Spontaneous attentional fluctuations in impaired states and pathological conditions: a neurobiological hypothesis

Letter Reversals, Default Mode, and Childhood ADHD

Objective: To investigate the relationship of static reversals, handedness and gender to reaction time variability (RTV) in a sequentional sample of 1,109 children referred to a child psychiatry clinic for investigation of possible ADHD. Method: A DSM-III ADHD diagnosis and ADHD severity ratings (mild, moderate, and severe) by the present investigator was recorded. The age at which the children were still manifesting static reversals as reported by their mother, and right, left, or both-handedness as reported by the mother and observed by the investigator, were noted. Results: The age that letter reversals were still manifested was significantly associated with RTV for male and female children. Conclusions: The findings may represent an early manifestation of a failure of suppression of visually symmetrical information and/or a failure of default mode suppression.

Cognition in Context: Understanding the Everyday Predictors of Cognitive Performance in a New Era of Measurement

Background

Research suggests that variability in attention and working memory scores, as seen across time points, may be a sensitive indicator of impairment compared with a singular score at one point in time. Given that fluctuation in cognitive performance is a meaningful metric of real-world function and trajectory, it is valuable to understand the internal state-based and environmental factors that could be driving these fluctuations in performance.

Objective

In this viewpoint, we argue for the use of repeated mobile assessment as a way to better understand how context shapes moment-to-moment cognitive performance. To elucidate potential factors that give rise to intraindividual variability, we highlight existing literature that has linked both internal and external modifying variables to a number of cognitive domains. We identify ways in which these variables could be measured using mobile assessment to capture them in ecologically meaningful settings (ie, in daily life). Finally, we describe a number of studies that have already begun to use mobile assessment to measure changes in real time cognitive performance in people’s daily environments and the ways in which this burgeoning methodology may continue to advance the field.

Methods

This paper describes selected literature on contextual factors that examined how experimentally induced or self-reported contextual variables (ie, affect, motivation, time of day, environmental noise, physical activity, and social activity) related to tests of cognitive performance. We also selected papers that used mobile assessment of cognition; these papers were chosen for their use of high-frequency time-series measurement of cognition using a mobile device.

Results

Upon review of the relevant literature, it is evident that contextual factors have the potential to meaningfully impact cognitive performance when measured in laboratory and daily life environments. Although this research has shed light on the question of what gives rise to real-life variability in cognitive function (eg, affect and activity), many of the studies were limited by traditional methods of data collection (eg, involving retrospective recall). Furthermore, cognition has often been measured in one domain or in one age group, which does not allow us to extrapolate results to other cognitive domains and across the life span. On the basis of the literature reviewed, mobile assessment of cognition shows high levels of feasibility and validity and could be a useful method for capturing individual cognitive variability in real-world contexts via passive and active measures.

Conclusions

We propose that, through the use of mobile assessment, there is an opportunity to combine multiple sources of contextual and cognitive data. These data have the potential to provide individualized digital signatures that could improve diagnostic precision and lead to meaningful clinical outcomes in a wide range of psychiatric and neurological disorders.

Exploring white matter functional networks in children with attention-deficit/hyperactivity disorder

Attention-deficit/hyperactivity disorder has been identified to involve the impairment of large-scale functional networks within grey matter, and recent studies have suggested that white matter, which also encodes neural activity, can manifest intrinsic functional organization similar to that of grey matter. However, the alterations in white matter functional networks in attention-deficit/hyperactivity disorder remain unknown. We recruited a total of 99 children, including 66 drug-naive patients and 33 typically developing controls aged from 6 to 14, to characterize the alterations in functional networks within white matter in drug-naive children with attention-deficit/hyperactivity disorder. Using clustering analysis, resting-state functional MRI data in the white matter were parsed into different networks. Intrinsic activity within each network and connectivity between networks and the associations between network activity strength and clinical symptoms were assessed. We identified eight distinct white matter functional networks: the default mode network, the somatomotor network, the dorsal attention network, the ventral attention network, the visual network, the deep frontoparietal network, the deep frontal network and the inferior corticospinal-posterior cerebellum network. The default mode, somatomotor, dorsal attention and ventral attention networks showed lower spontaneous neural activity in patients. In particular, the default mode network and the somatomotor network largely showed higher connectivity with other networks, which correlated with more severe hyperactive behaviour, while the dorsal and ventral attention networks mainly had lower connectivity with other networks, which correlated with poor attention performance. In conclusion, there are two distinct patterns of white matter functional networks in children with attention-deficit/hyperactivity disorder, with one being the hyperactivity-related hot networks including default mode network and somatomotor network and the other being inattention-related cold networks including dorsal attention and ventral attention network. These results extended upon our understanding of brain functional networks in attention-deficit/hyperactivity disorder from the perspective of white matter dysfunction.

The Low-Frequency Fluctuation of Trial-by-Trial Frontal Theta Activity and Its Correlation With Reaction-Time Variability in Sustained Attention

Reaction-time variability is a critical index of sustained attention. However, researchers still lack effective measures to establish the association between neurophysiological activity and this behavioral variability. Here, the present study recorded reaction time (RT) and cortical electroencephalogram (EEG) in healthy subjects when they continuously performed an alternative responding task. The frontal theta activity and reaction-time variability were examined trial by trial using the measures of standard deviation (SD) in the time domain and amplitude of low-frequency fluctuation (ALFF) in the frequency domain. Our results showed that the SD of reaction-time variability did not have any correlation with the SD of trial-by-trial frontal theta activity, and the ALFF of reaction-time variability has a significant correlation with the ALFF of trial-by-trial frontal theta activity in 0.01–0.027 Hz. These results suggested the methodological significance of ALFF in establishing the association between neurophysiological activity and reaction-time variability. Furthermore, these findings also support the low-frequency fluctuation as a potential feature of sustained attention.

Brain functional connectivity in chronic tic disorders and Gilles de la Tourette syndrome

The pathophysiology of chronic tic disorder (cTD) and Gilles de la Tourette syndrome (GTS) is characterized by the dysfunction of both motor and non - motor cortico - striatal - thalamo - cortical (CSTC) circuitries, which leads to tic release and comorbids. A role of fronto - parietal network (FPN) connectivity breakdown has been postulated for tic pathogenesis, given that the FPN entertain connections with limbic, paralimbic, and CSTC networks. Our study was aimed at characterizing the FPN functional connectivity in cTD and GTS in order to assess the role of its deterioration in tic severity and the degree of comorbids. We recorded scalp EEG during resting state in patients with cTD and GTS. The eLORETA current source densities were analyzed, and the lagged phase synchronization (LPS) was calculated to estimate nonlinear functional connectivity between cortical areas. We found that the FPN functional connectivity in delta band was more detrimental in more severe GTS patients. Also, the sensorimotor functional connectivity in beta2 band was stronger in more severe cTD and GTS patients. FPN functional connectivity deterioration correlated with comorbids presence and severity in patients with GTS. Our data suggest that a FPN disconnection may contribute to the motoric symptomatology and comorbid severity in GTS, whereas sensorimotor disconnection may contribute to tic severity in cTD and GTS. Although preliminary, our study points out a differently disturbed brain connectivity between patients with cTD and GTS. This may serve as diagnostic marker and potentially interesting base to develop pharmacological and noninvasive neuromodulation trials aimed at reducing tic symptomatology.

