Attentional Selection and Suppression in Children With Attention-Deficit/Hyperactivity Disorder

The scalp prefrontal-limbic functional connectivity moderates stress-related rumination effects on stress recovery

BACKGROUND

Mood disorders are often associated with hypothalamic-pituitary-adrenal (HPA) axis dysfunction, and rumination has been implicated in delayed cortisol recovery. However, research findings on the impact of rumination on cortisol recovery have been inconsistent. The moderating effects of scalp prefrontal-limbic connections on the relationship between rumination and cortisol recovery may explain these discrepancies.

METHOD

Acute stress was induced by a 5-min simulated job interview. Salivary samples and affective ratings were collected at seven pre-determined time points. After the simulated job interview, 35 healthy adult participants were randomly assigned to either the rumination condition (n = 17) or the distraction condition (n = 18).

RESULTS

Inducing stress and rumination led to increased cortisol levels, negative mood, and state rumination. Compared with the distraction group, the rumination group displayed delayed cortisol recovery and decreased scalp prefrontal-limbic connectivities, that is, left ventrolateral prefrontal cortex (LVLPFC) and left temporal area (LTMP) [ps < .05], and right dorsolateral prefrontal cortex (RDLPFC) and anterior cingulate cortex (ACC) [ps < .05]. The relationship between rumination and cortisol recovery was moderated by connectivities between the left dorsolateral prefrontal cortex (LDLPFC) and LTMP, RDLPFC and LTMP, LDLPFC and ACC, and RDLPFC and ACC [B = -0.98 to -0.35, SE = 0.15-0.34, ps < .05]. Higher rumination combined with reduced scalp prefrontal-limbic connectivities to predict delayed cortisol recovery.

CONCLUSION

The current findings suggest that scalp prefrontal-limbic connectivity is a neural underpinning related to emotion regulation for the effects of state rumination on stress recovery. These findings also provide a potential target for non-invasive intervention in HPA axis dysregulation.

Overactivated contextual visual perception and response to a single dose of methylphenidate in children with ADHD

The pathogenesis of overactivated visual perception in attention-deficit hyperactivity disorder (ADHD) remains unclear, which is interpreted as a cognitive compensation. The existing studies have proposed that perceptual abnormalities in neurodevelopmental disorders are associated with dysfunction of the contextual knowledge system, which influences the development and formation of perception. We hypothesized that alterations in contextual states may also be responsible for inducing perceptual abnormalities in ADHD. Therefore, the present study evaluated the characteristics of pre-stimulus alpha and its response to a single dose of methylphenidate (MPH). A total of 135 Chinese children participated in the first study, including 70 children with ADHD (age = 10.61 ± 1.93 years, female = 17) and 65 age- and sex-matched control children (age = 10.73 ± 1.93 years, female = 20). The second clinical trial included 19 Chinese children with ADHD (age = 11.85 ± 1.72 years, female = 4), with an identical visual spatial search task. Pre-stimulus alpha oscillations and P1 activity were significantly greater in children with ADHD than in the controls. Overactivated pre-stimulus alpha positively predicted P1. Both pre-stimulus alpha and P1 overactivation have beneficial effects on cognitive performance in children with ADHD. No intervening effect of a single dose of MPH on the compensatory activation of pre-stimulus alpha and P1 were observed. Our findings extended the perceptual activation to the contextual knowledge system, suggesting that compensatory perception in children with ADHD is more likely to be a top-down regulated cognitive operational process.

