Enhancing attention through training

Executive and attentional functioning interventions in preterm children: a systematic review

OBJECTIVE

This systematic review, performed in accordance with the PRISMA guidelines, seeks to summarize the interventions that have been developed in order to improve executive functioning and attention in children born prematurely.

METHODS

The PICOS framework helped guide the structure and relevant terms selected for the study. Electronic systematic searches of the databases PubMed (NLM), Ovid Medline, Ovid All EBM Reviews, Ovid Embase, and Ovid PsycINFO were completed in March 2022. This review focuses on interventions that target attention and executive functioning in prematurely born children between birth and 12 years old, with outcome measures assessed between 3 and 12 years old, even if the age range in the study can exceed our own parameters. Data extraction included sample characteristics, country of recruitment, type of intervention, description of the intervention group and control group, outcome measures, and overall results. An assessment of the quality of methodology of studies was performed through an adaptation of the Downs and Black checklist for both randomized and nonrandomized studies in healthcare interventions. An assessment of the risk of bias was also presented using the Cochrane risk of bias tool for randomized trials 2.0.

RESULTS

A total of 517 premature children received an intervention at some point between birth and early adolescence. Eleven different interventions were assessed in 17 studies, with rating of the quality of methodology and outcomes ranging from lower quality studies (44% quality rating) to robust studies (96% quality rating) in terms of reporting standards, external and internal validity, and power. Five of those studies focused on interventions administered in the neonatal intensive care unit or shortly postdischarge (e.g., the Mother-Infant Transaction Program and the Newborn Individualized Developmental Care and Assessment Program, documented in two articles each [11%] or the Infant Behavioral Assessment and Intervention Program assessed in one study [about 5%]), while 12 articles reported on interventions administered between the ages of 1.5-12 years old [mostly computerized cognitive training programs such as Cogmed (23%) and BrainGame Brian (17%)]. Of the 17 articles examined, 12 (70%) showed positive short-term outcomes postintervention and 3 (17%) demonstrated positive long-term results with small to large effect sizes (0.23-2.3). Among included studies, 50% showed an overall high risk of bias, 21.4% showed some concerns, and 28.6% were low risk of bias.

CONCLUSIONS

Due to the heterogeneity of the programs reviewed, the presented findings should be interpreted as descriptive results. A careful and individualized selection from the various available interventions should be made based on the target population (i.e., age at intervention administration and outcome testing) before implementing these program protocols in clinical settings.

Using mindfulness-based intervention to promote executive function in young children: a multivariable and multiscale sample entropy study

Early childhood marks a pivotal period in the maturation of executive function, the cognitive ability to consciously regulate actions and thoughts. Mindfulness-based interventions have shown promise in bolstering executive function in children. This study used the functional near-infrared spectroscopy technique to explore the impact of mindfulness-based training on young children. Brain imaging data were collected from 68 children (41 boys, aged 61.8 ± 10.7 months) who were randomly assigned to either an intervention group (N = 37, aged 60.03 ± 11.14 months) or a control group (N = 31, aged 59.99 ± 10.89 months). Multivariate and multiscale sample entropy analyses were used. The results showed that: (1) brain complexity was reduced in the intervention group after receiving the mindfulness-based intervention in all three executive function tasks (ps < 0.05), indicating a more efficient neural processing mechanism after the intervention; (2) difference comparisons between the intervention and control groups showed significant differences in relevant brain regions during cognitive shifting (left dorsolateral prefrontal cortex and medial prefrontal cortex) and working memory tasks (left dorsolateral prefrontal cortex), which corroborates with improved behavioral results in the intervention group (Z = -3.674, P < 0.001 for cognitive shifting; Z = 2.594, P < 0.01 for working memory). These findings improve our understanding of early brain development in young children and highlight the neural mechanisms by which mindfulness-based interventions affect executive function. Implications for early intervention to promote young children's brain development are also addressed.

