ADHD Symptoms in Post-Institutionalized Children Are Partially Mediated by Altered Frontal EEG Asymmetry

Relationship between Traumatic Experiences, Circadian Preference and ADHD Symptoms in Adolescents with ADHD Residing in Institutional Care: A Controlled Study

Circadian preference, describes biological and behavioural characteristics that influence the ability to plan daily activities according to optimal waking times. It is divided into three main categories: morning, evening and intermediate. In particular, the evening chronotype is associated with conditions such as Attention Deficit Hyperactivity Disorder (ADHD) and Post Traumatic Stress Disorder (PTSD). This study was conducted in three groups aged 14-18 years: The first group consisted of 34 adolescents diagnosed with ADHD who had been in institutional care for at least two years and had not used medication in the last six months. The second group included 29 adolescents with ADHD living with their families who had not used medication in the last six months. The third control group consisted of 32 healthy adolescents. The study utilized sociodemographic data forms, the Turgay DSM-IV Disruptive Behavior Disorders Rating Scale (T-DSM-IV-S) to measure ADHD symptoms, the Childhood Chronotype Questionnaire (CCQ), and the Childhood Trauma Questionnaire (CTQ). In institutionalized adolescents with diagnosed ADHD, ADHD and disruptive behavior symptoms were more severe. Increased trauma scores were associated with higher ADHD and disruptive behaviour symptom severity and evening chronotype. In the conducted mediation analysis, evening chronotype was identified as a full mediator in the relationship between trauma symptoms and ADHD symptoms, while it was determined as a partial mediator in the relationship between trauma symptoms and PTSD symptoms. In conclusion, traumatic experiences in institutionalized adolescents with diagnosed ADHD may exacerbate ADHD and disruptive behavior symptoms. Evening chronotype is associated with ADHD and disruptive behavior symptoms, and therefore, the chronotypes of these adolescents should be assessed. Chronotherapeutic interventions may assist in reducing inattention, hyperactivity, and behavioral problems.

Systematic Review and Meta-analysis: The Science of Early-Life Precursors and Interventions for Attention-Deficit/Hyperactivity Disorder

OBJECTIVE

To evaluate which early neurocognitive and behavioral precursors are associated with the development of attention-deficit/hyperactivity disorder (ADHD) and whether these are currently targeted in early interventions.

METHOD

We conducted 2 systematic reviews and meta-analyses of empirical studies to examine the following: (1) early-life (0-5 years) neurocognitive and behavioral precursors associated with familial likelihood for ADHD, an early ADHD diagnosis/elevated ADHD symptoms, and/or the presence of later-childhood ADHD; and (2) interventions delivered to children aged 0 to 5 years targeting the identified precursors or measuring these as outcomes. Standardized mean differences (Hedges' g) and pre-post-treatment change scores (SMD) were computed.

RESULTS

A total of 149 studies (165,095 participants) investigating 8 neurocognitive and behavioral domains met inclusion criteria for part 1. Multi-level random-effects meta-analyses on 136 studies revealed significant associations between ADHD and poorer cognitive (g = -0.46 [95% CIs: -0.59, -0.33]), motor (g = -0.35 [CIs: -0.48, -0.21]) and language (g = -0.43 [CIs: -0.66, -0.19]) development, social (g = 0.23 [CIs: 0.03, 0.43]) and emotional (g = 0.46 [CIs: 0.33, 0.58]) difficulties, early regulatory (g = 0.30 [CIs: 0.18, 0.43]) and sleep (g = 0.29 [CIs: 0.14, 0.44]) problems, sensory atypicalities (g = 0.52 [CIs: 0.16, 0.88]), elevated activity levels (g = 0.54 [CIs: 0.37, 0.72]), and executive function difficulties (g = 0.34 [CIs: 0.05, 0.64] to -0.87 [CIs: -1.35, -0.40]). A total of 32 trials (28 randomized, 4 nonrandomized, 3,848 participants) testing early interventions that targeted the identified precursors met inclusion criteria for part 2. Multi-level random-effects meta-analyses on 22 studies revealed significant intervention-related improvements in ADHD symptoms (SMD = 0.43 [CIs: 0.22, 0.64]) and working memory (SMD = 0.37 [CIs: 0.06, 0.69]).

CONCLUSION

Children aged 0 to 5 years with current or later-emerging ADHD are likely to experience difficulties in multiple neurocognitive/behavioral functions. Early interventions show some effectiveness in reducing ADHD symptoms, but their effects on neurocognitive/behavioral difficulties require further study.

Psychological Distress Symptoms and Resilience Assets in Adolescents in Residential Care

Most studies with institutionalised children and adolescents focus on evaluating the impact of negative life events on emotional development. However, few have investigated the relationship between resilience assets and the teenagers’ psychopathological problems. The purpose of the present study was to investigate differences in psychological distress symptoms and in resilience assets in institutionalised and non-institutionalised adolescents. A total of 266 adolescents aged between 12 and 19 years old took part in the study (60.5% female): 125 lived in residential care and 144 resided with their families. Results found a significant and inverse relation between psychopathology and the perception of individual resilience assets, specifically with self-efficacy and self-awareness in the community sample, and with empathy in the institutionalised sample. Overall, and regardless of the age group, adolescents in residential care tend to perceive themselves as significantly less resilient in perceived self-efficacy and empathy, and they report fewer goals and aspirations for the future. The importance of promoting mental health and resilience assets in adolescents, particularly in those in residential care, is discussed. This can be achieved through early interventions that may prevent emotional suffering and deviant life paths, with transgenerational repercussions.