Functional reorganization of brain activity in children with attention-deficit/hyperactivity disorder: Evidence from the modulatory effect of cognitive demand during visuospatial attention task

Previous studies reported that the inferior parietal lobule (IPL) had lower activation during visuospatial attention in children with attention-deficit/hyperactivity disorder (ADHD), while the functional connectivity (FC) between the IPL and other brain regions and how cognitive demand might modulate IPL's FC remain unclear. We performed a functional magnetic resonance imaging experiment recruiting two task conditions with relatively low and high cognitive demand of visuospatial attention. Forty-four children with ADHD and 36 age- and sex-matched healthy controls were included. IPL's regional activation and FC intensities were compared between groups and correlated with clinical measurements. We found that the IPL had significantly reduced activation in children with ADHD compared to healthy controls and this abnormal activation was not modulated by the cognitive demand of visuospatial attention. Importantly, further analysis revealed that the functional connectivity between IPL and inferior frontal gyrus was modulated by the cognitive demand of visuospatial attention in children with ADHD. These results revealed a modulatory effect of cognitive demand of visuospatial attention on IPL's functional connectivity but not IPL's activation in children with ADHD. More generally, these results highlight the functional reorganization of the brain activity as a possible compensatory strategy in response to the symptoms of ADHD.

Total sleep deprivation impairs visual selective attention and triggers a compensatory effect: evidence from event-related potentials

Many studies have demonstrated the impairment of sustained attention due to total sleep deprivation (TSD). However, it remains unclear whether and how TSD affects the processing of visual selective attention. In the current study, 24 volunteers performed a visual search task before and after TSD over a period of 36 h while undergoing spontaneous electroencephalography. Paired-sample t-tests of behavioral performance revealed that, compared with baseline values, the participants showed lower accuracy and higher variance in response time in visual search tasks performed after TSD. Analysis of the event-related potentials (ERPs) showed that the mean amplitude of the N2-posterior-contralateral (N2pc) difference wave after TSD was less negative than that at baseline and the mean amplitude of P3 after TSD was more positive than that at baseline. Our findings suggest that TSD significantly attenuates attentional direction/orientation processing and triggers a compensatory effect in the parietal brain to partially offset the impairments. These findings provide new evidence and improve our understanding of the effects of sleep loss.

Relationship Between Inhibitory Control and Arithmetic in Elementary School Children With ADHD: The Mediating Role of Working Memory

OBJECTIVES

To test if inhibitory control was a significant predictor for arithmetic in children with ADHD and if the relationship between inhibitory control and arithmetic was mediated by working memory.

METHODS

Eighty-four children (ADHD, n = 54; Non-ADHD, n = 30) were tested on their interference control, behavioral inhibition, working memory, and arithmetic. Regression analysis was used to test the predictive role of inhibitory control in arithmetic. Moreover, mediation analysis was done to test whether working memory mediated the relationship between inhibitory control and arithmetic memory.

RESULTS

Interference control but not behavioral inhibition was a significant predictor for arithmetic. In addition, interference control had direct and indirect effects via working memory on arithmetic.

CONCLUSIONS

Results demonstrated that inhibitory control contributed to arithmetic in children with ADHD. Furthermore, interference control had direct and indirect effects via working memory on arithmetic, suggesting interventions for arithmetic difficulties should involve training on both inhibition and working memory.

Irrelevant sights and sounds require spatial suppression: ERP evidence

Both real-world experience and behavioral laboratory research suggest that entirely irrelevant stimuli (distractors) can interfere with a primary task. However, it is as yet unknown whether such interference reflects competition for spatial attention - indeed, prominent theories of attention predict that this should not be the case. Whilst electrophysiological indices of spatial capture and spatial suppression have been well-investigated, experiments have primarily utilized distractors which share a degree of task-relevance with targets, and are limited to the visual domain. The present research measured behavioral and ERP responses to test the ability of salient yet entirely task-irrelevant visual and auditory distractors to compete for spatial attention during a visual task, while also testing for potentially enhanced competition from multisensory distractors. Participants completed a central letter search task, while ignoring lateralized visual (e.g., image of a dog), auditory (e.g., barking), or multisensory (e.g., image + barking) distractors. Results showed that visual and multisensory distractors elicited a P_D component indicative of active lateralized suppression. We also establish for the first time an auditory analog of the P_D component, the P_AD , elicited by auditory and multisensory distractors. Interestingly, there was no evidence to suggest enhanced ability of multisensory distractors to compete for attentional selection, despite previous proposals of a "special" saliency status for such items. Our findings hence suggest that irrelevant multisensory and unisensory distractors are similarly capable of eliciting a spatial "attend-to-me" signal - a precursor of spatial attentional capture - but at least in the present data set did not elicit full spatial attentional capture.