Lateralization of attention in adults with ADHD: Evidence of pseudoneglect

Background.

We investigated whether adults with attention-deficit/hyperactivity disorder (ADHD) show pseudoneglect—preferential allocation of attention to the left visual field (LVF) and a resulting slowing of mean reaction times (MRTs) in the right visual field (RVF), characteristic of neurotypical (NT) individuals —and whether lateralization of attention is modulated by presentation speed and incentives.

Method.

Fast Task, a four-choice reaction-time task where stimuli were presented in LVF or RVF, was used to investigate differences in MRT and reaction time variability (RTV) in adults with ADHD (n = 43) and NT adults (n = 46) between a slow/no-incentive and fast/incentive condition. In the lateralization analyses, pseudoneglect was assessed based on MRT, which was calculated separately for the LVF and RVF for each condition and each study participant.

Results.

Adults with ADHD had overall slower MRT and increased RTV relative to NT. MRT and RTV improved under the fast/incentive condition. Both groups showed RVF-slowing with no between-group or between-conditions differences in RVF-slowing.

Conclusion.

Adults with ADHD exhibited pseudoneglect, a NT pattern of lateralization of attention, which was not attenuated by presentation speed and incentives.

Investigation of Psychiatric and Neuropsychological Correlates of Default Mode Network and Dorsal Attention Network Anticorrelation in Children

The default mode network (DMN) and dorsal attention network (DAN) demonstrate an intrinsic "anticorrelation" in healthy adults, which is thought to represent the functional segregation between internally and externally directed thought. Reduced segregation of these networks has been proposed as a mechanism for cognitive deficits that occurs in many psychiatric disorders, but this association has rarely been tested in pre-adolescent children. The current analysis used data from the Adolescent Brain Cognitive Development study to examine the relationship between the strength of DMN/DAN anticorrelation and psychiatric symptoms in the largest sample to date of 9- to 10-year-old children (N = 6543). The relationship of DMN/DAN anticorrelation to a battery of neuropsychological tests was also assessed. DMN/DAN anticorrelation was robustly linked to attention problems, as well as age, sex, and socioeconomic factors. Other psychiatric correlates identified in prior reports were not robustly linked to DMN/DAN anticorrelation after controlling for demographic covariates. Among neuropsychological measures, the clearest correlates of DMN/DAN anticorrelation were the Card Sort task of executive function and cognitive flexibility and the NIH Toolbox Total Cognitive Score, although these did not survive correction for socioeconomic factors. These findings indicate a complicated relationship between DMN/DAN anticorrelation and demographics, neuropsychological function, and psychiatric problems.

Ventromedial Prefrontal Volume in Adolescence Predicts Hyperactive/Inattentive Symptoms in Adulthood

Youths with attention-deficit/hyperactivity disorder symptomatology often exhibit residual inattention and/or hyperactivity in adulthood; however, this is not true for all individuals. We recently reported that dimensional, multi-informant ratings of hyperactive/inattentive symptoms are associated with ventromedial prefrontal cortex (vmPFC) structure. Herein, we investigate the degree to which vmPFC structure during adolescence predicts hyperactive/inattentive symptomatology at 5-year follow-up. Structural equation modeling was used to test the extent to which adolescent vmPFC volume predicts hyperactive/inattentive symptomatology 5 years later in early adulthood. 1104 participants (M = 14.52 years, standard deviation = 0.42; 583 females) possessed hyperactive/inattentive symptom data at 5-year follow-up, as well as quality controlled neuroimaging data and complete psychometric data at baseline. Self-reports of hyperactive/inattentive symptomatology were obtained during adolescence and at 5-year follow-up using the Strengths and Difficulties Questionnaire (SDQ). At baseline and 5-year follow-up, a hyperactive/inattentive latent variable was derived from items on the SDQ. Baseline vmPFC volume predicted adult hyperactive/inattentive symptomatology (standardized coefficient = -0.274, P < 0.001) while controlling for baseline hyperactive/inattentive symptomatology. These results are the first to reveal relations between adolescent brain structure and adult hyperactive/inattentive symptomatology, and suggest that early structural development of the vmPFC may be consequential for the subsequent expression of hyperactive/inattentive symptoms.

In Quest of Pathognomonic/Endophenotypic Markers of Attention Deficit Hyperactivity Disorder (ADHD): Potential of EEG-Based Frequency Analysis and ERPs to Better Detect, Prevent and Manage ADHD

Attention deficit hyperactivity disorder (ADHD) is a chronic heritable developmental delay psychiatric disorder requiring chronic management, characterized by inattention, hyperactivity, hyperkinectivity and impulsivity. Subjective clinical evaluation still remains crucial in its diagnosis. Discussed are two key aspects in the “characterizing ADHD” and on the quest for objective “pathognomonic/endophenotypic diagnostic markers of ADHD”. The first aspect briefly revolves around issues related to identification of pathognomonic/endophenotypic diagnostic markers in ADHD. Issues discussed include changes in ADHD definition, remission/persistence and overlapping-symptoms cum shared-heritability with its co-morbid cross-border mental disorders. The second aspect discussed is neurobiological and EEG-based studies on ADHD. Given the neurobiological and temporal aspects of ADHD symptoms the electroencephalograph (EEG) like NeuralScan by Medeia appears as an appropriate tool. The EEGs appropriateness is further enhanced when coupled with suitable behavior/cognitive/motor/psychological tasks/paradigms yielding EEG-based markers like event-related-potential (ERPs like P3 amplitudes and latency), reaction time variability (RTV), Theta:Beta ratio (TBR) and sensorimotor rhythm (SMR). At present, these markers could potentially help in the neurobiological characterization of ADHD and either help in identifying or lay the groundwork for identifying pathognomonic and/or endophenotypic EEG-based markers enabling its diagnosis, treatment and management.

How Is Temporal Processing Affected in Children with Attention-deficit/hyperactivity Disorder?

We compared the performance of children with ADHD and typically developing children on two temporal tasks, a bisection task and a reproduction task, in auditory and visual modalities. Children with ADHD presented a larger variability when performing auditory and visual temporal tasks. Moreover, they overestimated the durations in bisection tasks and underproduced duration intervals in the visual reproduction task. In the context of the pacemaker-accumulator model, these results suggest that temporal deficits might result from a dysfunction in the switch and/or memory impairment.

Topological Data Analysis Reveals Robust Alterations in the Whole-Brain and Frontal Lobe Functional Connectomes in Attention-Deficit/Hyperactivity Disorder

Attention-deficit/hyperactivity disorder (ADHD) is a developmental disorder characterized by difficulty to control the own behavior. Neuroimaging studies have related ADHD with the interplay of fronto-parietal attention systems with the default mode network (DMN; Castellanos and Aoki, 2016). However, some results have been inconsistent, potentially due to methodological differences in the analytical strategies when defining the brain functional network, i.e., the functional connectivity threshold and/or the brain parcellation scheme. Here, we make use of topological data analysis (TDA) to explore the brain connectome as a function of the filtration value (i.e., the connectivity threshold), instead of using a static connectivity threshold. Specifically, we characterized the transition from all nodes being isolated to being connected into a single component as a function of the filtration value. We explored the utility of such a method to identify differences between 81 children with ADHD (45 male, age: 7.26–17.61 years old) and 96 typically developing children (TDC; 59 male, age: 7.17–17.96 years old), using a public dataset of resting state (rs)fMRI in human subjects. Results were highly congruent when using four different brain segmentations (atlases), and exhibited significant differences for the brain topology of children with ADHD, both at the whole-brain network and the functional subnetwork levels, particularly involving the frontal lobe and the DMN. Therefore, this is a solid approach that complements connectomics-related methods and may contribute to identify the neurophysio-pathology of ADHD.