Alpha electroencephalogram (EEG) asymmetry among toddlers in foster care

The majority of children living in foster care in the United States have a history of maltreatment and/or disrupted caregiving. Maltreatment in early childhood adversely affects development at many levels, including neurobiology and behavior. One neurobiological measure associated with maltreatment is alpha electroencephalogram (EEG) asymmetry. Prior research has found greater right frontal asymmetry among children with a history of maltreatment. However, little research has been extended developmentally downward to examine alpha asymmetry and its behavioral correlates among toddlers in foster care; this was the purpose of the present study. Differences in EEG asymmetry were examined between a sample of foster toddlers (mean age = 3.21 years, n = 38) and a community comparison, low-income sample without a history of foster care (mean age = 3.04 years, n = 16). The toddlers in the foster care group exhibited greater right alpha asymmetry, primarily driven by differences in parietal asymmetry. Neither frontal nor parietal asymmetry were clearly related to internalizing or externalizing behaviors, measured concurrently or at previous time points. These findings reveal differences in alpha EEG asymmetry among toddlers in foster care, and highlight the need to better understand associations between neurobiological and behavioral functioning following early adversity.

Early adversity and children's regulatory deficits: Does postadoption parenting facilitate recovery in postinstitutionalized children?

Children reared in orphanages typically experience the lack of stable, reliable caregivers and are at increased risk for deficits in regulatory abilities including difficulties in inhibitory control, attention, and emotion regulation. Although adoption results in a radical shift in caregiving quality, there remains variation in postadoption parenting, yet little research has examined postadoption parenting that may promote recovery in children experiencing early life adversity in the form of institutional care. Participants included 93 postinstitutionalized children adopted between 15 and 36 months of age and 52 nonadopted same-aged peers. Parenting was assessed four times during the first 2 years postadoption (at 2, 8, 16, and 24 months postadoption) and children's regulation was assessed at age 5 (M age = 61.68 months) and during kindergarten (M age = 71.55 months). Multiple parenting dimensions including sensitivity/responsiveness, structure/limit setting, and consistency in routines were examined. Both parental sensitivity and structure moderated the effect of preadoption adversity on children's emotion regulation while greater consistency was associated with better inhibitory control and fewer attention problems. Results support the notion that postadoption parenting during toddlerhood and the early preschool years promotes better regulation skills following early adversity.

Microstates-based resting frontal alpha asymmetry approach for understanding affect and approach/withdrawal behavior

The role of resting frontal alpha-asymmetry in explaining neural-mechanisms of affect and approach/withdrawal behavior is still debatable. The present study explores the ability of the quasi-stable resting EEG asymmetry information and the associated neurovascular synchronization/desynchronization in bringing more insight into the understanding of neural-mechanisms of affect and approach/withdrawal behavior. For this purpose, a novel frontal alpha-asymmetry based on microstates, that assess quasi-stable EEG scalp topography information, is proposed and compared against standard frontal-asymmetry. Both proposed and standard frontal alpha-asymmetries were estimated from thirty-nine healthy volunteers resting-EEG simultaneously acquired with resting-fMRI. Further, neurovascular mechanisms of these asymmetry measures were estimated through EEG-informed fMRI. Subsequently, the Hemodynamic Lateralization Index (HLI) of the neural-underpinnings of both asymmetry measures was assessed. Finally, the robust correlation of both asymmetry-measures and their HLI’s with PANAS, BIS/BAS was carried out. The standard resting frontal-asymmetry and its HLI yielded no significant correlation with any psychological-measures. However, the microstate resting frontal-asymmetry correlated significantly with negative affect and its neural underpinning’s HLI significantly correlated with Positive/Negative affect and BIS/BAS measures. Finally, alpha-BOLD desynchronization was observed in neural-underpinning whose HLI correlated significantly with negative affect and BIS. Hence, the proposed resting microstate-frontal asymmetry better assesses the neural-mechanisms of affect, approach/withdrawal behavior.

Paternal-but Not Maternal-Autistic Traits Predict Frontal EEG Alpha Asymmetry in Infants with Later Symptoms of Autism

Previous research found that the parental autism phenotype is associated with child autism spectrum disorder (ASD), even if the pathway between autistic traits in parents and child ASD is still largely unknown. Several studies investigated frontal asymmetry in alpha oscillation (FAA) as an early marker for ASD. However, no study has examined the mediational effect of FAA between parental autistic traits and child ASD symptoms in the general population. We carried out a prospective study of 103 typically developing infants and measured FAA as a mediator between both maternal and paternal autistic traits and child ASD traits. We recorded infant baseline electroencephalogram (EEG) at 6 months of age. Child ASD symptoms were measured at age 24 months by the Child Behavior Checklist 1½-5 Pervasive Developmental Problems Scale, and parental autistic traits were scored by the Autism spectrum Quotient questionnaire. The mediation model showed that paternal vs. maternal autistic traits are associated with greater left FAA which, in turn, is associated with more child ASD traits with a significant indirect effect only in female infants vs. male infants. Our findings show a potential cascade of effects whereby paternal autistic traits drive EEG markers contributing to ASD risk.