1
|
Storebø OJ, Storm MRO, Pereira Ribeiro J, Skoog M, Groth C, Callesen HE, Schaug JP, Darling Rasmussen P, Huus CML, Zwi M, Kirubakaran R, Simonsen E, Gluud C. Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD). Cochrane Database Syst Rev 2023; 3:CD009885. [PMID: 36971690 PMCID: PMC10042435 DOI: 10.1002/14651858.cd009885.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed and treated psychiatric disorders in childhood. Typically, children and adolescents with ADHD find it difficult to pay attention and they are hyperactive and impulsive. Methylphenidate is the psychostimulant most often prescribed, but the evidence on benefits and harms is uncertain. This is an update of our comprehensive systematic review on benefits and harms published in 2015. OBJECTIVES To assess the beneficial and harmful effects of methylphenidate for children and adolescents with ADHD. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, three other databases and two trials registers up to March 2022. In addition, we checked reference lists and requested published and unpublished data from manufacturers of methylphenidate. SELECTION CRITERIA We included all randomised clinical trials (RCTs) comparing methylphenidate versus placebo or no intervention in children and adolescents aged 18 years and younger with a diagnosis of ADHD. The search was not limited by publication year or language, but trial inclusion required that 75% or more of participants had a normal intellectual quotient (IQ > 70). We assessed two primary outcomes, ADHD symptoms and serious adverse events, and three secondary outcomes, adverse events considered non-serious, general behaviour, and quality of life. DATA COLLECTION AND ANALYSIS Two review authors independently conducted data extraction and risk of bias assessment for each trial. Six review authors including two review authors from the original publication participated in the update in 2022. We used standard Cochrane methodological procedures. Data from parallel-group trials and first-period data from cross-over trials formed the basis of our primary analyses. We undertook separate analyses using end-of-last period data from cross-over trials. We used Trial Sequential Analyses (TSA) to control for type I (5%) and type II (20%) errors, and we assessed and downgraded evidence according to the GRADE approach. MAIN RESULTS We included 212 trials (16,302 participants randomised); 55 parallel-group trials (8104 participants randomised), and 156 cross-over trials (8033 participants randomised) as well as one trial with a parallel phase (114 participants randomised) and a cross-over phase (165 participants randomised). The mean age of participants was 9.8 years ranging from 3 to 18 years (two trials from 3 to 21 years). The male-female ratio was 3:1. Most trials were carried out in high-income countries, and 86/212 included trials (41%) were funded or partly funded by the pharmaceutical industry. Methylphenidate treatment duration ranged from 1 to 425 days, with a mean duration of 28.8 days. Trials compared methylphenidate with placebo (200 trials) and with no intervention (12 trials). Only 165/212 trials included usable data on one or more outcomes from 14,271 participants. Of the 212 trials, we assessed 191 at high risk of bias and 21 at low risk of bias. If, however, deblinding of methylphenidate due to typical adverse events is considered, then all 212 trials were at high risk of bias. PRIMARY OUTCOMES methylphenidate versus placebo or no intervention may improve teacher-rated ADHD symptoms (standardised mean difference (SMD) -0.74, 95% confidence interval (CI) -0.88 to -0.61; I² = 38%; 21 trials; 1728 participants; very low-certainty evidence). This corresponds to a mean difference (MD) of -10.58 (95% CI -12.58 to -8.72) on the ADHD Rating Scale (ADHD-RS; range 0 to 72 points). The minimal clinically relevant difference is considered to be a change of 6.6 points on the ADHD-RS. Methylphenidate may not affect serious adverse events (risk ratio (RR) 0.80, 95% CI 0.39 to 1.67; I² = 0%; 26 trials, 3673 participants; very low-certainty evidence). The TSA-adjusted intervention effect was RR 0.91 (CI 0.31 to 2.68). SECONDARY OUTCOMES methylphenidate may cause more adverse events considered non-serious versus placebo or no intervention (RR 1.23, 95% CI 1.11 to 1.37; I² = 72%; 35 trials 5342 participants; very low-certainty evidence). The TSA-adjusted intervention effect was RR 1.22 (CI 1.08 to 1.43). Methylphenidate may improve teacher-rated general behaviour versus placebo (SMD -0.62, 95% CI -0.91 to -0.33; I² = 68%; 7 trials 792 participants; very low-certainty evidence), but may not affect quality of life (SMD 0.40, 95% CI -0.03 to 0.83; I² = 81%; 4 trials, 608 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS The majority of our conclusions from the 2015 version of this review still apply. Our updated meta-analyses suggest that methylphenidate versus placebo or no-intervention may improve teacher-rated ADHD symptoms and general behaviour in children and adolescents with ADHD. There may be no effects on serious adverse events and quality of life. Methylphenidate may be associated with an increased risk of adverse events considered non-serious, such as sleep problems and decreased appetite. However, the certainty of the evidence for all outcomes is very low and therefore the true magnitude of effects remain unclear. Due to the frequency of non-serious adverse events associated with methylphenidate, the blinding of participants and outcome assessors is particularly challenging. To accommodate this challenge, an active placebo should be sought and utilised. It may be difficult to find such a drug, but identifying a substance that could mimic the easily recognised adverse effects of methylphenidate would avert the unblinding that detrimentally affects current randomised trials. Future systematic reviews should investigate the subgroups of patients with ADHD that may benefit most and least from methylphenidate. This could be done with individual participant data to investigate predictors and modifiers like age, comorbidity, and ADHD subtypes.
Collapse
Affiliation(s)
- Ole Jakob Storebø
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Child and Adolescent Psychiatric Department, Region Zealand, Roskilde, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | | | | | - Maria Skoog
- Clinical Study Support, Clinical Studies Sweden - Forum South, Lund, Sweden
| | - Camilla Groth
- Pediatric Department, Herlev University Hospital, Herlev, Denmark
| | | | | | | | | | - Morris Zwi
- Islington Child and Adolescent Mental Health Service, Whittington Health, London, UK
| | - Richard Kirubakaran
- Cochrane India-CMC Vellore Affiliate, Prof. BV Moses Centre for Evidence Informed Healthcare and Health Policy, Christian Medical College, Vellore, India
| | - Erik Simonsen
- Research Unit, Mental Health services, Region Zealand Psychiatry, Roskilde, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital ─ Rigshospitalet, Copenhagen, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
2
|
Michelini G, Norman LJ, Shaw P, Loo SK. Treatment biomarkers for ADHD: Taking stock and moving forward. Transl Psychiatry 2022; 12:444. [PMID: 36224169 PMCID: PMC9556670 DOI: 10.1038/s41398-022-02207-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/20/2022] [Accepted: 09/23/2022] [Indexed: 11/09/2022] Open
Abstract
The development of treatment biomarkers for psychiatric disorders has been challenging, particularly for heterogeneous neurodevelopmental conditions such as attention-deficit/hyperactivity disorder (ADHD). Promising findings are also rarely translated into clinical practice, especially with regard to treatment decisions and development of novel treatments. Despite this slow progress, the available neuroimaging, electrophysiological (EEG) and genetic literature provides a solid foundation for biomarker discovery. This article gives an updated review of promising treatment biomarkers for ADHD which may enhance personalized medicine and novel treatment development. The available literature points to promising pre-treatment profiles predicting efficacy of various pharmacological and non-pharmacological treatments for ADHD. These candidate predictive biomarkers, particularly those based on low-cost and non-invasive EEG assessments, show promise for the future stratification of patients to specific treatments. Studies with repeated biomarker assessments further show that different treatments produce distinct changes in brain profiles, which track treatment-related clinical improvements. These candidate monitoring/response biomarkers may aid future monitoring of treatment effects and point to mechanistic targets for novel treatments, such as neurotherapies. Nevertheless, existing research does not support any immediate clinical applications of treatment biomarkers for ADHD. Key barriers are the paucity of replications and external validations, the use of small and homogeneous samples of predominantly White children, and practical limitations, including the cost and technical requirements of biomarker assessments and their unknown feasibility and acceptability for people with ADHD. We conclude with a discussion of future directions and methodological changes to promote clinical translation and enhance personalized treatment decisions for diverse groups of individuals with ADHD.
