Interference control in attention-deficit/hyperactivity disorder: differential Stroop effects for colour-naming versus counting

Differential Impact of WM Load on Attention in Young Adults Versus Children and Adolescents

Background: This study aimed to examine how concurrent working memory (WM) loads affect selective attention, and to explore developmental differences between young adults and children/adolescents aged 10 to 14 years. Methods: We employed a modified Stroop task with verbal or spatial WM loads to assess their impact on attention. Results: In adults, we found increased Stroop effects when WM load overlapped with target processing and decreased Stroop effects when WM load overlapped with distractor processing. Conversely, in children/adolescents, WM loads did not significantly impact target or distractor processing, indicating no change in Stroop effects under dual-task conditions. Interestingly, results from the correlational analyses revealed that as participants' ages increase, the interference effect under the WM load that shares resources with distractor processing in the attention task decreases. Conclusions: Our findings suggest that the interaction between attention and WM differs across developmental stages. While adults showed distinctive effects of concurrent WM loads on attention processing depending on the cognitive resources utilized, children/adolescents failed to show the interaction between the two cognitive systems. Furthermore, a significant relationship between age and the effects of WM load on attention was observed, providing insights into the development of the interaction between WM and attention.

Comparación de la respuesta inhibitoria en niños y adolescentes diagnosticados con TOC y TDAH

Antecedentes: Los trastornos de comportamiento tienen asociados una serie de factores que van más allá de los síntomas, entre los cuales está el funcionamiento cognoscitivo. En TOC y TDAH se han encontrado dificultades en el funcionamiento ejecutivo, siendo la inhibición de respuestas una de las fallas más consistentes en diferentes estudios. Objetivos: Comparar la respuesta inhibitoria de niños y adolescentes diagnosticados con TDAH, TOC con población sana. Método: Se analizaron 31 pacientes con TDAH, 31 con TOC y 66 controles a partir del Test Stroop de colores y palabras segunda edición (Golden, 1999). Resultados: Se encuentran diferencias de los grupos clínicos con los controles; TOC vs controles (p = 0.03419), TDAH vs controles (p= 0.00244), pero no entre los grupos clínico TOC vs TDAH (p= 0.2793). Al comparar rango de edad se encuentran diferencias específicas entre los mismos grupos para los participantes entre 13-16 años (TDAH: p=0.005 y TOC: 0.018) y controles. Conclusiones: Los resultados son coherentes con lo reportado en la literatura, respecto a la alteración del control inhibitorio de personas con TOC y TDAH. Se deben realizar análisis más amplios en otros dominios cognitivos para poder tener un perfil más claro de los aspectos comunes y diferenciables de personas con trastornos del neurodesarrollo y manifestaciones anormales de comportamiento.

Post-Error Slowing in Patients With ADHD: A Meta-Analysis

OBJECTIVE

Post-error slowing (PES) is a cognitive mechanism for adaptive responses to reduce the probability of error in subsequent trials after error. To date, no meta-analytic summary of individual studies has been conducted to assess whether ADHD patients differ from controls in PES.

METHOD

We identified 15 relevant publications, reporting 26 pairs of comparisons (ADHD, n = 1,053; healthy control, n = 614). Random-effect meta-analysis was used to determine the statistical effect size (ES) for PES.

RESULTS

PES was diminished in the ADHD group as compared with controls, with an ES in the medium range (Cohen's d = 0.42). Significant group difference was observed in relation to the inter-stimulus interval (ISI): While healthy participants slowed down after an error during long (3,500 ms) compared with short ISIs (1,500 ms), ADHD participants sustained or even increased their speed.

CONCLUSION

The pronounced group difference suggests that PES may be considered as a behavioral indicator for differentiating ADHD patients from healthy participants.