Functional neural correlates of psychopathy: a meta-analysis of MRI data

Neuroimaging studies over the last two decades have begun to specify the neurobiological correlates of psychopathy, a personality disorder that is strongly related to criminal offending and recidivism. Despite the accumulation of neuroimaging studies of psychopathy, a clear and comprehensive picture of the disorder's neural correlates has yet to emerge. The current study is a meta-analysis of functional MRI studies of psychopathy. Multilevel kernel density analysis was used to identify consistent findings across 25 studies (460 foci) of task-related brain activity. Psychopathy was associated with increased task-related activity predominantly in midline cortical regions overlapping with the default mode network (dorsomedial prefrontal cortex, posterior cingulate, and precuneus) as well as medial temporal lobe (including amygdala). Psychopathy was related to decreased task-related activity in a region of the dorsal anterior cingulate cortex overlapping with the salience network. These findings challenge predominant theories of amygdala hypoactivity and highlight the potential role of hyperactivity in medial default mode network regions and hypoactivity in a key node of the salience network during task performance in psychopathy.

Mind-wandering and sleepiness in adults with attention-deficit/hyperactivity disorder

Sleepiness and mind-wandering are frequently experienced by patients with attention-deficit/hyperactivity disorder (ADHD), without ever having been jointly explored. We aimed to investigate the co-occurrence of these two phenomena in ADHD adults. Drug-free ADHD adults (n = 25) and healthy controls (n = 28) underwent an online experience sampling of mind-wandering episodes and subjective sleepiness. Participants completed self-reported measures of mind-wandering and sleepiness in daily life. Higher trait of mind-wandering was observed in ADHD patients compared to controls. On the whole sample, self-reported mind-wandering propensity was strongly associated with the severity of inattentive, impulsive and hyperactive symptoms. During the probes, patients reported more frequent episodes of mind-wandering and mind-blanking, and higher sleepiness. Their mind-wandering episodes were less intentional and belonged less frequently to a structured succession of thoughts. In both groups, mind-wandering and mind-blanking were associated with higher sleepiness. On the SART, patients were less accurate than controls. We provide first initial evidence for higher propensity of mind-wandering and mind-blanking using experience sampling in patients with formal ADHD diagnosis. This propensity was associated with sleepiness without negatively impacting attention performances. Mind-wandering and sleepiness have common determinants potentially involved in ADHD pathophysiology. Correlates of mind-blanking in ADHD adults remain to be characterized.

Is Increased Response Time Variability Related to Deficient Emotional Self-Regulation in Children With ADHD?

Objective: Elevated response time intrasubject variability (RT-ISV) characterizes ADHD. Deficient emotional self-regulation (DESR), defined by summating Child Behavior Checklist Anxious/Depressed, Aggressive, and Attention subscale scores, has been associated with worse outcome in ADHD. To determine if DESR is differentially associated with elevated RT-ISV, we examined RT-ISV in children with ADHD with and without DESR and in typically developing children (TDC). Method: We contrasted RT-ISV during a 6-min Eriksen Flanker Task in 31 children with ADHD without DESR, 34 with ADHD with DESR, and 65 TDC. Results: Regardless of DESR, children with ADHD showed significantly greater RT-ISV than TDC (p < .001). The ADHD subgroups, defined by presence or absence of DESR, did not differ from each other. Conclusion: Increased RT-ISV characterizes ADHD regardless of comorbid DESR. Alongside similar findings in children and adults with ADHD, these results suggest that RT-ISV is related to cognitive rather than emotional dysregulation in ADHD.

Shared and distinct resting functional connectivity in children and adults with attention-deficit/hyperactivity disorder

Attention-deficit/hyperactivity disorder (ADHD) often persists into adulthood, with a shift of symptoms including less hyperactivity/impulsivity and more co-morbidity of affective disorders in ADHD_adult. Many studies have questioned the stability in diagnosing of ADHD from childhood to adulthood, and the shared and distinct aberrant functional connectivities (FCs) between ADHD_child and ADHD_adult remain unidentified. We aim to explore shared and distinct FC patterns in ADHD_child and ADHD_adult, and further investigated the cross-cohort predictability using the identified FCs. After investigating the ADHD-discriminative FCs from healthy controls (HCs) in both child (34 ADHD_child, 28 HCs) and adult (112 ADHD_adult,77 HCs) cohorts, we identified both shared and distinct aberrant FC patterns between cohorts and their association with clinical symptoms. Moreover, the cross-cohort predictability using the identified FCs were tested. The ADHD-HC classification accuracies were 84.4% and 81.0% for children and male adults, respectively. The ADHD-discriminative FCs shared in children and adults lie in the intra-network within default mode network (DMN) and the inter-network between DMN and ventral attention network, positively correlated with total scores of ADHD symptoms. Particularly, inter-network FC between somatomotor network and dorsal attention network was uniquely impaired in ADHD_child, positively correlated with hyperactivity index; whereas the aberrant inter-network FC between DMN and limbic network exhibited more adult-specific ADHD dysfunction. And their cross-cohort predictions were 70.4% and 75.6% between each other. This work provided imaging evidence for symptomatic changes and pathophysiological continuity in ADHD from childhood to adulthood, suggesting that FCs may serve as potential biomarkers for ADHD diagnosis.

Attention-deficit hyperactivity disorder

Attention-deficit hyperactivity disorder (ADHD), like other psychiatric disorders, represents an evolving construct that has been refined and developed over the past several decades in response to research into its clinical nature and structure. The clinical presentation and course of the disorder have been extensively characterised. Efficacious medication-based treatments are available and widely used, often alongside complementary psychosocial approaches. However, their effectiveness has been questioned because they might not address the broader clinical needs of many individuals with ADHD, especially over the longer term. Non-pharmacological approaches to treatment have proven less effective than previously thought, whereas scientific and clinical studies are starting to fundamentally challenge current conceptions of the causes of ADHD in ways that might have the potential to alter clinical approaches in the future. In view of this, we first provide an account of the diagnosis, epidemiology, and treatment of ADHD from the perspective of both the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders and the eleventh edition of the International Classification of Diseases. Second, we review the progress in our understanding of the causes and pathophysiology of ADHD on the basis of science over the past decade or so. Finally, using these discoveries, we explore some of the key challenges to both the current models and the treatment of ADHD, and the ways in which these findings can promote new perspectives.

Functional connectivity of specific brain networks related to social and communication dysfunction in adolescents with attention-deficit hyperactivity disorder

BACKGROUND

Adolescents with attention-deficit hyperactivity disorder (ADHD) may have impaired social cognition and communication. However, the functioning of the brain networks involved in the social cognition and communication impairment in ADHD patients remains unclear.