Collapse
Affiliation(s)
- Giorgia Michelini
- grid.4868.20000 0001 2171 1133Department of Biological and Experimental Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK ,grid.19006.3e0000 0000 9632 6718Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA USA
| | - Luke J. Norman
- grid.416868.50000 0004 0464 0574Office of the Clinical Director, NIMH, Bethesda, MD USA
| | - Philip Shaw
- grid.416868.50000 0004 0464 0574Office of the Clinical Director, NIMH, Bethesda, MD USA ,grid.280128.10000 0001 2233 9230Section on Neurobehavioral and Clinical Research, Social and Behavioral Research Branch, National Human Genome Research Institute, NIH, Bethesda, MD USA
| | - Sandra K. Loo
- grid.19006.3e0000 0000 9632 6718Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA USA
| |
Collapse
|
3
|
Arnett AB, Rutter TM, Stein MA. Neural Markers of Methylphenidate Response in Children With Attention Deficit Hyperactivity Disorder. Front Behav Neurosci 2022; 16:887622. [PMID: 35600991 PMCID: PMC9121006 DOI: 10.3389/fnbeh.2022.887622] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/05/2022] [Indexed: 01/09/2023] Open
Abstract
Background Despite widespread use of stimulants to treat ADHD, individual responses vary considerably and few predictors of response have been identified. The identification of reliable and clinically feasible biomarkers would facilitate a precision medicine approach to pharmacological treatment of ADHD. We test the hypothesis that two electroencephalography (EEG) based neural signatures of ADHD, resting aperiodic slope exponent and novelty P3 amplitude, are markers of methylphenidate response in children. We hypothesize that positive response to methylphenidate treatment will be associated with greater abnormality of both neural markers. Methods Twenty-nine 7-11 year-old children with ADHD and a history of methylphenidate treatment, and 30 controls completed resting EEG and visual oddball event related potential (ERP) paradigms. ADHD participants were characterized as methylphenidate responders (n = 16) or non-responders (n = 13) using the clinical global improvement (CGI-I) scale during blinded retrospective interview. All participants abstained from prescribed medications for at least 48 hours prior to the EEG. Results As expected, methylphenidate responders (CGI-I rating < 3) demonstrated attenuated P3 amplitude relative to controls. Unexpectedly, methylphenidate non-responders showed atypically flat aperiodic spectral slope relative to controls, while responders did not differ on this measure. Conclusion ADHD symptoms associated with atypical patterns of intrinsic neural activity may be less responsive to methylphenidate. In contrast, ADHD symptoms associated with abnormal frontal-striatal neural network excitation may be correctable with methylphenidate. Altogether, EEG is a feasible and promising candidate methodology for identifying biomarkers of stimulant response.
Collapse
Affiliation(s)
- Anne B Arnett
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Cambridge, MA, United States
| | - Tara M Rutter
- Department of Psychology, Seattle Pacific University, Seattle, WA, United States
| | - Mark A Stein
- Department of Psychiatry & Behavioral Medicine, Seattle Children's Hospital, Seattle, WA, United States.,Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, United States
| |
Collapse
|
4
|
Facial Expression Processing of Children Orphaned by Parental HIV/AIDS: A Cross-Sectional ERP Study with Rapid Serial Visual Presentation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18199995. [PMID: 34639297 PMCID: PMC8507910 DOI: 10.3390/ijerph18199995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/12/2021] [Accepted: 09/14/2021] [Indexed: 11/16/2022]
Abstract
Existing behavioral studies have suggested that individuals with early life stress usually show abnormal emotional processing. However, limited event-related brain potentials (ERPs) evidence was available to explore the emotional processes in children orphaned by parental HIV/AIDS ("AIDS orphans"). The current study aims to investigate whether there are behavioral and neurological obstacles in the recognition of emotional faces in AIDS orphans and also to further explore the processing stage at which the difference in facial emotion recognition exists. A total of 81 AIDS orphans and 60 non-orphan children were recruited through the local communities and school systems in Henan, China. Participants completed a computer version of the rapid serial visual presentation (RSVP) task while recording ERPs. Behavioral results showed that orphans displayed higher response accuracy and shorter reaction time than the control (ps < 0.05). As for the ERPs analysis, the attenuated amplitude of N170 (i.e., an early component sensitive to facial configuration) was observed in AIDS orphans compared to the non-orphan control with happy and neutral faces; P300 (i.e., an endogenous component for affective valence evaluation in emotional processing) also showed significant differences in parietal lobe between groups, the non-orphan control group produced larger P300 amplitudes than orphans (p < 0.05). The results suggested that compared to the control group, AIDS orphans showed impaired facial emotion recognition ability with reduced brain activation.
Collapse
|
5
|
Peisch V, Rutter T, Wilkinson CL, Arnett AB. Sensory processing and P300 event-related potential correlates of stimulant response in children with attention-deficit/hyperactivity disorder: A critical review. Clin Neurophysiol 2021; 132:953-966. [PMID: 33677205 PMCID: PMC7981253 DOI: 10.1016/j.clinph.2021.01.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/23/2020] [Accepted: 01/29/2021] [Indexed: 02/04/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder associated with considerable impairment in psychiatric and functional domains. Although stimulant medication can reduce core symptoms of inattention, hyperactivity, and impulsivity, a subgroup of patients does not respond to this intervention. A precision medicine approach has been proposed, whereby biomarkers are used to identify an effective treatment approach for a given individual. This review synthesizes the existing literature on event-related potential (ERP) correlates of stimulant response in children diagnosed with ADHD, with the goal of evaluating the potential for ERP to inform precision medicine care in this population. Forty-three articles were examined and results tentatively suggest that stimulant medications normalize the amplitude of the P300 component, and this is also associated with behavioral improvement. In contrast, results generally indicate that stimulants do not significantly alter early processing components, although there are some exceptions to this finding. Implications for research, theory, and clinical work are considered and concrete recommendations for future directions are provided. While recognizing limitations of existing literature (e.g., homogenous samples, variable methodologies), we conclude that ERP methods represent a promising approach for precision medicine care of patients with ADHD.