Cognitive Improvement of Attention and Inhibition in the Late Afternoon in Children With Attention-Deficit Hyperactivity Disorder (ADHD) Treated With Osmotic-Release Oral System Methylphenidate

Long-acting medications have been developed and approved for use in the treatment of attention-deficit hyperactivity disorder (ADHD). These compounds are intended to optimize and maintain symptoms control throughout the day. We tested prolonged effects of osmotic-release oral system methylphenidate on both attention and inhibition, in the late afternoon. A double-blind, randomized, placebo-controlled study was conducted in 36 boys (7-12 years) with ADHD and 40 typically developing children. The ADHD children received an individualized dose of placebo or osmotic-release oral system methylphenidate. They were tested about 8 hours after taking with 2 continuous performance tests (continuous performance test-X [CPT-X] and continuous performance test-AX [CPT-AX]) and a counting Stroop. A positive effect of osmotic-release oral system methylphenidate was present in CPT-AX with faster and less variable reaction times under osmotic-release oral system methylphenidate than under placebo, and no difference with typically developing children. In the counting Stroop, we found a decreased interference with osmotic-release oral system methylphenidate but no difference between children with ADHD under placebo and typically developing children.

Pathophysiology of ADHD and associated problems-starting points for NF interventions?

Attention deficit hyperactivity disorder (ADHD) is characterized by severe and age-inappropriate levels of hyperactivity, impulsivity and inattention. ADHD is a heterogeneous disorder, and the majority of patients show comorbid or associated problems from other psychiatric disorders. Also, ADHD is associated with cognitive and motivational problems as well as resting-state abnormalities, associated with impaired brain activity in distinct neuronal networks. This needs to be considered in a multimodal treatment, of which neurofeedback (NF) may be a promising component. During NF, specific brain activity is fed-back using visual or auditory signals, allowing the participants to gain control over these otherwise unaware neuronal processes. NF may be used to directly improve underlying neuronal deficits, and/or to establish more general self-regulatory skills that may be used to compensate behavioral difficulties. The current manuscript describes pathophysiological characteristics of ADHD, heterogeneity of ADHD subtypes and gender differences, as well as frequently associated behavioral problems such as oppositional defiant/conduct or tic disorder. It is discussed how NF may be helpful as a treatment approach within these contexts.

Impairment in flexible regulation of speed and accuracy in children with ADHD

Attention deficit hyperactivity disorder (ADHD) is characterized by poor adaptation of behavior to environmental demands, including difficulties in flexibly regulating behavior. To understand whether ADHD is associated with a reduction of strategic flexibility in modulating speed and accuracy, we used a perceptual decision-making task that required participants to randomly stress either fast or accurate responding. Thirty-one drug-free boys with ADHD combined-type (mean age: 10.2 years) and 33 healthy control boys (mean age: 10.7 years), matched for age and IQ, participated. Both reaction time and accuracy data were analyzed. Our findings demonstrated significantly lower accuracy in ADHD children than in controls when switching from speed to accuracy instructions. This deficit was directly associated with hyperactivity symptoms but not with inattention. Our results showed that ADHD is associated with a deficit in dynamically switching response strategy according to task demands on a trial-to-trial basis.

Beyond interference control impairment in ADHD: evidence from increased intraindividual variability in the color-stroop test

The present study investigates intraindividual variability (IIV) in the Color-Stroop test and in a simple reaction time (SRT) task. Performance level and variability in reaction times (RTs)-quantified with different measures such as individual standard deviation (ISD) and coefficient of variation (ICV), as well as ex-Gaussian parameters (mu, sigma, tau)-were analyzed in 24 children with attention deficit/hyperactivity disorder (ADHD) and 24 typically developing children (TDC). Children with ADHD and TDC presented equivalent Color-Stroop interference effects when mean RTs were considered, and the two groups did not differ in the SRT task. Interestingly, compared to TDC, children with ADHD were more variable in their responses, showing increased ISD and ICV in the Color-Stroop interference condition and in the SRT task. Moreover, children with ADHD exhibited higher tau values-that is, more frequent abnormally long RTs-in the Color-Stroop interference condition than did the TDC, but comparable tau values in the SRT, suggesting more variable responses. These results speak in favor of a general deficit in more basic and central processes that only secondarily may affect the efficiency of inhibitory processes in children with ADHD. Overall the present findings confirm the role of IIV as a cornerstone in the ADHD cognitive profile and support the search for fine-grained analysis of performance fluctuations.