METHODS

In total, 18 adolescents with ADHD and 16 age- and sex-matched typically developing adolescents (controls)-all of whom underwent a brain magnetic resonance imaging examination-were enrolled. Their parents filled out Swanson, Nolan, and Pelham IV (SNAP-IV) and Social Responsiveness Scale (SRS) questionnaires. Functional connectivity analyses based on the default mode network, frontoparietal network, and cinguloopercular network were performed.

RESULTS

Compared with controls, adolescents with ADHD exhibited higher total and subscale scores on SNAP-IV and SRS. Higher SNAP-IV and SRS scores were associated with higher functional connectivity between the default mode network (ventromedial prefrontal cortex) and cinguloopercular network (anterior insula) and between the FPN (dorsolateral and prefrontal cortex) and cinguloopercular network, but with lower functional connectivity between the default mode network (posterior cingulate cortex) and frontoparietal network (inferior parietal lobule) and between the default mode network (precuneus) and cinguloopercular network (temporoparietal junction).

DISCUSSION

Social cognition and communication impairment and ADHD may commonly share the aberrant functional connectivity in the default mode network, frontoparietal network, and cinguloopercular network.

Methylphenidate Alters Functional Connectivity of Default Mode Network in Drug-Naive Male Adults With ADHD

Objective: This study evaluated the hypothesis that methylphenidate immediate release (MPH-IR) treatment would improve Default Mode Network (DMN) within-connectivity. Method: Resting-state functional connectivity of the main nodes of DMN was evaluated in a highly homogeneous sample of 18 drug-naive male adult participants with ADHD. Results: Comparing resting-state functional connectivity functional magnetic resonance imaging (R-fMRI) scans before and after MPH treatment focusing exclusively on within-DMN connectivity, we evidenced the strengthening of functional connectivity between two nodes of the DMN: posterior cingulate cortex (PCC) and left lateral parietal cortex (LLP). Conclusion: Our results contribute to the further understanding on how MPH affects functional connectivity within DMN of male adults with ADHD and corroborate the hypothesis of ADHD being a delayed neurodevelopmental disorder.

Involvement of the Cortico-Basal Ganglia-Thalamocortical Loop in Developmental Stuttering

Stuttering is a complex neurodevelopmental disorder that has to date eluded a clear explication of its pathophysiological bases. In this review, we utilize the Directions Into Velocities of Articulators (DIVA) neurocomputational modeling framework to mechanistically interpret relevant findings from the behavioral and neurological literatures on stuttering. Within this theoretical framework, we propose that the primary impairment underlying stuttering behavior is malfunction in the cortico-basal ganglia-thalamocortical (hereafter, cortico-BG) loop that is responsible for initiating speech motor programs. This theoretical perspective predicts three possible loci of impaired neural processing within the cortico-BG loop that could lead to stuttering behaviors: impairment within the basal ganglia proper; impairment of axonal projections between cerebral cortex, basal ganglia, and thalamus; and impairment in cortical processing. These theoretical perspectives are presented in detail, followed by a review of empirical data that make reference to these three possibilities. We also highlight any differences that are present in the literature based on examining adults versus children, which give important insights into potential core deficits associated with stuttering versus compensatory changes that occur in the brain as a result of having stuttered for many years in the case of adults who stutter. We conclude with outstanding questions in the field and promising areas for future studies that have the potential to further advance mechanistic understanding of neural deficits underlying persistent developmental stuttering.

Using virtual reality to define the mechanisms linking symptoms with cognitive deficits in attention deficit hyperactivity disorder

The mechanisms underpinning attentional deficits are only partially understood. Here we ask if shifts in a child's field of view (FOV) act as a mediator between symptoms of attention deficit hyperactivity disorder (ADHD) and associated cognitive anomalies, particularly in attentional processes. Real time measurement of shifts in FOV were obtained on 85 children (mean age 9.4 (SD 1.9) years; 45 with DSM 5-defined ADHD) as they completed the continuous performance task in a "virtual classroom". We extracted measures reflecting focused and selective attention across the task, along with diffusion modelling of latent cognitive processes of information uptake, response conservativeness and non-decision time. Mediation analyses showed that shifts in FOV partially mediated the relationship between hyperactive impulsive symptoms and both poor focused attention and information uptake. Performance accuracy decreased and shifts in FOV increased during the task, but these changes over time did not differ by symptom severity. Employing virtual reality and mediation analysis, we implicate shifts in FOV as a mechanism linking symptoms of ADHD and deficits in focused attention and in the gathering of information to make decisions. The identification of mediating mechanisms might provide new targets for intervention.

Electrophysiological dynamics of antagonistic brain networks reflect attentional fluctuations

Neuroimaging evidence suggests that the default mode network (DMN) exhibits antagonistic activity with dorsal attention (DAN) and salience (SN) networks. Here we use human intracranial electroencephalography to investigate the behavioral relevance of fine-grained dynamics within and between these networks. The three networks show dissociable profiles of task-evoked electrophysiological activity, best captured in the high-frequency broadband (HFB; 70-170 Hz) range. On the order of hundreds of milliseconds, HFB responses peak fastest in the DAN, at intermediate speed in the SN, and slowest in the DMN. Lapses of attention (behavioral errors) are marked by distinguishable patterns of both pre- and post-stimulus HFB activity within each network. Moreover, the magnitude of temporally lagged, negative HFB coupling between the DAN and DMN (but not SN and DMN) is associated with greater sustained attention performance and is reduced during wakeful rest. These findings underscore the behavioral relevance of temporally delayed coordination between antagonistic brain networks.

Use of Virtual Reality Working Memory Task and Functional Near-Infrared Spectroscopy to Assess Brain Hemodynamic Responses to Methylphenidate in ADHD Children

Virtual reality (VR) neuropsychological tests have emerged as a method to explore drug effects in real-life contexts in attention deficit hyperactivity disorder (ADHD) children. Functional near-infrared spectroscopy (fNIRS) is a useful tool to measure brain activity during VR tasks in ADHD children with motor restlessness. The present study aimed to explore the acute effects of methylphenidate (MPH) on behavioral performance and brain activity during a VR-based working memory task simulating real-life classroom settings in ADHD children. In total, 23 children with ADHD performed a VR n-back task before and 2 h after MPH administration concurrent with measurements of oxygenated hemoglobin signal changes with fNIRS. Altogether, 12 healthy control (HC) subjects participated in the same task but did not receive MPH treatment. Reaction time (RT) was shortened after MPH treatment in the 1-back condition, but changes in brain activation were not observed. In the 2-back condition, activation of the left dorsolateral prefrontal cortex (DLPFC) and bilateral medial prefrontal cortex (mPFC) was decreased alongside behavioral changes such as shorter RT, lower RT variability, and higher accuracy after MPH administration. Bilateral mPFC activation in the 2-back condition inversely correlated with task accuracy in the pre-MPH condition; this inverse correlation was not observed after MPH administration. In ADHD children, deactivation of the default mode network mediated by mPFC reduced during high working memory load, which was restored through MPH treatment. Our results suggest that the combination of VR classroom tasks and fNIRS examination makes it easy to assess drug effects on brain activity in ADHD children in settings simulating real-life.