Collapse
Affiliation(s)
- Virginia Peisch
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA.
| | - Tara Rutter
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA; Department of Clinical Psychology, Seattle Pacific University, Seattle, WA, USA
| | - Carol L Wilkinson
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Anne B Arnett
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| |
Collapse
|
6
|
Rubinson M, Horowitz I, Naim-Feil J, Gothelf D, Levit-Binnun N, Moses E. Effects of methylphenidate on the ERP amplitude in youth with ADHD: A double-blind placebo-controlled cross-over EEG study. PLoS One 2019; 14:e0217383. [PMID: 31150439 PMCID: PMC6544236 DOI: 10.1371/journal.pone.0217383] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 05/11/2019] [Indexed: 11/18/2022] Open
Abstract
Methylphenidate (MPH) is a first line drug for attention-deficit/hyperactivity disorder (ADHD), yet the neuronal mechanisms underlying the condition and the treatment are still not fully understood. Previous EEG studies on the effect of MPH in ADHD found changes in evoked response potential (ERP) components that were inconsistent between studies. These inconsistencies highlight the need for a well-designed study which includes multiple baseline sessions and controls for possible fatigue, learning effects and between-days variability. To this end, we employ a double-blind placebo-controlled cross-over study and explore the effect of MPH on the ERP response of subjects with ADHD during a Go/No-Go cognitive task. Our ERP analysis revealed significant differences in ADHD subjects between the placebo and MPH conditions in the frontal-parietal region at 250ms-400ms post stimulus (P3). Additionally, a decrease in the late 650ms-800ms ERP component (LC) is observed in frontal electrodes of ADHD subjects compared to controls. The standard deviation of response time of ADHD subjects was significantly smaller in the MPH condition compared to placebo and correlated with the increased P3 ERP response in the frontoparietal electrodes. We suggest that mental fatigue plays a role in the decrease of the P3 response in the placebo condition compared to pre-placebo, a phenomenon that is significant in ADHD subjects but not in controls, and which is interestingly rectified by MPH.
Collapse
Affiliation(s)
- Mica Rubinson
- Department of Physics of Complex Systems, The Weizmann Institute of Science, Rehovot, Israel
- * E-mail:
| | - Itai Horowitz
- Beer Yaacov–Ness Ziona Mental Health Center, Beer Yaacov, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jodie Naim-Feil
- Department of Physics of Complex Systems, The Weizmann Institute of Science, Rehovot, Israel
| | - Doron Gothelf
- Child and Adolescent Psychiatry Unit, The Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Nava Levit-Binnun
- Sagol Center for Brain and Mind, School of Psychology, Interdisciplinary Center, Herzliya, Israel
| | - Elisha Moses
- Department of Physics of Complex Systems, The Weizmann Institute of Science, Rehovot, Israel
| |
Collapse
|
7
|
Griffiths KR, Jurigova BG, Leikauf JE, Palmer D, Clarke SD, Tsang TW, Teber ET, Kohn MR, Williams LM. A Signature of Attention-Elicited Electrocortical Activity Distinguishes Response From Non-Response to the Non-Stimulant Atomoxetine in Children and Adolescents With ADHD. J Atten Disord 2019; 23:744-753. [PMID: 28974127 PMCID: PMC8215986 DOI: 10.1177/1087054717733044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Atomoxetine has several characteristics that make it an attractive alternative to stimulants for treating ADHD, but there are currently no tests identifying individuals for whom the medication should be a first-line option. METHOD Within the ADHD Controlled Trial Investigation Of a Non-stimulant (ACTION) study, we examined neuro-cortical activity in 52 youth with ADHD. Baseline event-related potentials (ERP) were compared between those who subsequently responded to 6 weeks of atomoxetine versus those who did not. RESULTS Responders were distinguished by significantly lower auditory oddball N2 amplitudes than both non-responders and typically developing controls, particularly in the right frontocentral region ( p = .002, Cohen's d = 1.1). Leave-one-out cross validation determined that N2 amplitude in this region was able to accurately predict non-responders with a specificity of 80.8%. There were no P3 differences between responders and non-responders. CONCLUSION The N2 amplitude is a biomarker that may have utility in predicting response to atomoxetine for youth with ADHD.
Collapse
Affiliation(s)
- Kristi R. Griffiths
- Brain Dynamics Centre, The Westmead Institue for Medical Research, The University of Sydney, Westmead, New South Wales, Australia
| | - Barbora G. Jurigova
- Brain Dynamics Centre, The Westmead Institue for Medical Research, The University of Sydney, Westmead, New South Wales, Australia
| | - John E. Leikauf
- Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Donna Palmer
- Brain Resource, Sydney, New South Wales, Australia
| | - Simon D. Clarke
- Brain Dynamics Centre, The Westmead Institue for Medical Research, The University of Sydney, Westmead, New South Wales, Australia,Adolescent & Young Adult Medicine, Westmead Hospital, Westmead, New South Wales, Australia,Centre for Research into Adolescents Health, Westmead, New South Wales, Australia
| | - Tracey W. Tsang
- Brain Dynamics Centre, The Westmead Institue for Medical Research, The University of Sydney, Westmead, New South Wales, Australia,Discipline of Child & Adolescent Health, Sydney Medical School, University of Sydney, New South Wales, Australia
| | - Erdahl T. Teber
- Children's Medical Research Institute, Westmead, New South Wales, Australia
| | - Michael R. Kohn
- Brain Dynamics Centre, The Westmead Institue for Medical Research, The University of Sydney, Westmead, New South Wales, Australia,Adolescent & Young Adult Medicine, Westmead Hospital, Westmead, New South Wales, Australia,Centre for Research into Adolescents Health, Westmead, New South Wales, Australia
| | - Leanne M. Williams
- Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| |
Collapse
|
8
|
Ogrim G, Kropotov JD. Predicting Clinical Gains and Side Effects of Stimulant Medication in Pediatric Attention-Deficit/Hyperactivity Disorder by Combining Measures From qEEG and ERPs in a Cued GO/NOGO Task. Clin EEG Neurosci 2019; 50:34-43. [PMID: 29940782 PMCID: PMC6291902 DOI: 10.1177/1550059418782328] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The study aim was to develop 2 scales: predicting clinical gains and risk of acute side effects of stimulant medication in pediatric attention-deficit/hyperactivity disorder (ADHD), combining measures from EEG spectra, event-related potentials (ERPs), and a cued visual GO/NOGO task. METHODS Based on 4-week systematic medication trials, 87 ADHD patients aged 8 to 17 years were classified as responders (REs, n = 62) or non-REs (n = 25), and belonging to the side effects (SEs, n = 42) or no-SEs (n = 45) groups. Before starting the trial, a 19-channel EEG was registered twice: Test 1 (T1) without medication and T2 on a single dose of stimulant medication a few days before the trial. EEG was registered T1 and T2: 3 minutes eyes-closed, 3 minutes eyes-open, and 20 minutes cued GO/NOGO. EEG spectra, ERPs, omissions, commissions, reaction time (RT), and RT variability were computed. Groups were compared at T1 and T2 on quantitative EEG (qEEG), ERPs and behavioral parameters; effect sizes ( d) were estimated. Variables with d > 0.5 were converted to quartiles, multiplied by corresponding d, and summed to obtain 2 global scales. RESULTS Six variables differed significantly between REs and non-REs (T1: theta/alpha ratio, P3NOGO amplitude. Differences T2-T1: Omissions, RT variability, P3NOGO, contingent negative variation [CNV]). The global scale d was 1.86. Accuracy (receiver operating characteristic) was 0.92. SEs and no-SEs differed significantly on 4 variables. (T1: RT, T2: novelty component and alpha peak frequency, and RT changes. Global scale d = 1.08 and accuracy = 0.78. CONCLUSION Gains and side effects of stimulants in pediatric ADHD can be predicted with high accuracy by combining EEG spectra, ERPs, and behavior from baseline and single-dose tests. ClinicalTrials.gov identifier: NCT02695355.