The effects of first-dose methylphenidate on the neural signatures of visual selective attention in children with attention-deficit/hyperactivity disorder

Although methylphenidate (MPH) has been shown to significantly improve selective attention in children with attention-deficit/hyperactivity disorder (ADHD), the neural mechanism of this effect remains unclear. We investigated the effects of first-dose MPH on the neural signatures of visual selective attention in children with ADHD. We measured the impact of first-dose MPH on electrophysiological indexes from eighteen children with ADHD (8.9-15.2 years; 15 boys) while they performed a visual search task. MPH was administered in a double-blind placebo-controlled crossover design. MPH led to decreases in behavioral error rates and reaction times. For the electrophysiological indexes, MPH significantly increased the target-elicited N2pc amplitude and posterior P3 amplitude during the selective attention process. The trial-based correlation analysis revealed that the enhanced N2pc (more negative) and P3 (more positive) promoted the behavioral response speed for children with ADHD. The lower individual P3 amplitude was associated with higher severity of inattention symptoms. The severer inattention symptoms were related to weaker MPH effect on N2pc amplitude. These findings suggest that N2pc and P3 are closely related to the mechanism of MPH in the ADHD treatment.

Total sleep deprivation selectively impairs motor preparation sub-stages in visual search task: Evidence from lateralized readiness potentials

Introduction

Many studies have provided evidence of a damage effect triggered by total sleep deprivation (TSD). However, it remains unclear whether the motor preparation processing is affected by TSD.

Methods

In the current study, 23 volunteers performed a stimulus-response compatibility visual search task before and after TSD while undergoing spontaneous electroencephalography (EEG).

Results

Repeated-measures analysis of variance revealed that: Compared with that at baseline, the visual search task's accuracy decreased after TSD, while the response time variance increased significantly. The peak amplitude of the stimulus-locked lateralized readiness potential (LRP) induced by a compatible stimulus was significantly more negative than that induced by an incompatible stimulus before TSD, whereas this difference was not significant after TSD. However, when taking sleep status into consideration, there were no significant main or interaction effects on response-locked LRPs.

Discussion

Our findings suggest that TSD damages visual search behavior, selectively impairs the earlier sub-stages of motor preparation (sensory integration). These findings will provide a new perspective for understanding the effects of sleep loss.

Sound localization and auditory selective attention in school-aged children with ADHD

This study aimed to identify the neurophysiologic bases of auditory attention deficits in children with attention-deficit/hyperactivity disorder (ADHD), focusing on the electroencephalography component of auditory spatial selective attention [the N2 anterior contralateral component (N2ac)]. EEG data were collected from 7- to 11-year-old children with ADHD (n = 54) and age-, sex-, and IQ-matched typically developing (TD) children (n = 61), while they performed an auditory spatial selective task. For behavior, the children with ADHD showed a shorter reaction time (RT) but a higher RT coefficient of variability (RT_CV) than TD children. For ERPs, the TD group showed a significant "adult-like" N2ac component; however, the N2ac component was absent in children with ADHD. More importantly, the smaller N2ac component could predict longer RT in both groups, as well as higher severity of inattentive symptoms in children with ADHD. Our results indicated that 7- to 11-year-old TD children have developed an "adult-like" ability to balance auditory target selection and distractor suppression; the absence of N2ac in children with ADHD provided novel evidence supporting their dysfunctional auditory spatial selective attention.