Prefrontal hypoactivation during cognitive control in early abstinent methamphetamine-dependent subjects

Individuals who abuse methamphetamine (MA) perform at levels below those of healthy controls on tests that require cognitive control. As cognitive control deficits may influence the success of treatment for addiction, we sought to help clarify the neural correlates of this deficit. MA-dependent (n=10, abstinent 4-7 days) and control subjects (n=18) performed a color-word Stroop task, which requires cognitive control, during functional MRI (fMRI). The task included a condition in which participants were required to respond to one stimulus dimension while ignoring another conflicting dimension, and another condition without conflict. We compared the groups on performance and neural activation in the two conditions. MA-dependent subjects made more errors and responded more slowly than controls. Controlling for response times in the incongruent condition, voxel-wise mixed effects analyses (whole-brain corrected) demonstrated that MA-dependent subjects had less activation than control subjects in the right inferior frontal gyrus, supplementary motor cortex/anterior cingulate gyrus and the anterior insular cortex during the incongruent condition only. MA-dependent subjects did not exhibit greater activation in any brain region in either of the Stroop conditions. These preliminary findings suggest that hypofunction in cortical areas that are important for executive function underlies cognitive control deficits associated with MA dependence.

Virtual environment to quantify the influence of colour stimuli on the performance of tasks requiring attention

Background

Recent studies indicate that the blue-yellow colour discrimination is impaired in ADHD individuals. However, the relationship between colour and performance has not been investigated. This paper describes the development and the testing of a virtual environment that is capable to quantify the influence of red-green versus blue-yellow colour stimuli on the performance of people in a fun and interactive way, being appropriate for the target audience.

Methods

An interactive computer game based on virtual reality was developed to evaluate the performance of the players.

The game's storyline was based on the story of an old pirate who runs across islands and dangerous seas in search of a lost treasure. Within the game, the player must find and interpret the hints scattered in different scenarios. Two versions of this game were implemented. In the first, hints and information boards were painted using red and green colours. In the second version, these objects were painted using blue and yellow colours. For modelling, texturing, and animating virtual characters and objects the three-dimensional computer graphics tool Blender 3D was used. The textures were created with the GIMP editor to provide visual effects increasing the realism and immersion of the players. The games were tested on 20 non-ADHD volunteers who were divided into two subgroups (A1 and A2) and 20 volunteers with ADHD who were divided into subgroups B1 and B2. Subgroups A1 and B1 used the first version of the game with the hints painted in green-red colors, and subgroups A2 and B2 the second version using the same hints now painted in blue-yellow. The time spent to complete each task of the game was measured.

Results

Data analyzed with ANOVA two-way and posthoc TUKEY LSD showed that the use of blue/yellow instead of green/red colors decreased the game performance of all participants. However, a greater decrease in performance could be observed with ADHD participants where tasks, that require attention, were most affected.

Conclusions

The game proved to be a user-friendly tool capable to detect and quantify the influence of color on the performance of people executing tasks that require attention and showed to be attractive for people with ADHD.

Perceptual and motor inhibition in adolescents/young adults with childhood-diagnosed ADHD

OBJECTIVE

This study examined perceptual and motor inhibition in a longitudinal sample of adolescents/young adults who were diagnosed with ADHD in childhood, and as a function of the relative persistence of ADHD.

METHOD

Ninety-eight participants diagnosed with ADHD in childhood were reevaluated approximately 10 years later. Eighty-five never-ADHD controls similar in age, IQ, sociodemographic background, and gender distribution served as a comparison group. Participants were administered a psychiatric interview and the Stimulus and Response Conflict Tasks (Nassauer & Halperin, 2003).

RESULTS

Participants with childhood ADHD demonstrated slower and less accurate responses to both control and conflict conditions relative to the comparison group, as well as more variable responses in both conditions of the motor inhibition task; there was no specific effect of childhood ADHD on perceptual or motor inhibition. ADHD persisters and partial remitters did not differ in overall accuracy, speed or variability in responding, but relative to partial remitters, persisters demonstrated greater slowing in response to perceptual conflict.