Collapse
Affiliation(s)
- Geir Ogrim
- 1 Neuropsychiatric Unit, Østfold Hospital Trust, Fredrikstad, Norway.,2 Institute of Psychology, Norwegian University of Science and Technology, Trondheim, Norway.,3 Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden
| | - Juri D Kropotov
- 4 P. Bechtereva Institute of the Human Brain, Russian Academy of Sciences, St Petersburg, Russia.,5 Department of Neuropsychology, Andrzej Frycz-Modrzewski Krakow University, Krakow, Poland
| |
Collapse
|
9
|
Dolu N, Altınkaynak M, Güven A, Özmen S, Demirci E, İzzetoğlu M, Pektaş F. Effects of methylphenidate treatment in children with ADHD: a multimodal EEG/fNIRS approach. PSYCHIAT CLIN PSYCH 2018. [DOI: 10.1080/24750573.2018.1542779] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Nazan Dolu
- Department of Physiology, Medical Faculty, Başkent University, Ankara, Turkey
| | - Miray Altınkaynak
- Department of Biomedical Engineering, Engineering Faculty, Erciyes University, Kayseri, Turkey
| | - Ayşegül Güven
- Department of Biomedical Engineering, Engineering Faculty, Erciyes University, Kayseri, Turkey
| | - Sevgi Özmen
- Department of Child Psychiatry, Medical Faculty, Erciyes University, Kayseri, Turkey
| | - Esra Demirci
- Department of Child Psychiatry, Medical Faculty, Erciyes University, Kayseri, Turkey
| | - Meltem İzzetoğlu
- Electrical and Computer Engineering Department, Villanova University, Villanova, USA
| | - Ferhat Pektaş
- Department of Physiology, Medical Faculty, Altınbaş University, İstanbul, Turkey
| |
Collapse
|
10
|
Yamamuro K, Ota T, Iida J, Nakanishi Y, Matsuura H, Uratani M, Okazaki K, Kishimoto N, Tanaka S, Kishimoto T. Event-related potentials reflect the efficacy of pharmaceutical treatments in children and adolescents with attention deficit/hyperactivity disorder. Psychiatry Res 2016; 242:288-294. [PMID: 27318633 DOI: 10.1016/j.psychres.2016.05.061] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 05/31/2016] [Accepted: 05/31/2016] [Indexed: 11/19/2022]
Abstract
Few objective biological measures of pharmacological treatment efficacy exist for attention deficit/hyperactivity disorder (ADHD). Although we have previously demonstrated that event-related potentials (ERPs) reflect the effects of osmotic-release methylphenidate in treatment of naïve pediatric patients with ADHD, whether this is true for the therapeutic effects of atomoxetine (ATX) is unknown. Here, we used the Japanese version of the ADHD rating-scale IV to evaluate 14 patients with ADHD, and compared their ERP data with 14 age- and sex-matched controls. We measured P300 and mismatch negativity (MMN) components during an auditory oddball task before treatment (treatment naïve) and after 2 months of ATX treatment. Compared with controls, P300 components at baseline were attenuated and prolonged in the ADHD group at Fz (fronto-central), Cz (centro-parietal), Pz (parietal regions), C3 and C4 electrodes. ATX treatment reduced ADHD symptomology, and after 2 months of treatment, P300 latencies at Fz, Cz, Pz, C3, and C4 electrodes were significantly shorter than those at baseline. Moreover, MMN amplitudes at Cz and C3 electrodes were significantly greater than those at baseline. Thus, ERPs may be useful for evaluating the pharmacological effects of ATX in pediatric and adolescent patients with ADHD.
Collapse
Affiliation(s)
- Kazuhiko Yamamuro
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Toyosaku Ota
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan.
| | - Junzo Iida
- Faculty of Nursing, Nara Medical University School of Medicine, Kashihara, Japan
| | - Yoko Nakanishi
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | | | - Mitsuhiro Uratani
- Department of Psychiatry, Nara Prefectural General Rehabilitation Center, Shiki, Japan
| | - Kosuke Okazaki
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Naoko Kishimoto
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Shohei Tanaka
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Toshifumi Kishimoto
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| |
Collapse
|
11
|
Ogrim G, Aasen IE, Brunner JF. Single-dose effects on the P3no-go ERP component predict clinical response to stimulants in pediatric ADHD. Clin Neurophysiol 2016; 127:3277-87. [PMID: 27567447 DOI: 10.1016/j.clinph.2016.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 06/20/2016] [Accepted: 07/23/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Approximately 30% of children and adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD) and treated with stimulants are considered non-responders (non-REs). Reliable predictors of response are missing. We examined changes in Event-Related Potentials (ERPs) induced by a single dose of stimulant medication in order to predict later clinical response. METHODS ERPs were registered twice during performance of a visual cued go/no-go task in 87 ADHD patients (27 girls) aged 8-18years; the second recording on a single dose of stimulant medication, followed by a systematic medication trial lasting 4weeks. Based on the four-week trial, participants were categorized as responders (REs, N=62) or non-REs (N=25). Changes among REs and non-REs in ERP components (cueP3, CNV, P3go, N2no-go, P3no-go) and behavioral-test variables were then compared. RESULTS REs and non-REs differed significantly in medication-induced changes in P3no-go, cue-P3, CNV, omission errors, reaction time, and reaction-time variability. The largest effect size was found for P3no-go amplitude (p<.001; d=1.76). Changes in P3no-go and omission errors correctly classified 90% of the REs and 76% of the non-REs, when controlling for the age of the participants. CONCLUSION Clinical response to stimulants can be predicted by assessing single-dose changes in the P3no-go ERP component amplitude. SIGNIFICANCE Changes in P3no-go may be a clinically useful marker of response to stimulants.
