal new origins of psychopathological behaviours in attention deficit/hyperactivity disorder.

The molecular genetics of executive function: role of monoamine system genes

Executive control processes, such as sustained attention, response inhibition, and error monitoring, allow humans to guide behavior in appropriate, flexible, and adaptive ways. The consequences of executive dysfunction for humans can be dramatic, as exemplified by the large range of both neurologic and neuropsychiatric disorders in which such deficits negatively affect outcome and quality of life. Much evidence suggests that many clinical disorders marked by executive deficits are highly heritable and that individual differences in quantitative measures of executive function are strongly driven by genetic differences. Accordingly, intense research effort has recently been directed toward mapping the genetic architecture of executive control processes in both clinical (e.g., attention-deficit/hyperactivity disorder) and nonclinical populations. Here we review the extant literature on the molecular genetic correlates of three exemplar but dissociable executive functions: sustained attention, response inhibition, and error processing. Our review focuses on monoaminergic gene variants given the strong body of evidence from cognitive neuroscience and pharmacology implicating dopamine, noradrenaline, and serotonin as neuromodulators of executive function. Associations between DNA variants of the dopamine beta hydroxylase gene and measures of sustained attention accord well with cognitive-neuroanatomical models of sustained attention. Equally, functional variants of the dopamine D2 receptor gene are reliably associated with performance monitoring, error processing, and reinforcement learning. Emerging evidence suggests that variants of the dopamine transporter gene (DAT1) and dopamine D4 receptor gene (DRD4) show promise for explaining significant variance in individual differences in both behavioral and neural measures of inhibitory control.

Inhibition control and error processing in children with attention deficit/hyperactivity disorder: an event-related potentials study

We studied inhibitory control and error processing in a task requiring inhibition of a motor response. Behavioral and ERP indices were recorded in fourteen ADHD and fourteen healthy children aged between 6 and 10years during the Stop signal task (SST). The ADHD group made more variable in RT and showed less accuracy, more omissions and choice errors. Also, the ADHD group had a tendency toward a lower probability of inhibition and a longer Stop signal reaction time. The ADHD group also displayed a flatter response inhibition slope compared to the control group. Smaller P1 in ADHD group reflected that the ADHD group has less efficient attention than the control group. Furthermore, the ADHD group showed normal ERN, reduced Pe (retrieved from response-locked epochs), and reduced LPW (retrieved from Stop signal-locked epochs), suggesting that they might be normal in early error monitoring process related to error detection, but show abnormal in later error monitoring process associated with a conscious evaluation of the error. Behavioral and ERP data of the present study show deficient selective attention, inhibitory control, and error processing in children of ADHD.

Predictors of performance monitoring abilities following traumatic brain injury: the influence of negative affect and cognitive sequelae

Performance monitoring is a cognitive control process modulated by both cognitive and affective variables. This study examined the relative contributions of negative affect (NA) and cognitive sequelae to performance monitoring dysfunction following severe traumatic brain injury (TBI). We used the error-related negativity (ERN) and post-error positivity (Pe) components of the event-related potential (ERP) to test the hypothesis that NA and cognitive sequelae would predict performance monitoring dysfunction beyond time since injury, and injury severity. Nineteen survivors of severe TBI completed neuropsychological tests, measures of NA, and a computerized Stroop task. Scores on NA and neuropsychological measures were standardized to form magnitude of cognitive sequelae and negative affect composite scores. Separate hierarchical regression analyses with ERN and Pe amplitudes as dependent variables and injury severity, time since injury, magnitude of cognitive sequelae, and NA as independent variables indicated that NA and cognitive sequelae significantly predicted ERN amplitude, with a larger relative contribution of NA than cognitive sequelae. Increased levels of NA were associated with decreased amplitude ERN. Cognitive sequelae, but not NA, predicted Pe amplitude. Injury severity and time since injury were not significant predictors. Results suggest that both NA and cognitive sequelae play critical roles in performance monitoring decrements following TBI and indicate a possible dissociation between the ERN and Pe, with the ERN more related to affective processes and the Pe to cognitive processes.

Thirty-day self-reported risky driving behaviors of ADHD and non-ADHD drivers

The present study aims to compare differences in reported risky driving behaviors of drivers - males and females - having and not having Attention Deficit Hyperactivity Disorder (ADHD), by using a checklist of driving behaviors based on the Driving Behavior Questionnaire (DBQ). Unlike the studies which employ the DBQ by asking the subjects to fill the questionnaire once, in this present study, the participants were asked to report their behaviors on a daily basis for 30 consequent days. The checklist included two factors of risky driving behavior: Violation and Faults. Thirty-eight drivers - 10 males and 9 females with ADHD, and 9 males and 10 females without ADHD (N-ADHD) as control groups - participated in the study. The results showed that the mean of the unsafe behaviors of ADHD was higher, i.e., less safe driving, compared to that of N-ADHD. However, a statistically significant effect was found only between male ADHD and male N-ADHD for the Faults. In order to check the effect of the length of the study, the 30 days duration of the research was divided into three consecutive periods. The reported driving habits of the female ADHD showed safer behaviors than those of the males. Unlike the findings of N-ADHD of both genders, which showed a tendency towards safer driving reports in the three periods, both genders of the ADHD showed higher rates of Faults, i.e., a decrease in safety driving reports, in the three periods. The findings suggest that ADHD drivers differ from the N-ADHD drivers in making driving mistakes, i.e., Faults, due to their lack of sustained attention, but not in making Violations. However, some of the results in the present study were not very strong. Possible explanations for this as well as methodological considerations are discussed, and further research is suggested.