Application of Attention-Deficit/Hyperactivity Disorder Diagnostic Tools: Strengths and Weaknesses of the Korean ADHD Rating Scale and Continuous Performance Test

PURPOSE

We aimed to compare the Korean version of the ADHD Rating Scale (K-ARS) and Integrated Visual and Auditory Plus (IVA+Plus), a continuous performance test, by analyzing their abilities to distinguish different groups (attention-deficit/hyperactivity disorder [ADHD], ADHD-not otherwise specified [NOS], and normal control [NC]).

PATIENTS AND METHODS

Individuals of 7-12 years of age who visited our child and adolescent psychiatric clinic were recruited. Seventy-four participants (58 males, 16 females) were classified into three groups according to results from the Korean Version of Diagnostic Interview Schedule for Children Version IV. The K-ARS and IVA+Plus were administered. An analysis of covariance (ANCOVA) was conducted. The tools' accuracy in discriminating patients with ADHD or NOS from NCs was evaluated using a receiver operating characteristic (ROC) curve analysis.

RESULTS

ANCOVA revealed significant differences in the K-ARS results of the three groups (ADHD [n=29], NOS [n=33], NC [n=12]), whereas a difference in IVA+Plus results was observed only between the ADHD and NC groups. In the ROC curve analysis of the K-ARS, the areas under the curve (AUCs) for each group were 0.960 (ADHD vs NC), 0.885 (NOS vs NC), 0.920 (ADHD+NOS vs NC), and 0.779 (ADHD vs NOS+NC). In the ROC curve analysis for the IVA+Plus hyperactivity-impulsiveness scale, the AUCs for each group were 0.740 (ADHD vs NC), 0.643 (NOS vs NC), 0.688 (ADHD+NOS vs NC), and 0.626 (ADHD vs NOS+NC); those for the inattention scale were 0.731 (ADHD vs NC), 0.658 (NOS vs NC), 0.692 (ADHD+NOS vs NC), and 0.625 (ADHD+NOS vs NC).

CONCLUSION

The K-ARS was useful to distinguish the ADHD and NOS groups from the NC group, while the IVA+Plus was useful to distinguish the ADHD group from the NC group. Clinicians should ensure they understand the properties of each tool and apply them appropriately in the diagnosis of ADHD.

Brain damage by trauma

Traumatic brain injury (TBI) represents a major clinical and economic challenge for health systems worldwide, and it is considered one of the leading causes of disability in young adults. The recent development of brain-computer interface (BCI) tools to target cognitive and motor impairments has led to the exploration of these techniques as potential therapeutic tools in patients with TBI. However, little evidence has been gathered so far to support applicability and efficacy of BCIs for TBI in a clinical setting. In the present chapter, results from studies using BCI approaches in conscious patients with TBI or in animal models of TBI as well as an overview of future directions in the use of BCIs to treat cognitive symptoms in this patient population will be presented.

Dissociating Slow Responses From Slow Responding

Increased Intra-Subject Variability (ISV) is a candidate endophenotype of ADHD. ISV's relationship with response speed is highly relevant for ADHD as patients are highly variable but typically no slower than controls. This brief report addresses the relationship between variability and speed by employing dimensional analyses for differentiated performance measures, with a particular focus on the ex-Gaussian measures, across relevant ADHD studies and in young healthy adults (N = 70). For both patients with ADHD and healthy adults, we found that reaction time standard deviation and mean reaction time were strongly correlated, thus failing to dissociate, but ex-Gaussian tau (τ) shared only little variance with Gaussian mu (μ), thus dissociating slow responses (τ) from response speed or-if given-slow responding (μ). Our results highlight the utility of employing the ex-Gaussian measures to disentangle ISV and speed, particularly for ADHD data as patients make more slow responses but are not overall slower than typical controls.

New Insights on the Effects of Methylphenidate in Attention Deficit Hyperactivity Disorder

This narrative review describes an overview of the multiple effects of methylphenidate (MPH) in attention-deficit/hyperactivity disorder (ADHD) and its potential neurobiological targets. It addressed the following aspects: 1) MPH effects on attention and executive functions in ADHD; 2) the relation between MPH efficacy and dopamine transporter gene (DAT) polymorphism; and 3) the role of MPH as an epigenetic modulator in ADHD. Literature analysis showed that MPH, the most commonly used psychostimulant in the therapy of ADHD, acts on multiple components of the disorder. Marked improvements in attentional and executive dysfunction have been observed in children with ADHD during treatment with MPH, as well as reductions in neurological soft signs. MPH efficacy may be influenced by polymorphisms in the DAT, and better responses to treatment were associated with the 10/10 genotype. Innovative lines of research have suggested that ADHD etiopathogenesis and its neuropsychological phenotypes also depend on the expression levels of human endogenous retrovirus (HERV). In particular, several studies have revealed that ADHD is associated with HERV-H over-expression and that MPH administration results in decreased expression levels of this retroviral family and a reduction in the main symptoms of the disorder. In conclusion, there is a confirmed role for MPH as an elective drug in the therapy of ADHD alone or in association with behavioral therapy. Its effectiveness can vary based on DAT polymorphisms and can act as a modulator of HERV-H gene expression, pointing to targets for a precision medicine approach.

Multimodal alterations of directed connectivity profiles in patients with attention-deficit/hyperactivity disorders

Functional and effective connectivity measures for tracking brain region interactions that have been investigated using both electroencephalography (EEG) and magnetoencephalography (MEG) bringing up new insights into clinical research. However, the differences between these connectivity methods, especially at the source level, have not yet been systematically studied. The dynamic characterization of coherent sources and temporal partial directed coherence, as measures of functional and effective connectivity, were applied to multimodal resting EEG and MEG data obtained from 11 young patients (mean age 13.2 ± 1.5 years) with attention-deficit/hyperactivity disorder (ADHD) and age-matched healthy subjects. Additionally, machine-learning algorithms were applied to the extracted connectivity features to identify biomarkers differentiating the two groups. An altered thalamo-cortical connectivity profile was attested in patients with ADHD who showed solely information outflow from cortical regions in comparison to healthy controls who exhibited bidirectional interregional connectivity in alpha, beta, and gamma frequency bands. We achieved an accuracy of 98% by combining features from all five studied frequency bands. Our findings suggest that both types of connectivity as extracted from EEG or MEG are sensitive methods to investigate neuronal network features in neuropsychiatric disorders. The connectivity features investigated here can be further tested as biomarkers of ADHD.

Age-related hearing loss associated with altered response efficiency and variability on a visual sustained attention task

This study investigated the association between age-related hearing loss (ARHL) and differences in response efficiency and variability on a sustained attention task. The study population comprised 32 participants in a hearing loss group (HLG) and 34 controls without hearing loss (CG). Mean reaction time (RT) and accuracy were recorded to assess response efficiency. RT variability was decomposed to examine temporal aspects of variability associated with neural arousal and top-down executive control of vigilant attention. The HLG had a significantly longer mean RT, possibly reflecting a strategic approach to maintain accuracy. The HLG also demonstrated altered variability (indicative of greater decline in neural arousal) but maintained executive control that was significantly predictive of poorer response efficiency. Adults with ARHL may rely on higher-order attention networks to compensate for decline in both peripheral sensory function and in subcortical arousal systems which mediate lower-order automatic neurocognitive processes.