Collapse
Affiliation(s)
- Geir Ogrim
- Neuropsychiatric Unit, Østfold Hospital Trust, Aasebraatveien 27, 1605 Fredrikstad, Norway; Institute of Psychology, Norwegian University of Science and Technology, 7491 Trondheim, Norway.
| | - Ida Emilia Aasen
- Institute of Psychology, Norwegian University of Science and Technology, 7491 Trondheim, Norway; Department of Neuropsychology, Helgeland Hospital, 8656 Mosjøen, Norway.
| | - Jan Ferenc Brunner
- Institute of Psychology, Norwegian University of Science and Technology, 7491 Trondheim, Norway; Department of Neuropsychology, Helgeland Hospital, 8656 Mosjøen, Norway; Department of Neuroscience, NTNU, 7491 Trondheim, Norway.
| |
Collapse
|
12
|
Storebø OJ, Ramstad E, Krogh HB, Nilausen TD, Skoog M, Holmskov M, Rosendal S, Groth C, Magnusson FL, Moreira‐Maia CR, Gillies D, Buch Rasmussen K, Gauci D, Zwi M, Kirubakaran R, Forsbøl B, Simonsen E, Gluud C. Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD). Cochrane Database Syst Rev 2015; 2015:CD009885. [PMID: 26599576 PMCID: PMC8763351 DOI: 10.1002/14651858.cd009885.pub2] [Citation(s) in RCA: 156] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed and treated psychiatric disorders in childhood. Typically, children with ADHD find it difficult to pay attention, they are hyperactive and impulsive.Methylphenidate is the drug most often prescribed to treat children and adolescents with ADHD but, despite its widespread use, this is the first comprehensive systematic review of its benefits and harms. OBJECTIVES To assess the beneficial and harmful effects of methylphenidate for children and adolescents with ADHD. SEARCH METHODS In February 2015 we searched six databases (CENTRAL, Ovid MEDLINE, EMBASE, CINAHL, PsycINFO, Conference Proceedings Citations Index), and two trials registers. We checked for additional trials in the reference lists of relevant reviews and included trials. We contacted the pharmaceutical companies that manufacture methylphenidate to request published and unpublished data. SELECTION CRITERIA We included all randomised controlled trials (RCTs) comparing methylphenidate versus placebo or no intervention in children and adolescents aged 18 years and younger with a diagnosis of ADHD. At least 75% of participants needed to have an intellectual quotient of at least 70 (i.e. normal intellectual functioning). Outcomes assessed included ADHD symptoms, serious adverse events, non-serious adverse events, general behaviour and quality of life. DATA COLLECTION AND ANALYSIS Seventeen review authors participated in data extraction and risk of bias assessment, and two review authors independently performed all tasks. We used standard methodological procedures expected within Cochrane. Data from parallel-group trials and first period data from cross-over trials formed the basis of our primary analyses; separate analyses were undertaken using post-cross-over data from cross-over trials. We used Trial Sequential Analyses to control for type I (5%) and type II (20%) errors, and we assessed and downgraded evidence according to the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach for high risk of bias, imprecision, indirectness, heterogeneity and publication bias. MAIN RESULTS The studies.We included 38 parallel-group trials (5111 participants randomised) and 147 cross-over trials (7134 participants randomised). Participants included individuals of both sexes, at a boys-to-girls ratio of 5:1, and participants' ages ranged from 3 to 18 years across most studies (in two studies ages ranged from 3 to 21 years). The average age across all studies was 9.7 years. Most participants were from high-income countries.The duration of methylphenidate treatment ranged from 1 to 425 days, with an average duration of 75 days. Methylphenidate was compared to placebo (175 trials) or no intervention (10 trials). Risk of Bias.All 185 trials were assessed to be at high risk of bias. Primary outcomes. Methylphenidate may improve teacher-rated ADHD symptoms (standardised mean difference (SMD) -0.77, 95% confidence interval (CI) -0.90 to -0.64; 19 trials, 1698 participants; very low-quality evidence). This corresponds to a mean difference (MD) of -9.6 points (95% CI -13.75 to -6.38) on the ADHD Rating Scale (ADHD-RS; range 0 to 72 points; DuPaul 1991a). A change of 6.6 points on the ADHD-RS is considered clinically to represent the minimal relevant difference. There was no evidence that methylphenidate was associated with an increase in serious (e.g. life threatening) adverse events (risk ratio (RR) 0.98, 95% CI 0.44 to 2.22; 9 trials, 1532 participants; very low-quality evidence). The Trial Sequential Analysis-adjusted intervention effect was RR 0.91 (CI 0.02 to 33.2). SECONDARY OUTCOMES Among those prescribed methylphenidate, 526 per 1000 (range 448 to 615) experienced non-serious adverse events, compared with 408 per 1000 in the control group. This equates to a 29% increase in the overall risk of any non-serious adverse events (RR 1.29, 95% CI 1.10 to 1.51; 21 trials, 3132 participants; very low-quality evidence). The Trial Sequential Analysis-adjusted intervention effect was RR 1.29 (CI 1.06 to 1.56). The most common non-serious adverse events were sleep problems and decreased appetite. Children in the methylphenidate group were at 60% greater risk for trouble sleeping/sleep problems (RR 1.60, 95% CI 1.15 to 2.23; 13 trials, 2416 participants), and 266% greater risk for decreased appetite (RR 3.66, 95% CI 2.56 to 5.23; 16 trials, 2962 participants) than children in the control group.Teacher-rated general behaviour seemed to improve with methylphenidate (SMD -0.87, 95% CI -1.04 to -0.71; 5 trials, 668 participants; very low-quality evidence).A change of seven points on the Child Health Questionnaire (CHQ; range 0 to 100 points; Landgraf 1998) has been deemed a minimal clinically relevant difference. The change reported in a meta-analysis of three trials corresponds to a MD of 8.0 points (95% CI 5.49 to 10.46) on the CHQ, which suggests that methylphenidate may improve parent-reported quality of life (SMD 0.61, 95% CI 0.42 to 0.80; 3 trials, 514 participants; very low-quality evidence). AUTHORS' CONCLUSIONS The results of meta-analyses suggest that methylphenidate may improve teacher-reported ADHD symptoms, teacher-reported general behaviour, and parent-reported quality of life among children and adolescents diagnosed with ADHD. However, the low quality of the underpinning evidence means that we cannot be certain of the magnitude of the effects. Within the short follow-up periods typical of the included trials, there is some evidence that methylphenidate is associated with increased risk of non-serious adverse events, such as sleep problems and decreased appetite, but no evidence that it increases risk of serious adverse events.Better designed trials are needed to assess the benefits of methylphenidate. Given the frequency of non-serious adverse events associated with methylphenidate, the particular difficulties for blinding of participants and outcome assessors point to the advantage of large, 'nocebo tablet' controlled trials. These use a placebo-like substance that causes adverse events in the control arm that are comparable to those associated with methylphenidate. However, for ethical reasons, such trials should first be conducted with adults, who can give their informed consent.Future trials should publish depersonalised individual participant data and report all outcomes, including adverse events. This will enable researchers conducting systematic reviews to assess differences between intervention effects according to age, sex, comorbidity, type of ADHD and dose. Finally, the findings highlight the urgent need for large RCTs of non-pharmacological treatments.