The effect of perceptual expectation on processing gain, attention and the perceptual decision bias in children and adolescents with Autism Spectrum Disorder (ASD)

Perceptual expectations influence perception, attention and the perceptual decision bias during visuospatial orienting, which is impaired in individuals with Autism Spectrum Disorder (ASD). In this study, we investigated whether during visuospatial orienting, perceptual expectations in ASD differentially influence perception, attention and the perceptual decision bias relative to neurotypical controls (NT). Twenty-three children and adolescents with ASD and 23 NT completed a visuospatial orienting task, which compared the effect of a valid relative to an invalid perceptual expectation on target detection (cue validity effect). Group differences were calculated regarding the cue validity effect on neural correlates of processing gain (N1a amplitude) and attention (N1pc amplitude), the perceptual decision bias and mean reaction time (RT). In ASD relative to NT, findings showed a reduced processing gain for validly relative to invalidly cued targets and increased attentional response following invalidly relative to validly cued targets. Increased attention correlated with faster performance across groups. Increased processing correlated with a higher perceptual decision bias and faster mean RT in NT, but not in ASD. Results suggest that during visuospatial orienting, perceptual expectations in ASD may drive changes in sensory processing and stimulus-driven attention, which may differentially guide behavioural responses.

Information-based multivariate decoding reveals imprecise neural encoding in children with attention deficit hyperactivity disorder during visual selective attention

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in school-age children. Attentional orientation is a potential clinical diagnostic marker to aid in the early diagnosis of ADHD. However, the underlying pathophysiological substrates of impaired attentional orienting in childhood ADHD remain unclear. Electroencephalography (EEG) was measured in 135 school-age children (70 with childhood ADHD and 65 matched typically developing children) to directly investigate target localization during spatial selective attention through univariate ERP analysis and information-based multivariate pattern machine learning analysis. Compared with children with typical development, a smaller N2pc was found in the ADHD group through univariate ERP analysis. Children with ADHD showed a lower parieto-occipital multivariate decoding accuracy approximately 240-340 ms after visual search onset, which predicts a slower reaction time and larger standard deviation of reaction time. Furthermore, a significant correlation was found between N2pc and decoding accuracy in typically developing children but not in children with ADHD. These observations reveal that impaired attentional orienting in ADHD may be due to inefficient neural encoding responses. By using a personalized information-based multivariate machine learning approach, we have advanced the understanding of cognitive deficits in neurodevelopmental disorders. Our study provides potential research directions for the early diagnosis and optimization of personalized intervention in children with ADHD.

The Monash Autism-ADHD genetics and neurodevelopment (MAGNET) project design and methodologies: a dimensional approach to understanding neurobiological and genetic aetiology

Background

ASD and ADHD are prevalent neurodevelopmental disorders that frequently co-occur and have strong evidence for a degree of shared genetic aetiology. Behavioural and neurocognitive heterogeneity in ASD and ADHD has hampered attempts to map the underlying genetics and neurobiology, predict intervention response, and improve diagnostic accuracy. Moving away from categorical conceptualisations of psychopathology to a dimensional approach is anticipated to facilitate discovery of data-driven clusters and enhance our understanding of the neurobiological and genetic aetiology of these conditions. The Monash Autism-ADHD genetics and neurodevelopment (MAGNET) project is one of the first large-scale, family-based studies to take a truly transdiagnostic approach to ASD and ADHD. Using a comprehensive phenotyping protocol capturing dimensional traits central to ASD and ADHD, the MAGNET project aims to identify data-driven clusters across ADHD-ASD spectra using deep phenotyping of symptoms and behaviours; investigate the degree of familiality for different dimensional ASD-ADHD phenotypes and clusters; and map the neurocognitive, brain imaging, and genetic correlates of these data-driven symptom-based clusters.

Methods

The MAGNET project will recruit 1,200 families with children who are either typically developing, or who display elevated ASD, ADHD, or ASD-ADHD traits, in addition to affected and unaffected biological siblings of probands, and parents. All children will be comprehensively phenotyped for behavioural symptoms, comorbidities, neurocognitive and neuroimaging traits and genetics.