The Pharmacology of Visual Hallucinations in Synucleinopathies

Visual hallucinations (VH) are commonly found in the course of synucleinopathies like Parkinson's disease and dementia with Lewy bodies. The incidence of VH in these conditions is so high that the absence of VH in the course of the disease should raise questions about the diagnosis. VH may take the form of early and simple phenomena or appear with late and complex presentations that include hallucinatory production and delusions. VH are an unmet treatment need. The review analyzes the past and recent hypotheses that are related to the underlying mechanisms of VH and then discusses their pharmacological modulation. Recent models for VH have been centered on the role played by the decoupling of the default mode network (DMN) when is released from the control of the fronto-parietal and salience networks. According to the proposed model, the process results in the perception of priors that are stored in the unconscious memory and the uncontrolled emergence of intrinsic narrative produced by the DMN. This DMN activity is triggered by the altered functioning of the thalamus and involves the dysregulated activity of the brain neurotransmitters. Historically, dopamine has been indicated as a major driver for the production of VH in synucleinopathies. In that context, nigrostriatal dysfunctions have been associated with the VH onset. The efficacy of antipsychotic compounds in VH treatment has further supported the notion of major involvement of dopamine in the production of the hallucinatory phenomena. However, more recent studies and growing evidence are also pointing toward an important role played by serotonergic and cholinergic dysfunctions. In that respect, in vivo and post-mortem studies have now proved that serotonergic impairment is often an early event in synucleinopathies. The prominent cholinergic impairment in DLB is also well established. Finally, glutamatergic and gamma aminobutyric acid (GABA)ergic modulations and changes in the overall balance between excitatory and inhibitory signaling are also contributing factors. The review provides an extensive overview of the pharmacology of VH and offers an up to date analysis of treatment options.

From State-to-Trait Meditation: Reconfiguration of Central Executive and Default Mode Networks

While brain default mode network (DMN) activation in human subjects has been associated with mind wandering, meditation practice has been found to suppress it and to increase psychological well-being. In addition to DMN activity reduction, experienced meditators (EMs) during meditation practice show an increased connectivity between the DMN and the central executive network (CEN).

While brain default mode network (DMN) activation in human subjects has been associated with mind wandering, meditation practice has been found to suppress it and to increase psychological well-being. In addition to DMN activity reduction, experienced meditators (EMs) during meditation practice show an increased connectivity between the DMN and the central executive network (CEN). However, the gradual change between DMN and CEN configuration from pre-meditation, during meditation, and post-meditation is unknown. Here, we investigated the change in DMN and CEN configuration by means of brain activity and functional connectivity (FC) analyses in EMs across three back-to-back functional magnetic resonance imaging (fMRI) scans: pre-meditation baseline (trait), meditation (state), and post-meditation (state-to-trait). Pre-meditation baseline group comparison was also performed between EMs and healthy controls (HCs). Meditation trait was characterized by a significant reduction in activity and FC within DMN and increased anticorrelations between DMN and CEN. Conversely, meditation state and meditation state-to-trait periods showed increased activity and FC within the DMN and between DMN and CEN. However, the latter anticorrelations were only present in EMs with limited practice. The interactions between networks during these states by means of positive diametric activity (PDA) of the fractional amplitude of low-frequency fluctuations (fALFFs) defined as CEN fALFF¯ − DMN fALFF¯ revealed no trait differences but significant increases during meditation state that persisted in meditation state-to-trait. The gradual reconfiguration in DMN and CEN suggest a neural mechanism by which the CEN negatively regulates the DMN and is probably responsible for the long-term trait changes seen in meditators and reported psychological well-being.

Preliminary evidence of altered gray matter volume in subjects with internet gaming disorder: associations with history of childhood attention-deficit/hyperactivity disorder symptoms

Attention-deficit/hyperactivity disorder (ADHD) is commonly comorbid with Internet gaming disorder (IGD). Although childhood ADHD symptoms may decline during late brain maturation, structural alterations in some brain areas may persist into adulthood. This study investigated whether young adults with IGD and a history of childhood ADHD symptoms had gray matter volume (GMV) alterations that were distinct from subjects without a history of childhood ADHD. As an exploratory investigation, we conducted a whole-brain voxel-based morphometry with the diffeomorphic anatomical registration using an exponentiated Lie algebra algorithm and applied an uncorrected threshold at the voxel level for multiple comparisons. GMVs of IGD subjects with a history of childhood ADHD (IGD_ADHD+ group; n = 20; 24.5 ± 2.5 years) were compared to those of subjects without a history of childhood ADHD (IGD_ADHD- group; n = 20; 23.9 ± 2.5 years) and controls (n = 20; 22.7 ± 2.4 years). Compared with controls, both IGD groups had a smaller GMV in the right anterior cingulate cortex, the left inferior frontal gyrus, and the left insula, yet had a larger GMV in the right angular gyrus. The IGD_ADHD+ group had a larger GMV in the right precuneus than the IGD_ADHD- group and controls. When controlling for other comorbid psychiatric symptoms, the IGD_ADHD+ group also had a smaller GMV in the right inferior frontal gyrus. In conclusion, we found that young adults with IGD and a history of childhood ADHD symptoms had characteristic GMV alterations, which may be linked with their manifestation of childhood ADHD.

ADHD desynchronizes brain activity during watching a distracted multi-talker conversation

Individuals with attention-deficit/hyperactivity disorder (ADHD) have difficulties navigating dynamic everyday situations that contain multiple sensory inputs that need to either be attended to or ignored. As conventional experimental tasks lack this type of everyday complexity, we administered a film-based multi-talker condition with auditory distractors in the background. ADHD-related aberrant brain responses to this naturalistic stimulus were identified using intersubject correlations (ISCs) in functional magnetic resonance imaging (fMRI) data collected from 51 adults with ADHD and 29 healthy controls. A novel permutation-based approach introducing studentized statistics and subject-wise voxel-level null-distributions revealed that several areas in cerebral attention networks and sensory cortices were desynchronized in participants with ADHD (n = 20) relative to healthy controls (n = 20). Specifically, desynchronization of the posterior parietal cortex occurred when irrelevant speech or music was presented in the background, but not when irrelevant white noise was presented, or when there were no distractors. We also show regionally distinct ISC signatures for inattention and impulsivity. Finally, post-scan recall of the film contents was associated with stronger ISCs in the default-mode network for the ADHD and in the dorsal attention network for healthy controls. The present study shows that ISCs can further our understanding of how a complex environment influences brain states in ADHD.

Dynamic synergetic configurations of resting-state networks in ADHD

Attention deficit hyperactivity disorder (ADHD) is characterized by high distractibility and impaired executive functions. Notably, there is mounting evidence suggesting that ADHD could be regarded as a default mode network (DMN) disorder. In particular, failure in regulating the dynamics of activity and interactions of the DMN and cognitive control networks have been hypothesized as the main source of task interference causing attentional problems. On the other hand, previous studies indicated pronounced fluctuations in the strength of functional connections over time, particularly for the inter-network connections between the DMN and fronto-parietal control networks. Hence, characterization of connectivity disturbances in ADHD requires a thorough assessment of time-varying functional connectivity (FC). In this study, we proposed a dynamical systems perspective to assess how the DMN over time recruits different configurations of network segregation and integration. Specifically, we were interested in configurations for which both intra- and inter-network connections are retained, as opposed to commonly used methods which assess network segregation as a single measure. From resting-state fMRI data, we extracted three different stable configurations of FC patterns for the DMN, namely synergies. We provided evidence supporting our hypothesis that ADHD differs compared to controls, both in terms of recruitment rate and topology of specific synergies between resting-state networks. In addition, we found a relationship between synergetic cooperation patterns of the DMN with cognitive control networks and a behavioral measure which is sensitive to ADHD-related symptoms, namely the Stroop color-word task.

