Electrophysiological indices of aberrant error-processing in adults with ADHD: a new region of interest

Electrophysiological indices of reward anticipation as ADHD risk and prognostic biomarkers

The attention-deficit/hyperactivity disorder (ADHD) clinical phenotype has limitations for deciphering ADHD etiology and predicting prognosis. Although relative to the clinical phenotype, intermediate phenotypes may have better explanatory and prognostic power, the extent to which ADHD intermediate phenotypes are associated with ADHD risk and prognosis is unknown. The aim of this study was to evaluate evidence for event-related potential (ERP) measures of reward anticipation as ADHD risk and prognostic biomarkers. We examined, whether (1) in a sample of adolescents (N = 304; Mage = 15.78 years, SD = 1.08; 39.5% female), accounting for the effects of age, sex, ADHD severity and depression, ERPs are associated with ADHD polygenic risk scores (PRSs) (ADHD risk) and (2) in a sample of adolescents at-risk for ADHD (n = 99; Mage = 15.78 years, SD = 1.08; 39.5% female), accounting for the effects of age, sex, ADHD severity, depression, and baseline outcome values, ERPs are associated, prospectively, with alcohol misuse (ADHD prognosis). In adolescents, greater ADHD PRSs were associated with lower electrophysiological anticipatory attention to motivationally relevant feedback (b = -0.115, p = .046 95%CI [-0.228; -0.002]). The predictors accounted for 5% of the variance in the outcome. In adolescents at-risk for ADHD, at 18-month follow-up, lower electrophysiological anticipatory attention to motivationally relevant feedback was associated with greater alcohol consumption (b = -7.454, p = .007, 95%CI [-12.873; -2.034]). The predictors accounted for 31% of the variance in this outcome. These findings were replicated in sensitivity analyses with behavioral performance variables added as covariates. The current findings support the hypothesis that ERP amplitudes of reward anticipation may be ADHD risk and prognostic biomarkers and suggest that intermediate phenotypes may confer advantages over the ADHD clinical phenotype in delineating etiology and predicting prognosis.

Can electroencephalography (EEG) identify ADHD subtypes? A systematic review

Attention Deficit/Hyperactivity Disorder (ADHD) has been associated with atypical patterns of neural activity measured by electroencephalography (EEG). However, the identification of EEG diagnostic biomarkers has been complicated by the disorder's heterogeneity. The objective of this review was to synthesize the literature investigating EEG variation in patients diagnosed with ADHD, addressing the following questions: 1) Are the diagnostic ADHD subtypes associated with different EEG characteristics? 2) Are EEG measures correlated with ADHD traits and/or symptom severity? and 3) Do classification techniques using EEG measures reveal different clinical presentations of ADHD? Outcomes highlight the potential for electrophysiological measures to provide meaningful insights into the heterogeneity of ADHD, although direct translation of EEG biomarkers for diagnostic purposes is not yet supported. Key measures that show promise for the discrimination of existing ADHD subtypes and symptomatology include: resting state and task-related modulation of alpha, beta and theta power, and the event-related N2 and P3 components. Prescriptions are discussed for future studies that may help to bridge the gap between research and clinical application.

Cortical reorganization to improve dynamic balance control with error amplification feedback

Background

Error amplification (EA), virtually magnify task errors in visual feedback, is a potential neurocognitive approach to facilitate motor performance. With regional activities and inter-regional connectivity of electroencephalography (EEG), this study investigated underlying cortical mechanisms associated with improvement of postural balance using EA.

Methods

Eighteen healthy young participants maintained postural stability on a stabilometer, guided by two visual feedbacks (error amplification (EA) vs. real error (RE)), while stabilometer plate movement and scalp EEG were recorded. Plate dynamics, including root mean square (RMS), sample entropy (SampEn), and mean frequency (MF) were used to characterize behavioral strategies. Regional cortical activity and inter-regional connectivity of EEG sub-bands were characterized to infer neural control with relative power and phase-lag index (PLI), respectively.