Conclusion

The MAGNET project will be the first large-scale family study to take a transdiagnostic approach to ASD-ADHD, utilising deep phenotyping across behavioural, neurocognitive, brain imaging and genetic measures.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13229-021-00457-3.

Atypical Developmental Trajectories of Early Perception Among School-Age Children With Attention Deficit Hyperactivity Disorder During a Visual Search Task

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by cognitive deficits associated with attention. Prior studies have revealed the potential impact of ADHD on basic perception and cognitive ability in patients with ADHD. In this study, bilateral posterior P1 and N1 were measured in 122 Chinese children aged 7-12 years (64 with ADHD) to investigate the developmental characteristics of early perception during visual processing in school-age children with ADHD. For children with ADHD, a larger P1 activity with an atypical developmental pattern was evoked and observed for the visual search performance. These findings offer new insights into the mechanisms of cognitive developmental deficits and intervention techniques in children with ADHD.

Abnormal modulation of theta oscillations in children with attention-deficit/hyperactivity disorder

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We study frontal theta ERS and posterior theta lateralization in ADHD children.

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ADHD children show increased frontal theta ERS and posterior theta lateralization.

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Midfrontal theta ERS connects with right posterior theta modulation in ADHD children.

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Right posterior theta modulation is linked with RT variability in ADHD children.

Previous studies have found that theta activities exhibit posterior lateralized modulation as well as midfrontal event-related synchronization (ERS) during covert visual attention in adults. The present study investigated whether these theta modulations existed in children and whether they were associated with attentional problems in attention-deficit/hyperactivity disorder (ADHD). Electroencephalography signals were recorded from typically developing (TD) children and children with ADHD (TD: n = 24; ADHD: n = 22) while they performed a cued covert visual attention task. The participants responded to a target following a cue designed as human eyes that gazed to the left or right visual field (70% validity). Compared with the TD children, the children with ADHD showed increased midfrontal theta ERS and significant posterior theta lateralization in response to the cues. More importantly, we found that the stronger posterior theta lateralization in the right hemisphere exhibited a positive trial-based correlation with the larger midfrontal theta ERS and predicted lower RT variability at the trial level in the children with ADHD. We suggest that ADHD may be associated with some enhanced systems in the frontal and posterior areas via theta oscillations, which may be involved in the compensatory maturation for their attention deficits in childhood, thereby promoting the stability of behavioral responses.

Circadian misalignment impairs ability to suppress visual distractions

Evening-type individuals often perform poorly in the morning because of a mismatch between internal circadian time and external social time, a condition recognized as social jet lag. Performance impairments near the morning circadian (~24 hr) trough have been attributed to deficits in attention, but the nature of the impairment is unknown. Using electrophysiological indices of attentional selection (N2pc) and suppression (P_D ), we show that evening-type individuals have a specific disability in suppressing irrelevant visual distractions. More specifically, evening-type individuals managed to suppress a salient distractor in an afternoon testing session, as evidenced by a P_D , but were less able to suppress the distractor in a morning testing session, as evidenced by an attenuated P_D and a concomitant distractor-elicited N2pc. Morning chronotypes, who would be well past their circadian trough at the time of testing, did not show this deficit at either test time. These results indicate that failure to filter out irrelevant stimuli at an early stage of perceptual processing contributes to impaired cognitive functioning at nonoptimal times of day and may underlie real-world performance impairments, such as distracted driving, that have been associated with circadian mismatch.

Abnormal alpha modulation in response to human eye gaze predicts inattention severity in children with ADHD

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In response to the human eye gaze, compared with TD children, ADHD children showed a decreased alpha lateralization.

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The attenuation of alpha modulation in ADHD children was mainly manifested in the left hemisphere.

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The left hemisphere alpha modulation predicted higher inattentive severity and lower behavioural accuracy in ADHD children.