Collapse
Affiliation(s)
- Ole Jakob Storebø
- Region ZealandChild and Adolescent Psychiatric DepartmentBirkevaenget 3RoskildeDenmark4300
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
- University of Southern DenmarkDepartment of Psychology, Faculty of Health ScienceCampusvej 55OdenseDenmark5230
| | - Erica Ramstad
- Region ZealandChild and Adolescent Psychiatric DepartmentBirkevaenget 3RoskildeDenmark4300
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
| | - Helle B. Krogh
- Region ZealandChild and Adolescent Psychiatric DepartmentBirkevaenget 3RoskildeDenmark4300
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
| | | | | | | | - Susanne Rosendal
- Psychiatric Centre North ZealandThe Capital Region of DenmarkDenmark
| | - Camilla Groth
- Herlev University HospitalPediatric DepartmentCapital RegionHerlevDenmark
| | | | - Carlos R Moreira‐Maia
- Federal University of Rio Grande do SulDepartment of PsychiatryRua Ramiro Barcelos, 2350‐2201APorto AlegreRSBrazil90035‐003
| | - Donna Gillies
- Western Sydney Local Health District ‐ Mental HealthCumberland HospitalLocked Bag 7118ParramattaNSWAustralia2124
| | | | - Dorothy Gauci
- Department of HealthDirectorate for Health Information and Research95 G'Mangia HillG'MangiaMaltaPTA 1313
| | - Morris Zwi
- Whittington HealthIslington Child and Adolescent Mental Health Service580 Holloway RoadLondonLondonUKN7 6LB
| | - Richard Kirubakaran
- Christian Medical CollegeCochrane South Asia, Prof. BV Moses Center for Evidence‐Informed Health Care and Health PolicyCarman Block II FloorCMC Campus, BagayamVelloreTamil NaduIndia632002
| | - Bente Forsbøl
- Psychiatric Department, Region ZealandChild and Adolescent Psychiatric ClinicHolbaekDenmark
| | - Erik Simonsen
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
- Copenhagen UniversityInstitute of Clinical Medicine, Faculty of Health and Medical SciencesCopenhagenDenmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalThe Cochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
- Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchCopenhagenDenmark
| | | |
Collapse
|
13
|
Sangal RB, Sangal JM. Use of EEG Beta-1 Power and Theta/Beta Ratio Over Broca's Area to confirm Diagnosis of Attention Deficit/Hyperactivity Disorder in Children. Clin EEG Neurosci 2015; 46:177-82. [PMID: 24973230 DOI: 10.1177/1550059414527284] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 02/08/2014] [Indexed: 11/17/2022]
Abstract
The Food and Drug Administration has approved a medical device using the electroencephalogram (EEG) theta/beta ratio (tbr) to help assess pediatric attention deficit/hyperactivity disorder (ADHD). Tbr is reported to be higher in ADHD, with increased theta and decreased beta. This study examined theta and beta-1 power differences between ADHD and normal children, during tasks of selective attention, and elucidated topographical differences. EEGs were collected from 28 normal and 58 ADHD children, aged 6 to 14 years, using 31 scalp electrodes during auditory and visual tasks requiring selective attention. Spectral analysis was performed. Tbr was higher in ADHD than in normal children (2.60 vs 2.25, P = .007), with lower beta-1 (3.66 vs 4.22, P = .01), but no difference in theta power. There was lower beta-1 (P < .001) and higher tbr (P = .002) over Broca's area (electrode locations F7 and FC5). Beta-1 power over Broca's area was the best diagnostic test, with sensitivity 0.86 and specificity 0.57. Tbr is higher and beta-1 power lower in ADHD than in normal children, especially over Broca's area. Beta-1 power and tbr assist in confirming the diagnosis of ADHD in a sample with moderate pretest probability of ADHD.
Collapse
Affiliation(s)
- R Bart Sangal
- Attention Disorders Institute, Sterling Heights, MI, USA Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | | |
Collapse
|
14
|
Rostain A, Jensen PS, Connor DF, Miesle LM, Faraone SV. Toward quality care in ADHD: defining the goals of treatment. J Atten Disord 2015; 19:99-117. [PMID: 23422237 DOI: 10.1177/1087054712473835] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Therapeutic goals for chronic mental disorders like major depressive disorder (MDD) and schizophrenia have evolved in parallel with the growing medical knowledge about the course and treatment of these disorders. Although the knowledge base regarding the clinical course of ADHD, a chronic psychiatric disorder, has evolved beyond symptomatic improvement and short-term treatment response, long-term goals, such as functional remission, have not yet been clearly defined. METHOD A PubMed literature search was conducted to investigate the therapeutic goals of pharmacologic treatment referenced in the published literature from January 1998 through February 2010 using the following commonly used ADHD treatments as keywords: amphetamine, methylphenidate, atomoxetine, lisdexamfetamine, guanfacine, and clonidine. This search was then combined with an additional search that included the following outcome keywords: remission, relapse, remit, response, normal, normalization, recovery, and effectiveness. RESULTS Our search identified 102 publications. The majority (88.2% [90/102]) of these contained predefined criteria for treatment response. Predefined criteria for normalization and remission and/or relapse were presented in 4.9% (5/102), 12.7% (13/102), and 3.9% (4/102) of publications, respectively. There was a lack of consistency between the instruments used to measure outcomes as well as the criteria used to define treatment response, normalization, and remission as well as relapse. CONCLUSION The therapeutic goals in treating ADHD should address optimal treatment outcomes that go beyond modest reductions of ADHD symptoms to include syndromatic, symptomatic, and functional remission. Future work should focus on reliable and valid tools to measure these outcomes in the clinical trial setting.
Collapse
Affiliation(s)
| | - Peter S Jensen
- The REACH Institute, New York, NY, USA Mayo Clinic, Rochester, MN, USA
| | - Daniel F Connor
- University of Connecticut School of Medicine, Farmington, USA
| | | | | |
Collapse
|
15
|
Ogrim G, Kropotov J, Brunner JF, Candrian G, Sandvik L, Hestad KA. Predicting the clinical outcome of stimulant medication in pediatric attention-deficit/hyperactivity disorder: data from quantitative electroencephalography, event-related potentials, and a go/no-go test. Neuropsychiatr Dis Treat 2014; 10:231-42. [PMID: 24523588 PMCID: PMC3921081 DOI: 10.2147/ndt.s56600] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND We searched for predictors of the clinical outcome of stimulant medication in pediatric attention-deficit/hyperactivity disorder (ADHD), emphasizing variables from quantitative electroencephalography, event-related potentials (ERPs), and behavioral data from a visual go/no-go test. METHODS Nineteen-channel electroencephalography (EEG) was recorded during the resting state in eyes-open and eyes-closed conditions and during performance of the cued go/no-go task in 98 medication-naïve ADHD patients aged 7-17 years and in 90 controls with the same age and sex distribution as the patients. For patients, the recording was followed by a systematic trial on stimulant medication lasting at least 4 weeks. Based on data from rating scales and interviews, two psychologists who were blind to the electrophysiological results independently rated the patients as responders (REs) (N=74) or non-responders (non-REs) (N=24). Using a logistic regression model, comparisons were made between REs and non-REs on the EEG spectra, ERPs (cue P3, contingent negative variation, and P3 no-go of the ERP waves and independent components [ICs] extracted from these waves), reaction time, reaction time variability, number of commission and omission errors, intelligence quotient, age, sex, ADHD subtype, and comorbidities. RESULTS The two groups differed significantly on eight of the variables, with effect sizes (Cohen's d) ranging from 0.49 to 0.76. In the multivariate logistic regression analysis, only three of these variables were significantly associated with clinical outcome. The amplitude of the IC cue P3, which has a parietal-occipital distribution, was normal in REs but significantly smaller in non-REs, whereas the centrally distributed IC P3 no-go early was smaller in REs than in non-REs and controls. In addition, the REs had more power in the EEG theta band. A quartile-based index was calculated using these three variables. The group with the lowest scores comprised only 36% REs; response rates in the three other groups were 83%, 86%, and 89%. CONCLUSION The clinical outcome of stimulant medication was best predicted by electrophysiological parameters. The brain dysfunctions of the REs appear to be primarily associated with prefrontal lobe hypoactivation. The non-REs were deviant from the controls in parietal-occipital functions.