Results

In contrast to RE, EA magnified the errors in the visual feedback to twice its size during stabilometer stance. The results showed that EA led to smaller RMS of postural fluctuations with greater SampEn and MF than RE did. Compared with RE, EA altered cortical organizations with greater regional powers in the mid-frontal cluster (theta, 4–7 Hz), occipital cluster (alpha, 8–12 Hz), and left temporal cluster (beta, 13–35 Hz). In terms of the phase-lag index of EEG between electrode pairs, EA significantly reduced long-range prefrontal-parietal and prefrontal-occipital connectivity of the alpha/beta bands, and the right tempo-parietal connectivity of the theta/alpha bands. Alternatively, EA augmented the fronto-centro-parietal connectivity of the theta/alpha bands, along with the right temporo-frontal and temporo-parietal connectivity of the beta band.

Conclusion

EA alters postural strategies to improve stance stability on a stabilometer with visual feedback, attributable to enhanced error processing and attentional release for target localization. This study provides supporting neural correlates for the use of virtual reality with EA during balance training.

Diminished error-related negativity and error positivity in children and adults with externalizing problems and disorders: a meta-analysis on error processing

BACKGROUND

Deficits in error processing are reflected in an inability of people with externalizing problems to adjust their problem behaviour. The present study contains 2 meta-analyses, testing whether error processing - indexed by the event-related potentials error-related negativity (ERN) and error positivity (Pe) - is reduced in children and adults with externalizing problems and disorders compared to healthy controls.

METHODS

We conducted a systematic search in PubMed (1980 to December 2018), PsycInfo (1980 to December 2018) and Scopus (1970 to December 2018), identifying 328 studies. We included studies that measured error processing using the Eriksen flanker task, the go/no-go task or the stop-signal task in healthy controls and in adults or children with clearly described externalizing behavioural problems (e.g., aggression) or a clinical diagnosis on the externalizing spectrum (e.g., addiction).

RESULTS

Random-effect models (ERN: 23 studies, 1739 participants; Pe: 27 studies, 1456 participants) revealed a reduced ERN amplitude (Hedges' g = 0.44, 95% confidence interval [CI] 0.29 to 0.58) and a reduced Pe amplitude (Hedges' g = -0.27, 95% CI -0.44 to -0.09) during error processing in people with externalizing problems or disorders compared to healthy controls. Type of diagnosis, age and the presence of performance feedback or comorbidity did not moderate the results. The employed cognitive task was a moderator for Pe but not for ERN. The go/no-go task generated a greater amplitude difference in Pe than the Eriksen flanker task. Small-sample assessment revealed evidence of publication bias for both event-related potentials. However, a p curve analysis for ERN showed that evidential value was present; for Pe, the p curve analysis was inconclusive.

LIMITATIONS

The moderators did not explain the potential heterogeneity in most of the analysis, suggesting that other disorder- and patient-related factors affect error processing.

CONCLUSION

Our findings indicate the presence of compromised error processing in externalizing psychopathology, suggesting diminished activation of the prefrontal cortex during performance monitoring.

A systematic review and meta-analysis of altered electrophysiological markers of performance monitoring in Obsessive-Compulsive Disorder (OCD), Gilles de la Tourette Syndrome (GTS), Attention-Deficit/Hyperactivity disorder (ADHD) and Autism