Mindfulness enhances cognitive functioning: a meta-analysis of 111 randomized controlled trials

BACKGROUND

Currently no comprehensive meta-analysis of MBI efficacy on global and unique cognitive subdomains exist.

METHOD

Examined the effects of MBIs on global cognition and 15 cognitive subdomains. Inclusion criteria: meditation naïve participants; randomized controlled trial; outcome included one objective or subjective cognitive functioning measure; primary focus was teaching mindfulness skills. Exclusion criteria: inadequate data; one-session ; control condition contained any MBI component. Robust variance estimation and moderator analyses controlling for presence of treatment fidelity were conducted.

RESULTS

One-hundred-and-eleven RCTs (n = 9,538) met eligibility criteria. MBIs had small-to-moderate significant effects on global cognition, executive attention, working memory accuracy, inhibition accuracy, shifting accuracy, sustained attention, and subjective cognitive functioning (vs. waitlist/no-treatment, g = 0.257-0.643; vs. active controls, g = 0.192-0.394). MBIs did not impact executive functioning (EF) latency indices, verbal fluency, processing speed, episodic memory, and cognitive error. Treatment effects were stronger for those with elevated psychiatric symptoms vs. healthy controls, and medical samples, studies with complete-case (vs. intention-to-treat) analysis, face-to-face (vs. self-guided) delivery, and non-standard (vs. standard MBI).

CONCLUSION

MBIs consistently yielded small-to-moderate yet practically meaningful effect sizes on global cognition and six cognitive subdomains that captured accuracy vs. latency-based indices of EF and sustained accuracy.

Development of a serious game-based cognitive rehabilitation system for patients with brain injury

BACKGROUND

Traumatic brain injury (TBI) resulting from a forceful impact to the head can cause severe functional disabilities, with cognitive impairment being a major hindrance to patients' return to daily life. Encouraging patients to engage in rehabilitation programs consistently poses a significant challenge for therapists. To address this issue, gamification has gained momentum as an effective approach. This study aims to develop a serious game-based cognitive rehabilitation system tailored for patients with brain injury.

METHODS

The study included four stages. Initially, the requirements were analyzed through focus groups. Then the system structure and game content were discussed and was agreed as a conceptual model. In second stage, the system design was drawn using various modeling diagrams. In third stage, a system prototype was developed using the Unity game engine and C# programming. Finally, a heuristic evaluation method was employed to assess usability.

RESULTS

Based on the focus group meetings with seven participants, a conceptual model of the system structure and game content was designed. Game's interface was developed for both the therapist and patient versions. The focus groups determined a 2D casual gaming genre with a postman character and 10 missions on the smartphone platform. For example, in the first mission, the postman must move from mailboxes 1 to 10 and pick up the letters. This is according to Trail Making Test task. The 16 tasks in different subcategories of attention were selected to make these missions. The usability evaluation highlighted privacy, help and documentation, and aesthetic and minimalist design as the areas with the highest percentage of problems.

CONCLUSIONS

Cognitive rehabilitation is vital in facilitating patients' faster return to daily routines and enhancing their quality-of-life following brain injury. Incorporating a game-based system provides patients with increased motivation to engage in various cognitive exercises. Additionally, continuous monitoring by specialists ensures effective patient management. The game-based system offers different game stages to strengthen and rehabilitate attention in patients with brain injury. In the next step, the clinical effects of this system will be evaluated.