Self-perception of self-regulatory skills in children with attention-deficit/hyperactivity disorder aged 8-10 years

Several studies have reported a characteristic "positive illusory bias" in the self-evaluation of children with ADHD. However, results are controversial. The aim of the present study was to investigate whether children with ADHD aged 8 to 10 years can rate their self-regulatory skills accurately when assessed with an age appropriate instrument. Twenty-seven children with ADHD and 27 matched normal control children completed the Self-rating Scale of Self-regulatory Function (SelfReg), a new rating scale that has been specifically designed for this age group. As expected, children with ADHD rated themselves significantly more dysfunctional than control children. In most domains, self-ratings of children with ADHD did not diverge from parent and teacher ratings to a greater extent than self-ratings of control children, although overall results indicated a moderate tendency toward a positive bias. When a cluster analysis based on discrepancies between children's and adults' evaluations was carried out, three groups with different self-rating patterns emerged: A "positive bias" group containing exclusively children with ADHD, a "negative bias" group containing both children with ADHD and control children, and the largest group of accurate self-raters which also included children from both diagnostic groups. It is concluded that overly positive self-judgments are not a ubiquitous finding in ADHD, but may be confined to a specific subgroup of children whose specific characteristics remain to be determined.

Self-regulation in ADHD: the role of error processing

Attention-deficit hyperactivity disorder (ADHD) is characterized by persistent and impairing developmentally inappropriate levels of inattention, hyperactivity, and impulsivity. Such behavioral dysregulation may be a consequence of deficits in self-monitoring or adaptive control, both of which are required for adaptive behavior. Processing of contextual demands, ongoing monitoring of one's behavior to evaluate whether it is appropriate for a particular situation, and adjusting behavior when it is suboptimal are components of self-regulation. This review examines and integrates the emerging literature on error-processing and adaptive control as components of self-regulation into the prominent etiological theories of ADHD. Available data on error-processing, as reflected in event-related potentials (ERN and Pe) and behavioral performance, suggest that both early error detection and later error-evaluation may be diminished in ADHD, thereby interfering with adaptive control processes. However, variability in results limit broad conclusions, particularly for early error detection. A range of methodological issues, including ERP parameters and sample and task characteristics, likely contribute to this variability, and recommendations for future work are presented. The emerging literature on error-processing and adaptive control informs etiological theories of ADHD in general and may provide a method for testing self-regulation models in particular.

Conscious perception of errors and its relation to the anterior insula

To detect erroneous action outcomes is necessary for flexible adjustments and therefore a prerequisite of adaptive, goal-directed behavior. While performance monitoring has been studied intensively over two decades and a vast amount of knowledge on its functional neuroanatomy has been gathered, much less is known about conscious error perception, often referred to as error awareness. Here, we review and discuss the conditions under which error awareness occurs, its neural correlates and underlying functional neuroanatomy. We focus specifically on the anterior insula, which has been shown to be (a) reliably activated during performance monitoring and (b) modulated by error awareness. Anterior insular activity appears to be closely related to autonomic responses associated with consciously perceived errors, although the causality and directions of these relationships still needs to be unraveled. We discuss the role of the anterior insula in generating versus perceiving autonomic responses and as a key player in balancing effortful task-related and resting-state activity. We suggest that errors elicit reactions highly reminiscent of an orienting response and may thus induce the autonomic arousal needed to recruit the required mental and physical resources. We discuss the role of norepinephrine activity in eliciting sufficiently strong central and autonomic nervous responses enabling the necessary adaptation as well as conscious error perception.

Awareness of deficits and error processing after traumatic brain injury

Severe traumatic brain injury is frequently associated with alterations in performance monitoring, including reduced awareness of physical and cognitive deficits. We examined the relationship between awareness of deficits and electrophysiological indices of performance monitoring, including the error-related negativity and posterror positivity (Pe) components of the scalp-recorded event-related potential, in 16 traumatic brain injury survivors who completed a Stroop color-naming task while event-related potential measurements were recorded. Awareness of deficits was measured as the discrepancy between patient and significant-other ratings on the Frontal Systems Behavior Scale. The amplitude of the Pe, but not error-related negativity, was reliably associated with decreased awareness of deficits. Results indicate that Pe amplitude may serve as an electrophysiological indicator of awareness of abilities and deficits.