Collapse
Affiliation(s)
- Geir Ogrim
- Neuropsychiatric Unit, Østfold Hospital Trust, Fredrikstad, Norway ; National Resource Center for ADHD, Tourette's Syndrome, and Narcolepsy, Oslo, Norway ; Institute of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Juri Kropotov
- Institute of Psychology, Norwegian University of Science and Technology, Trondheim, Norway ; Institute of the Human Brain, Russian Academy of Sciences, Saint Petersburg, Russia ; Department of Neuropsychology, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | - Jan Ferenc Brunner
- Institute of Psychology, Norwegian University of Science and Technology, Trondheim, Norway ; Department of Physical Medicine and Rehabilitation, St Olav's Hospital, Trondheim, Norway ; Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Leiv Sandvik
- Oslo University Hospital, Department of Biostatistics, Epidemiology, and Health Economy, Oslo, Norway
| | - Knut A Hestad
- Institute of Psychology, Norwegian University of Science and Technology, Trondheim, Norway ; Division of Mental Health, Innlandet Hospital Trust, Brumunddal, Norway
| |
Collapse
|
16
|
Kratz O, Studer P, Baack J, Malcherek S, Erbe K, Moll GH, Heinrich H. Differential effects of methylphenidate and atomoxetine on attentional processes in children with ADHD: an event-related potential study using the Attention Network Test. Prog Neuropsychopharmacol Biol Psychiatry 2012; 37:81-9. [PMID: 22227291 DOI: 10.1016/j.pnpbp.2011.12.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 12/13/2011] [Accepted: 12/19/2011] [Indexed: 11/17/2022]
Abstract
Methylphenidate (MPH) and atomoxetine (ATX) are effective medications in the treatment of attention deficit/hyperactivity disorder (ADHD). The aim of this study was to investigate differential effects of MPH and ATX on attentional functions at the performance and the neuronal level in children with ADHD. Using the Attention Network Test (ANT), differential effects of both medications on the noradrenergic alerting network and the dopaminergic executive attention network were considered. Nineteen children with ADHD performed the ANT three times while event-related potentials (ERPs) were recorded. The baseline testing was conducted without medication. In two medication blocks of 8 weeks each, medication was individually titrated for each child (cross-over design, balanced order). At the end of the medication blocks the testing was repeated. While both medications comparably reduced ADHD symptomatology, MPH had some advantages over ATX with regard to performance measures on the ANT and the underlying neuronal mechanisms. Compared with ATX, MPH led to a larger reduction in reaction time variability, which was accompanied by an MPH-related increase in the contingent negative variation (CNV) compared to the baseline testing. Contrary to our expectations, specific alerting network effects were not observed with ATX. Due to the chosen study design, it remains unresolved to what extent e.g. shortened reaction times and smaller conflict scores that were observed with both medications reflect practice or medication effects. The differential pattern of MPH vs. ATX effects on attentional functions in children with ADHD may be explained by the dopaminergic effects of MPH within the cortico-striato-thalamo-cortical circuit.
Collapse
Affiliation(s)
- Oliver Kratz
- Department of Child & Adolescent Mental Health, University of Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany.
| | | | | | | | | | | | | |
Collapse
|
17
|
Tsai ML, Hung KL, Lu HH. Auditory event-related potentials in children with attention deficit hyperactivity disorder. Pediatr Neonatol 2012; 53:118-24. [PMID: 22503259 DOI: 10.1016/j.pedneo.2012.01.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 06/02/2011] [Accepted: 06/30/2011] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Recording of event-related potentials (ERPs) from the scalp is a noninvasive technique reflecting the sensory and cognitive processes associated with attention tasks. Attention deficit hyperactivity disorder (ADHD) is a disorder involving deficits in attention and behavioral control. The aim of this study was to investigate the difference in ERPs between normal children and those with ADHD. METHODS We examined 50 children with ADHD and 51 age-matched controls. All children with ADHD met the full criteria for ADHD according to Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). The auditory oddball paradigm was applied, and event-related long-latency components (N1, P2, N2 and P3) from Fz, Cz and Pz were measured in each test subject. RESULTS Children with ADHD showed a significantly longer latency and a lower amplitude of P3 compared to normal control children (p < 0.01). Delayed N2 latency at the Pz electrode was shown in children with ADHD compared to normal controls (p < 0.01). No differences in other ERP indices were found between children with ADHD and controls. When divided into four age groups, the latency of P3 was significantly increased in all age groups and a significantly smaller amplitude in P3 over the central region was found in children with ADHD > 10 years of age (p < 0.05). CONCLUSION We found that the endogenous ERPs (P3 and N2) were significantly affected in children with ADHD, compared to exogenous ERPs (N1 and P2). Increased latency of P3 suggests a slower processing speed, and decreased P3 amplitude is interpreted as disruption of inhibitory control in children with ADHD. These results indicate a neurocognitive abnormality in ADHD, as presented by a reduction in ERP response.
Collapse
Affiliation(s)
- Min-Lan Tsai
- Department of Pediatrics, Cheng-Hsin General Hospital, Taipei, Taiwan.
| | | | | |
Collapse
|
18
|
Abstract
Refinements in the methods of diagnosis for psychiatric disorders are critically needed. These new methods should be based on objectively measured brain characteristics that provide clinically useful information. Studying the brain with respect to psychiatric disorders, however, faces numerous challenges. Utilizing techniques learned in other areas of medicine to deal with symptoms that lead to complex disorders can provide insight into improving diagnostic models in psychiatry. Specifically, many areas of medicine use objective measures of an organ's function or characteristic to guide clinical management of particular subjective complaints. In psychiatry, an objectively measured brain characteristic that provides clinically useful information is proposed to be that person's "phronotype." Important requirements to developing phronotypes are discussed. Identifying phronotypes in psychiatry will require a specific investigative approach that must be grounded in rigorous scientific methodology. Successfully developing such markers will have a profound impact on clinical care, clinical research, basic science research, and most importantly the lives of those suffering from these illnesses.
Collapse
Affiliation(s)
- F Andrew Kozel
- Department of Psychiatry, University of Texas Southwestern Medical Center Dallas, TX, USA
| |
Collapse
|
19
|
Merzagora AC, Butti M, Polikar R, Izzetoglu M, Bunce S, Cerutti S, Bianchi AM, Onaral B. Model comparison for automatic characterization and classification of average ERPs using visual oddball paradigm. Clin Neurophysiol 2008; 120:264-74. [PMID: 19062338 DOI: 10.1016/j.clinph.2008.10.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Revised: 09/09/2008] [Accepted: 10/11/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine whether automated classifiers can be used for correctly identifying target categorization responses from averaged event-related potentials (ERPs) along with identifying appropriate features and classification models for computer-assisted investigation of attentional processes. METHODS ERPs were recorded during a target categorization task. Automated classification of average target ERPs versus average non-target ERPs was performed by extracting different combinations of features from the P300 and N200 components, which were used to train six classifiers: Euclidean classifier (EC), Mahalanobis discriminant (MD), quadratic classifier (QC), Fisher linear discriminant (FLD), multi-layer perceptron neural network (MLP) and support vector machine (SVM). RESULTS The best classification performance (accuracy: 91-92%; sensitivity: 85-86%; specificity: 95-99%) was provided by QC, MLP, SVM on feature vectors extracted from P300 recorded at multiple sites. In general, non-linear and non-parametric classifiers (QC, MLP, SVM) performed better than linear classifiers (EC, MD, FLD). The N200 did not explain variance beyond that of P300 recorded at multiple sites. CONCLUSIONS The results suggest that automatic characterization and classification of average target and non-target ERPs is feasible. Features of P300 recorded at multiple sites used to train non-linear classifiers are recommended for optimal classification performance. SIGNIFICANCE Automatic characterization of target ERPs can provide an objective approach for detecting and diagnosing abnormalities and evaluating interventions for clinical populations, paving the way for future real-time monitoring of attentional processes.