CONCLUSIONS

These findings are consistent with theories positing state regulation, but not inhibitory control deficits in the etiology of ADHD, and suggest that improved perceptual inhibition may be associated with better outcome for ADHD.

Cross-sectional evaluation of cognitive functioning in children, adolescents and young adults with ADHD

Attention-deficit/hyperactivity disorder (ADHD) often persists into adulthood, albeit with changes in clinical symptoms throughout the life span. Although effect sizes of neuropsychological deficits in ADHD are well established, developmental approaches have rarely been explored and little is yet known about age-dependent changes in cognitive dysfunction from childhood to adulthood. In this cross-sectional study, 20 male children (8-12 years), 20 adolescents (13-16 years), and 20 adults (18-40 years) with ADHD and a matched control group were investigated using six experimental paradigms tapping into different domains of cognitive dysfunction. Subjects with ADHD were more delay-aversive and showed deficits in time discrimination and time reproduction, but they were not impaired in working memory, interference control or time production. Independent of age, the most robust group differences were observed with respect to delay aversion and time reproduction, pointing to persistent dysfunction in the mesolimbic reward circuitry and in the frontal-striatal-cerebellar timing system in subjects with ADHD. Across all tasks, effect sizes were lowest for adolescents with ADHD compared to age-matched controls. Developmental dissociations were found only for simple stimuli comparison, which was particularly impaired in ADHD children. Thus, in line with current multiple-pathway approaches to ADHD, our data suggest that deficits in different cognitive domains are persistent across the lifespan, albeit less pronounced in adolescents with ADHD.

Neuropsychologische Diagnostik bei Kindern mit ADHS

Aktuelle Modelle zur Ätiopathogenese der Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) postulieren vor allem Defizite in den exekutiven Funktionen sowie motivationale Störungen als zentrale neuropsychologische Komponenten bei den betroffenen Patienten. Um die kognitiven und exekutiven Defizite der ADHS zu erfassen, finden derzeitig vor allem im englischen Sprachraum Testverfahren Anwendung, die auf der PASS-Theorie basieren. Durch die Erfassung der dynamischen kognitiven Prozesse Planungsfähigkeit und Aufmerksamkeit sowie sequenzielle und simultane Informationsverarbeitung zeigt sich die PASS-Theorie sensibel bezüglich der spezifischen kognitiven Probleme und exekutiven Defizite von Kindern mit Störungen der Aufmerksamkeit oder Hyperaktivität. Die Übersicht setzt sich ausführlich mit den neuropsychologischen Grundlagen der ADHS auseinander und stellt entsprechende diagnostische Verfahren vor. Die Rolle aktueller, auf der PASS-Theorie basierender Testverfahren für den diagnostischen Prozess und daraus resultierende Implikationen für den klinischen Alltag werden diskutiert.

Color perception deficits in co-existing attention-deficit/hyperactivity disorder and chronic tic disorders

Preliminary findings suggest that color perception, particularly of blue-yellow stimuli, is impaired in attention-deficit/hyperactivity disorder (ADHD) as well as in chronic tic disorders (CTD). However, these findings have been not replicated and it is unclear what these deficits mean for the comorbidity of ADHD + CTD. Four groups (ADHD, CTD, ADHD + CTD, controls) of children with similar age, IQ and gender distribution were investigated with the Farnsworth-Munsell 100 Hue Test (FMT) and the Stroop-Color-Word Task using a factorial design. Color perception deficits, as indexed by the FMT, were found for both main factors (ADHD and CTD), but there were no interaction effects. A preponderance of deficits on the blue-yellow compared to the red-green axis was detected for ADHD. In the Stroop task only the 'pure' ADHD group showed impairments in interference control and other parameters of Stroop performance. No significant correlations between any FMT parameter and color naming in the Stroop task were found. Basic color perception deficits in both ADHD and CTD could be found. Beyond that, it could be shown that these deficits are additive in the case of comorbidity (ADHD + CTD). Performance deficits on the Stroop task were present only in the 'pure' ADHD group. Hence, the latter may be compensated in the comorbid group by good prefrontal capabilities of CTD. The influence of color perception deficits on Stroop task performance might be negligible.