Electrophysiological indices of abnormal error-processing in adolescents with attention deficit hyperactivity disorder (ADHD)

BACKGROUND

Impaired cognitive control has been frequently observed in children and young people with attention deficit hyperactivity disorder (ADHD) and might underlie the excessive hyperactivity and impulsivity in this population. We investigated behavioural and electrophysiological indices relevant to one domain of cognitive control; namely error processing.

METHODS

Adolescents aged 14 to 17 with ADHD (n = 23) and a typically developing control group (HC; n = 19) performed a visual go/no-go task. Electro-encephalography (EEG) data were collected simultaneously and response-locked error trials were averaged to derive two event-related potentials, the error-related negativity (ERN) and error positivity (Pe). Evoked theta power and inter-trial phase coherence (ITC) were measured in two time windows ('early' and 'late') equivalent to those used for detection of the ERN and Pe.

RESULTS

Analysis revealed normal ERN amplitude and a statistical trend for smaller Pe amplitude at a fronto-central electrode site in the ADHD group. The group also showed significant reductions in late evoked theta power and early and late theta ITC. Relationships between behavioural measures and ITC were different between groups, particularly for post-error slowing, a measure of strategic response adjustment on trials immediately following an error.

CONCLUSIONS

The results reveal abnormalities in behavioural and electrophysiological indices of error processing in adolescents with ADHD and suggest that ITC is more sensitive than traditional ERP measures to error-processing abnormalities.

Action monitoring in children with or without a family history of ADHD--effects of gender on an endophenotype parameter

Attention-deficit/hyperactivity disorder (ADHD) is a frequent and highly heritable disorder overrepresented in boys. In a recent study investigating boys only, we found that action monitoring deficits as reflected by certain behavioral and electrophysiological parameters were familially driven. As gender may also have an important impact, this was examined in the current study with nonaffected children aged 8-15 years having relatives suffering from ADHD (N=37, 21 female symbol) and with age-matched controls without family history of ADHD (N=33, 11 female symbol). Extending our previous findings that action monitoring is a potential endophenotype for boys with ADHD, familially driven deficits were confirmed independently of gender. Thus, despite sharing the phenotype with controls, nonaffected siblings showed ADHD-like impairments albeit of smaller magnitude. However, girls performed generally more accurately, which in turn may have produced the differences between nonaffected siblings and controls in affective error processing that were not present in our boys-only assessment.

On the positive side of error processing: error-awareness positivity revisited

Performance errors are indexed in the brain even if they are not consciously registered, as demonstrated by the error-related negativity (ERN or Ne) event-related potential. It has recently been shown that another response-locked potential, the error positivity (Pe), follows the Ne, but only in those trials in which the participants consciously detect making the error ('Aware Errors'). In the present study we generalize these findings to an auditory task and investigate possible caveats in the interpretation of the Pe as an index of error awareness. In an auditory Go/No-Go error-awareness task (auditory EAT) participants pressed an additional 'fix error' button after noticing that they had made an error. As in visual tasks, the Ne was similar for aware ('fixed') and unaware ('unfixed') errors, while the Pe was enhanced only for Aware Errors. Within subjects, the Ne and Pe behaved in similar fashions for auditory and visual errors. A control condition confirmed that the awareness effect was not due to the requirement to report error awareness. These results reinforce the evidence in favor of the Pe as a correlate of conscious error processing, and imply that this process is not modality-specific. Nevertheless, single-trial analysis suggested that the Pe may be a delayed P3b related to stimulus processing rather than to response monitoring.

Error Monitoring in College Students with Attention-Deficit/Hyperactivity Disorder

Recent error-related event-related potential (ERP) studies suggest that children with attention-deficit/hyperactivity disorder (ADHD) display deficits in error monitoring compared to control children. Information regarding error monitoring deficit in adults with ADHD, however, is scarce. We investigated error monitoring in a sample of college students with ADHD and compared them to their control peers. In addition to error (-related) negativity (Ne/ERN) and error positivity (Pe), we examined behavioral performance such as reaction time (RT) as well as self-reported monitoring behaviors in daily-life situations. Thirty-two college students with no known disorders and 36 college students with ADHD between 18 and 30 years of age participated in this study. Results showed that college students with ADHD were slower in their RT and displayed more RT variability. College students with ADHD also demonstrated significantly smaller Ne/ERN amplitude and shorter Ne/ERN latency compared to control students. There were, however, no significant group differences in either Pe amplitude or Pe latency. With self-reported monitoring behaviors, ADHD students reported significantly more difficulties in both the Self-Monitor and Task Monitor scales of the Behavioral Rating Inventory of Executive Function – Adult Version (BRIEF-A) compared to control students. Collectively, these results suggest that college students with ADHD have atypical error monitoring as measured by brain processing, behavioral performance, and self-report.