Electrophysiological Correlates of Response Time Variability During a Sustained Attention Task

Individuals with Attention Deficit Hyperactivity Disorder (ADHD) tend to perform cognitive tasks with greater Response Time Variability (RTV). Greater RTV in ADHD may be due to inefficient functional connectivity of the brain during information processing. This study aimed to investigate the relationship between brain connectivity, RTV, and levels of ADHD symptoms. Twenty-eight children aged 9–12 years and 49 adolescents aged 15–18 years performed the Sustained Attention to Response Task (SART) while EEG was recorded. The participants’ levels of ADHD symptoms were measured using self- and parent-rated questionnaires. The ex-Gaussian analysis and The Fast Fourier Transform were used to measure multiple aspects of RTV. Functional connectivity between 64 electrodes was computed during task performance, and global efficiency and modularity were calculated, reflecting integration and segregation of the brain, respectively. There was a positive association between multiple RTV measures and the level of ADHD symptoms, where participants with higher levels of ADHD symptoms showed greater RTV, except for sigma from the ex-Gaussian analysis. More efficient brain network activity, measured by global efficiency, was associated with reduced RTV. Children showed greater RTV and less efficient brain network activity compared with the adolescents. These findings support the view that stable responses are achieved with more integrated (and efficient) brain connectivity.

Probing the "Default Network Interference Hypothesis" With EEG: An RDoC Approach Focused on Attention

Studies have shown that specific networks (default mode network [DMN] and task positive network [TPN]) activate in an anticorrelated manner when sustaining attention. Related EEG studies are scarce and often lack behavioral validation. We performed independent component analysis (ICA) across different frequencies (source-level), using eLORETA-ICA, to extract brain-network activity during resting-state and sustained attention. We applied ICA to the voxel domain, similar to functional magnetic resonance imaging methods of analyses. The obtained components were contrasted and correlated to attentional performance (omission errors) in a large sample of healthy subjects (N = 1397). We identified one component that robustly correlated with inattention and reflected an anticorrelation of delta activity in the anterior cingulate and precuneus, and delta and theta activity in the medial prefrontal cortex and with alpha and gamma activity in medial frontal regions. We then compared this component between optimal and suboptimal attentional performers. For the latter group, we observed a greater change in component loading between resting-state and sustained attention than for the optimal performers. Following the National Institute of Mental Health Research Domain Criteria (RDoC) approach, we prospectively replicated and validated these findings in subjects with attention deficit/hyperactivity disorder. Our results provide further support for the "default mode interference hypothesis."

Decreased resting gamma activity in adult attention deficit/hyperactivity disorder

Objectives: To delineate task-free gamma activity in adult ADHD and healthy control subjects based on high-density EEG recordings. Relationship of gamma activity with symptom severity was also examined, since gamma activity is considered to be an index of network functions in the brain that underlie higher-order cognitive processes.Methods: Spontaneous EEG was recorded in adult ADHD subjects (N = 42; 25 methylphenidate-naïve and 17 on methylphenidate treatment) and controls (N = 59) with eyes open. EEG absolute power gamma was investigated in the gamma₁ (30.25-39 Hz) and gamma₂ (39.25-48 Hz) frequency bands.Results: Gamma₁ and gamma₂ activity was diminished in ADHD compared with healthy control subjects. The difference between ADHD and controls was the most pronounced in the right centroparietal region for both gamma₁ and gamma₂. Inverse associations were found between gamma₁ and gamma₂ activity and ADHD symptoms in centroparietal scalp regions.Conclusions: Gamma activity is reduced in adult ADHD, and the reduction has a predominantly right centroparietal distribution. Our findings are consistent with childhood ADHD literature with respect to diminished posterior gamma activity in patients, which may reflect altered dorsal attention network functions. Gamma abnormalities might provide a link between neurophysiological functioning and neuropsychological deficiencies, thereby offering an opportunity to investigate the neurobiological mechanisms that underlie the clinical symptoms of ADHD.

Stroop-like animal size test: Links with child effortful control, personality and problem behavior

This study examined children's performance on the Stroop-like animal size test and its relations to parent-reported temperamental effortful control, personality, and common emotional and behavioral problems in a Russian sample of 5-12-year-olds (N = 202). The animal size test demonstrated a Stroop-like effect for accuracy and response time (RT) in both genders and across all ages. Children's performance on the animal size test considerably improved with age such that older children performed more accurately, were faster and their responses were less variable than younger children's responses. The findings indicated that RT was negatively related to temperamental trait of effortful control and its key components, attention focusing and inhibitory control, whereas RT variability was negatively related to both regulatory traits, effortful control and conscientiousness, and their components. Children's performance on the AST was meaningfully related to hyperactivity-inattention, externalizing behavior and overall level of childhood psychopathology. These findings provide support for the usefulness of the animal size test in the neuropsychological assessment of preschool and school-age children.

Event Representations and Predictive Processing: The Role of the Midline Default Network Core

The human brain is tightly coupled to the world through its sensory‐motor systems—but it also spends a lot of its metabolism talking to itself. One important function of this intrinsic activity is the establishment and updating of event models—representations of the current situation that can predictively guide perception, learning, and action control. Here, we propose that event models largely depend on the default network (DN) midline core that includes the posterior cingulate and anterior medial prefrontal cortex. An increasing body of data indeed suggests that this subnetwork can facilitate stimuli processing during both naturalistic event comprehension and cognitive tasks in which mental representations of prior situations, trials, and task rules can predictively guide attention and performance. This midline core involvement in supporting predictions through event models can make sense of an otherwise complex and conflicting pattern of results regarding the possible cognitive functions subserved by the DN.

Stawarczyk, Bezdek, and Zacks offer neuroscience evidence for a midline default network core, which appears to coordinate internal, top‐down mentation with externally‐triggered, bottom‐up attention in a push‐pull relationship. The network may enable the flexible pursuance of thoughts tuned into or detached from the current environment.

Reduced premovement positivity during the stimulus-response interval precedes errors: Using single-trial and regression ERPs to understand performance deficits in ADHD

Brain mechanisms linked to incorrect response selections made under time pressure during cognitive task performance are poorly understood, particularly in adolescents with attention-deficit hyperactivity disorder (ADHD). Using subject-specific multimodal imaging (electroencephalogram, magnetic resonance imaging, behavior) during flanker task performance by a sample of 94 human adolescents (mean age = 15.5 years, 50% female) with varying degrees of ADHD symptomatology, we examined the degree to which amplitude features of source-resolved event-related potentials (ERPs) from brain-independent component processes within a critical (but often ignored) period in the action selection process, the stimulus-response interval, were associated with motor response errors (across trials) and error rates (across individuals). Response errors were typically preceded by two smaller peaks in both trial-level and trial-averaged ERP projections from posterior medial frontal cortex (pMFC): a frontocentral P3 peaking about 390 ms after stimulus onset, and a premovement positivity (PMP) peaking about 110 ms before the motor response. Separating overlapping stimulus-locked and response-locked ERP contributions using a "regression ERP" approach showed that trial errors and participant error rates were primarily associated with smaller PMP, and not with frontocentral P3. Moreover, smaller PMP mediated the association between larger numbers of errors and ADHD symptoms, suggesting the possible value of using PMP as an intervention target to remediate performance deficits in ADHD.