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Classification analysis showed the left alpha modulation has a high capability to recognize ADHD from TD children.

Attention-deficit/hyperactivity disorder (ADHD) is characterized by problems in directing and sustaining attention. Recent behavioral studies indicated that children with ADHD are more likely to fail to show the orienting effect in response to human eye gaze. The present study aimed to identify the neurophysiological bases of attention deficits directed by social human eye gaze in children with ADHD, focusing on the relationship between alpha modulations and ADHD symptoms. The electroencephalography data were recorded from 8–13-year-old children (typically developing (TD): n = 24; ADHD: n = 21) while they performed a cued visuospatial covert attention task. The cues were designed as human eyes that might gaze to the left or right visual field. The results revealed that TD children showed a significant alpha lateralization in response to the gaze of human eyes, whereas children with ADHD showed an inverse pattern of alpha modulation in the left parieto-occipital area. Importantly, the abnormal alpha modulation in the left hemisphere predicted inattentive symptom severity and behavioral accuracy in children with ADHD. These results suggest that the dysfunction of alpha modulation in the left hemisphere in response to social cues might be a potential neurophysiologic marker of attention deficit in children with ADHD.

The neural correlations of spatial attention and working memory deficits in adults with ADHD

Working memory impairment is a typical cognitive abnormality in patients with attention-deficit/hyperactivity disorder (ADHD) and is closely related to attention. Exploring the interaction between working memory and attention in patients with ADHD is of great significance for studying the pathological mechanism of this disease. In this study, electrophysiological markers of attention, posterior contralateral N2 (N2pc), and working memory, contralateral delay activity (CDA), were used to explore the relationship between these two cognitive abilities in patients with ADHD. EEG data were collected from adults with ADHD and age-, sex-, and IQ-matched normal controls while performing a classical visuospatial working memory task that consisted of low-load and high-load memory conditions. In different memory load conditions, the memory array elicited a smaller N2pc (220–260 ms) and a smaller CDA (400–800 ms) in adults with ADHD than in normal controls. Further analysis revealed that the reduced CDA amplitude could be significantly predicted by the earlier and reduced N2pc amplitude in adults with ADHD. Moreover, when the number of memory items increased, the increase in N2pc highly predicted the increases in CDA. Our findings illustrate the relationship between spatial working memory and attention ability in ADHD adults from the neurophysiological aspect that reduced working memory is closely related to insufficient attention ability and provide a potential physiological basis for the pathological mechanism of ADHD.

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We investigate the relationship between attention and working memory in ADHD adults.

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Both the N2pc and CDA are reduced in ADHD adults compared with normal controls.

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The reduced N2pc is correlated with the reduced CDA in ADHD adults.

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Working memory deficits in adults with ADHD may be related to attention deficits.

Attentional selection predicts rapid automatized naming ability in Chinese-speaking children with ADHD

Children with attention-deficit/hyperactivity disorder (ADHD) are reported to have a significantly higher risk of showing reading difficulties or disorders. Here, we aimed to identify the relationship between electroencephalographic (EEG) marker of spatial attention and reading ability in Chinese children with ADHD. First, we demonstrated that rapid automatized naming (RAN) is a strong predictor of reading ability in Chinese-speaking children. Then, EEG data of 9-to 15-year-old children with ADHD (n = 38) and typically developing (TD) controls (n = 36) were collected while the children performed a classical visual search task. Children with ADHD showed slower RAN speed than TD children. For event-related potentials (ERPs), children with ADHD showed a reduced target-evoked N2pc component, which predicted their poorer RAN performance. However, in TD children the early occipital P1 amplitude was negatively correlated with their RAN performance. The correlation between decreased N2pc and poor RAN performance in children with ADHD suggests that their reading problems may in part be due to impaired attentional selection. In contrast, in TD children, development in early visual processing co-occurs with improvements in reading ability.