Altered performance monitoring is implicated in obsessive-compulsive disorder (OCD), Gilles de la Tourette syndrome (GTS), attention-deficit/hyperactivity disorder (ADHD) and autism. We conducted a systematic review and meta-analysis of electrophysiological correlates of performance monitoring (error-related negativity, ERN; error positivity, Pe; feedback-related negativity, FRN; feedback-P3) in individuals with OCD, GTS, ADHD or autism compared to control participants, or associations between correlates and symptoms/traits of these conditions. Meta-analyses on 97 studies (5890 participants) showed increased ERN in OCD (Hedge's g = 0.54[CIs:0.44,0.65]) and GTS (g = 0.99[CIs:0.05,1.93]). OCD also showed increased Pe (g = 0.51[CIs:0.21,0.81]) and FRN (g = 0.50[CIs:0.26,0.73]). ADHD and autism showed reduced ERN (ADHD: g=-0.47[CIs:-0.67,-0.26]; autism: g=-0.61[CIs:-1.10,-0.13]). ADHD also showed reduced Pe (g=-0.50[CIs:-0.69,-0.32]). These findings suggest overlap in electrophysiological markers of performance monitoring alterations in four common neurodevelopmental conditions, with increased amplitudes of the markers in OCD and GTS and decreased amplitudes in ADHD and autism. Implications of these findings in terms of shared and distinct performance monitoring alterations across these neurodevelopmental conditions are discussed. PROSPERO pre-registration code: CRD42019134612.

Error and post-error processing in children with attention-deficit/hyperactivity disorder: An electrical neuroimaging study

OBJECTIVE

Inaccurate and inconsistent response styles in attention-deficit/hyperactivity disorder (ADHD) have been observed in a wide variety of cognitive tasks, in line with regulatory deficit models of ADHD. Event-related potential (ERP) studies of error processing have provided evidence for these models, but are limited in specificity. We aimed to improve the isolation, localization and identification of error (self-monitoring and adaptive control) and post-error (implementation of cognitive control) processing in ADHD.

METHODS

ERPs were obtained for 46 ADHD and 51 typically developing (TD) children using the stop-signal task. Response-locked error (Ne and Pe) and stimulus-locked post-error (N2) components were compared between groups. Ne/Pe were corrected for preceding stimulus overlap and group differences were localized.

RESULTS

Ne was intact, while Pe amplitude was markedly reduced in children with ADHD (ηp² = 0.14). Pe differences were localized in the dorsal posterior/midcingulate (BA31/24) cortex. While the TD group showed increased N2 amplitude in post-error trials (ηp² = 0.24), localized in the left ventrolateral prefrontal cortex (VLPFC) and angular gyrus, the ADHD group did not.

CONCLUSIONS

Self-regulation deficits in ADHD are associated with later stages of error processing and subsequent implementation of cognitive control.

SIGNIFICANCE

We contribute to the literature by further specifying error processing deficits in ADHD.

Error monitoring and daily life executive functioning

Error monitoring during task execution is reflected in post-error slowing (PES), which refers to the tendency to slow down performance after making an error in order to prevent future mistakes. The key question of the present study is whether poor error monitoring (reduced magnitude of PES) has negative consequences for daily life executive function skills, as well as functioning in different life settings such as work, family, social, and academic settings. Eighty-five university students performed a lexical decision task and completed The Executive Function Index Scale (EFI), and the Weiss Functional Impairments Rating Scale (WFIRS). Individual academic achievement was measured using the Grade Point Average. Statistical analysis revealed that a decreased magnitude of PES was weakly associated with less efficient planning (one of the executive functions). Results suggest that error monitoring, as measured by PES, was not associated with functioning in a naturalistic environment, but could be interpreted to some extent as an experimental marker of planning in daily life executive functioning.

Impact of pubertal timing and depression on error-related brain activity in anxious youth

Anxiety disorders are associated with enhanced error-related negativity (ERN) across development but it remains unclear whether alterations in brain electrophysiology are linked to the timing of puberty. Pubertal timing and alterations of prefrontal and limbic development are implicated in risk for depression, but the interplay of these factors on the ERN-anxiety association has not been assessed. We examined the unique and interactive effects of pubertal timing and depression on the ERN in a sample of youth 10-19 years old with anxiety disorders (n = 30) or no history of psychopathology (n = 30). Earlier pubertal maturation was associated with an enhanced ERN. Among early, but not late maturing youth, higher depressive symptoms were associated with a reduced ERN. The magnitude of neural reactivity to errors is sensitive to anxiety, depression, and development. Early physical maturation and anxiety may heighten neural sensitivity to errors yet predict opposing effects in the context of depression.