Collapse
Affiliation(s)
- A C Merzagora
- School of Biomedical Engineering, Science and Health Systems, Drexel University, 3141 Chestnut Street, Philadelphia, PA 19104, USA.
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Monastra VJ. Quantitative electroencephalography and attention-deficit/hyperactivity disorder: implications for clinical practice. Curr Psychiatry Rep 2008; 10:432-8. [PMID: 18803918 DOI: 10.1007/s11920-008-0069-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although behavioral symptoms of inattention, impulsivity, and hyperactivity serve as a foundation for the accurate diagnosis of attention-deficit/hyperactivity disorder (ADHD), the low interrater reliability and specificity of behavioral rating scales and the absence of comprehensive screening for medical conditions that mimic ADHD have created a barrier to the effective treatment of ADHD. Recently published studies using quantitative electroencephalographic techniques have identified abnormal patterns of cortical activation through power spectral analysis, in event-related cortical potentials, and in slow cortical potentials that may serve as a basis for overcoming these barriers. This paper reviews the initial evidence indicating that power spectral analysis and event-related cortical potentials may be useful in differentiating ADHD from other psychiatric disorders, helping in medication selection, evaluating medication response, and improving the rate of treatment initiation and maintenance. Studies examining electroencephalogram biofeedback (neurotherapy) are reviewed using published efficacy guidelines.
Collapse
Affiliation(s)
- Vincent J Monastra
- FPI Attention Disorders Clinic, Department of Psychology, Binghamton University, 94 Marshall Drive, Endicott, NY 13760, USA.
| |
Collapse
|
21
|
Abstract
The purpose of this review is to summarize the neurobiological factors involved in the etiology of adolescent addiction and present evidence implicating various mechanisms in its development. Adolescents are at heightened risk for experimentation with substances, and early experimentation is associated with higher rates of SUD in adulthood. Both normative (e.g., immature frontal-limbic connections, immature frontal lobe development) and non-normative (e.g., lowered serotonergic function, abnormal hypothalamic-pituitary-adrenal axis function) neurobiological developmental factors can predispose adolescents to a heightened risk for SUD. In addition, a normative imbalance in the adolescent neurobiological motivational system may be caused by the relative underdevelopment of suppressive mechanisms when compared to stimulatory systems. These neurobiological liabilities may correspond to neurobehavioral impairments in decision-making, affiliation with deviant peers and externalizing behavior; these and other cognitive and behavioral traits converge with neurobiological factors to increase SUD risk. The progression to SUD acts as an amplifying feedback loop, where the development of SUD results in reciprocal impairments in neurobehavioral and neurobiological processes. A clearer understanding of adolescent neurobiology is a necessary step in the development of prevention and treatment interventions for adolescent SUD.
Collapse
Affiliation(s)
- Ty S Schepis
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | | | | |
Collapse
|
22
|
Okamura N. [Effect of mental fatigue induced by repeated continuous calculation tasks on event-related brain potential (P300)]. SANGYO EISEIGAKU ZASSHI = JOURNAL OF OCCUPATIONAL HEALTH 2007; 49:203-8. [PMID: 17938559 DOI: 10.1539/sangyoeisei.49.203] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It is well known that the amplitude and latency of P300 in event-related brain potentials (ERPs) evoked by performing the oddball paradigm reflect the extent of individuals' selective attention. The purpose of this study was to examine whether P300 is a reliable measure for evaluating mental fatigue. In addition to the measurement of auditory ERPs derived from Fz, Cz and Pz, the concentrations of lactic acid, cortisol in plasma and the reaction time of the oddball paradigm, which are believed to reflect fatigue, were measured. In an attempt to cause mental fatigue, 12 healthy college students (8 males, 4 females; 19.5 +/- 0.5 yr; mean +/- S.D.) were forced to perform a continuous addition task using the Uchida-Kreperin test paper for about 2 h. Before the task, the latencies of P300 in Fz, Cz and Pz were 295.6 +/- 8.7 msec, 298.8 +/- 8.5 msec and 297.5 +/- 7.2 msec (mean +/- S.D.), respectively, and after the task they were 312.6 +/- 11.2 msec, 314.6 +/- 10.1 msec and 315.8 +/- 8.7 msec, respectively. A significant difference in the latency before and after the task was detected (p<0.01). In all subjects, the latency of P300 was prolonged in all recording positions, Fz, Cz and Pz. In a control experiment where the continuous addition task was not loaded, a significant change of the latency was not detected. The amplitude of P300 didn't change significantly in all recording positions after the task. In the control experiment, the amplitude of P300 did not change significantly. On the other hand, the changes in the concentrations of lactic acid and cortisol and the reaction time were not induced by the continuous addition task. The prolongation of the latency of P300 would originate from a decline in brain function. In this study, a prolongation of the latency of P300 after the task was detected in all subjects. It is well known that the value of P300 changes with modification of the recording condition, therefore a recording of P300 under the same conditions is required for qualitative evaluation.
Collapse
Affiliation(s)
- Noritaka Okamura
- Department of Medical Technology, Faculty of Health Sciences, Ehime Prefectural University of Health Sciences, Iyo-gun, Ehime, Japan.
| |
Collapse
|
23
|
Sangal RB, Sangal JM. Attention-deficit/hyperactivity disorder: using P300 topography to choose optimal treatment. Expert Rev Neurother 2007; 6:1429-37. [PMID: 17078784 DOI: 10.1586/14737175.6.10.1429] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Attention-deficit/hyperactivity disorder is the most prevalent behavioral disorder in children, and persists into adulthood. Stimulants (methylphenidate and amphetamines) with dopaminergic mechanisms are the most commonly used pharmacological treatment. Nonselective (desipramine and imipramine) and selective (atomoxetine) norepinephrine reuptake inhibitors can also be effective. What constitutes a sufficient response to treatment? Too often a partial response, leaving the patient symptomatic, is accepted. If response is defined more strictly, allowing for a return to normal, then the usually quoted 70% response rates to any given attention-deficit/hyperactivity disorder medicine drop to approximately 40%. With different medicines and not enough patients responding robustly to any given medicine, we can use medicines sequentially to find the medicine that produces a robust response. Alternatively, P300 topography can be used to select optimal treatment.
Collapse
Affiliation(s)
- R Bart Sangal
- Attention Disorders Institute, 44199 Dequindre, Ste. 311, Troy, MI 48085, USA.
| | | |
Collapse
|