A New Method of Diagnosing Attention-Deficit Hyperactivity Disorder in Male Patients by Quantitative EEG Analysis

Attention-deficit hyperactivity disorder (ADHD) is one of the most common neuropsychiatric disorders of childhood. Diagnosis of ADHD is based on core symptoms and checklists. However, these are both subjective, which can lead to the problems of overdiagnosis and underdiagnosis. Elevated theta/beta ratio (TBR) of EEG band has been approved by the US Food and Drug Administration as a tool to assist in the diagnosis of ADHD. However, several recent studies have demonstrated that there are no significant differences in TBR between people with and without ADHD. In this study, we attempted to develop a new method for differentiating between male with and without ADHD by analyzing EEG features. Thirty boys with ADHD combined type (aged 8 years 5 months ± 1 year 11 months) and 30 age-matched controls (aged 8 years 5 months ± 1 year 8 months) were enrolled in this study. A classification analysis-based approach comprising training and classification phases was developed for classifying each subject's EEG features as ADHD or non-ADHD. Eight crucial feature descriptors were selected and ranked based on the t test. Compared with TBR in our study, the developed method had a higher area under the curve (87.78%), sensitivity (80.0%), and specificity (80.0%). Our method is more precise than using TBR in the diagnosis of ADHD. This newly developed method is a useful tool in identifying patients with ADHD and might reduce the possibility of overdiagnosis and underdiagnosis.

Individual differences in the effect of menstrual cycle on basal ganglia inhibitory control

Basal ganglia (BG) are involved in inhibitory control (IC) and known to change in structure and activation along the menstrual cycle. Therefore, we investigated BG activation and connectivity patterns related to IC during different cycle phases. Thirty-six naturally cycling women were scanned three times performing a Stop Signal Task and hormonal levels analysed from saliva samples. We found an impaired Stop signal reaction time (SSRT) during pre-ovulatory compared to menses the higher the baseline IC of women. Blood oxygen level dependent (BOLD)-response in bilateral putamen significantly decreased during the luteal phase. Connectivity strength from the left putamen displayed an interactive effect of cycle and IC. During pre-ovulatory the connectivity with anterior cingulate cortex and left inferior parietal lobe was significantly stronger the higher the IC, and during luteal with left supplementary motor area. Right putamen's activation and left hemisphere's connectivity predicted the SSRT across participants. Therefore, we propose a compensatory mechanism for the hormonal changes across the menstrual cycle based on a lateralized pattern.

The tempos of performance

Human performance fluctuates over time. Rather than random, the complex time course of variation reflects, among other factors, influences from regular periodic processes operating at multiple time scales. In this review, we consider evidence for how our performance ebbs and flows over fractions of seconds as we engage with sensory objects, over minutes as we perform tasks, and over hours according to homeostatic factors. We propose that rhythms of performance at these multiple tempos arise from the interplay among three sources of influence: intrinsic fluctuations in brain activity, periodicity of external stimulation, and the anticipation of the temporal structure of external stimulation by the brain.

Effects of Exercise on Cognitive Performance in Children and Adolescents with ADHD: Potential Mechanisms and Evidence-based Recommendations

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder with a complex symptomatology, and core symptoms as well as functional impairment often persist into adulthood. Recent investigations estimate the worldwide prevalence of ADHD in children and adolescents to be ~7%, which is a substantial increase compared to a decade ago. Conventional treatment most often includes pharmacotherapy with central nervous stimulants, but the number of non-responders and adverse effects call for treatment alternatives. Exercise has been suggested as a safe and low-cost adjunctive therapy for ADHD and is reported to be accompanied by positive effects on several aspects of cognitive functions in the general child population. Here we review existing evidence that exercise affects cognitive functions in children with and without ADHD and present likely neurophysiological mechanisms of action. We find well-described associations between physical activity and ADHD, as well as causal evidence in the form of small to moderate beneficial effects following acute aerobic exercise on executive functions in children with ADHD. Despite large heterogeneity, meta-analyses find small positive effects of exercise in population-based control (PBC) children, and our extracted effect sizes from long-term interventions suggest consistent positive effects in children and adolescents with ADHD. Paucity of studies probing the effect of different exercise parameters impedes finite conclusions in this regard. Large-scale clinical trials with appropriately timed exercise are needed. In summary, the existing preliminary evidence suggests that exercise can improve cognitive performance intimately linked to ADHD presentations in children with and without an ADHD diagnosis. Based on the findings from both PBC and ADHD children, we cautiously provide recommendations for parameters of exercise.

The Influence of Acetaminophen on Task Related Attention

Our study was designed to examine whether the pain reliever acetaminophen impacts the normal ebb-and-flow of off-task attentional states, such as captured by the phenomenon of mind wandering. In a placebo-controlled between-groups design, participants performed a sustained attention to response task while event-related potentials (ERPs) to target events were recorded. Participants were queried at random intervals for their attentional reports – either “on-task” or “off-task.” The frequency of these reports and the ERPs generated by the preceding target events were assessed. Behaviorally, the frequency of off-task attentional reports was comparable between groups. Electrophysiologically, two findings emerged: first, the amplitude of the P300 ERP component elicited by target events was significantly attenuated during off-task vs. on-task attentional states in both the acetaminophen and placebo groups. Second, the amplitude of the LPP ERP component elicited by target events showed a significant decrease during off-task attentional states that was specific to the acetaminophen group. Taken together, our findings support the conclusion that acetaminophen doesn’t impact our relative propensity to drift into off-task attentional states, but it does affect the depth of neurocognitive disengagement during off-task attentional states, and in particular, at the level of post-categorization stimulus evaluations indexed by the LPP.

Electroencephalogram Theta/Beta Ratio and Spectral Power Correlates of Executive Functions in Children and Adolescents With AD/HD

OBJECTIVE

The electroencephalogram (EEG) has been widely used in AD/HD research. The current study firstly aimed to replicate a recent trend related to EEG theta/beta ratio (TBR) in children and adolescents. Also, the study aimed to examine the value of resting EEG activity as biomarkers for executive function (EF) in participants with AD/HD.

METHOD

Fifty-three participants with AD/HD and 37 healthy controls were recruited. Resting EEG was recorded with eyes closed. Participants with AD/HD additionally completed EF tasks via the Cambridge Neuropsychological Test Automated Battery.

RESULTS

TBR did not differ between groups; however, TBR was positively correlated with inattentive symptoms in AD/HD. Other correlations were found between EEG activity and neuropsychological functions including spatial planning and decision making in the AD/HD group.

CONCLUSION

The results do not support the diagnostic value of TBR. Instead, given the heterogeneous features, the results support the prognostic value of EEG in AD/HD.