Reliable change in developmental outcomes of Brain Balance® participants stratified by baseline severity

The effects of comprehensive multimodal programs on developmental outcomes have not been well-studied. Emerging evidence suggests a possible role for the Brain Balance® (BB) program, a multimodal training program, in serving as a nonpharmacologic approach to addressing cognitive, attentional, and emotional issues in youth. In this analysis, we examined the effects of 3 months of participation in the BB program on the outcomes of children and adolescents with developmental difficulties (N = 4,041; aged 4-18 years; 69.7% male). Parent-rated scores on the Brain Balance-Multidomain Developmental Survey (BB-MDS) were used to assess six areas at baseline and post-program: (1) negative emotionality; (2) reading/writing difficulties; (3) hyperactive/disruptive behavior; (4) academic disengagement; (5) motor/coordination problems; and (6) social communication problems. To estimate change from pre- to post-program, we calculated effect size (Cohen's d) and the Reliable Change Index (RCI) for groups stratified by baseline severity. There was a very large effect size for the moderate/high severity (d = 1.63) and extreme severity (d = 2.08) groups, and a large effect size for the mild severity group (d = 0.87). The average percentage of participants who observed reliable change over all BB-MDS domains was 60.1% (RCICTT) for extreme severity, 46.6% (RCICTT) for moderate/high severity, and 21.1% (RCICTT) for baseline mild severity. In additional assessments of primitive reflexes and sensory motor activity, students demonstrated significantly diminished primitive reflexes from pre- to post-participation and significant improvements in sensory motor skills including fine motor skills, gait and aerobic ability, proprioception, rhythm and timing, and eye-gaze stability. Overall, these results demonstrate improvements in primitive reflex integration and sensory motor skills, as well as statistically significant reliable change in emotionality, reading/writing, behavior, academic engagement, motor skills, and social communication in BB participants from pre- to post-program, with the probability and degree of change increasing as the participants' baseline severity increases. These results contribute to the growing literature on the need for evidence-based nonpharmacologic approaches to addressing developmental issues. Future research with well-controlled designs, longitudinal follow-up, implementation across settings, and participant groups in which diagnoses are known, will help to more fully characterize the effects of the BB program.

Does Tennis Training Improve Attention? New Approach

This study aimed to examine the effect of a tennis training program on improving attention.

METHODS

A total of 40 tennis players from a Tennis Club, 20 in the experimental group (EG) and 20 in the control group (CG), participated in the study. The EG athletes received 40 serve balls from the trainer twice a week for nine weeks. The researcher applied the "d2 attention test" to the EG and CG before and after the nine-week period.

RESULTS

After comparing the pretest and posttest attention averages of the experimental group, there was a significant difference in the TN, TN-E, and CP mean scores (p < 0.001). In the comparison of the pretest and posttest attention averages of the CG, there was no significant difference in the TN, TN-E, and CP mean scores (p > 0.05). The comparison of the pretest attention averages of the EG and CG revealed no significant difference in the TN, TN-E, and CP mean scores (p > 0.05). The comparison of the posttest attention averages of the EG and CG revealed a significant difference in the mean scores of TN, TN-E, and CP (p < 0.05). There was a statistically significant difference between the posttest-pretest differences in the TN, TN-E, and CP values of the EG and CG (p < 0.05).

CONCLUSIONS

The study concluded that tennis training aimed at developing attention improved the results in the attention test.

Relationships among age, socioeconomic status, and distractibility in preschoolers as assessed by the Competitive Attention Test

In children, the ability to attend to relevant auditory information and ignore distracting information is crucial for learning and educational achievement. Distractibility, the propensity to pay attention to irrelevant information, depends on multiple components of cognition (voluntary attention orienting, sustained attention, distraction resulting from the capture of attention by a distractor, phasic arousal, impulsivity, and motor control) that may mature at different ages. Here, we used the Competitive Attention Test (CAT) to measure these components in children aged 3 to 5 years. Our goal was to characterize changes in the efficiency of attention during the preschool period and to determine whether distractibility varies as a function of socioeconomic status (SES). All 3-year-olds (n = 14) and some 4- and 5-year-olds (n = 21) needed to be excluded from the sample due to noncompliance with instructions, suggesting that the CAT might not be suitable for children with poorly developed skills in sustained attention. Among 4- and 5-year-olds who completed the CAT (n = 71), sustained attention improved with age, whereas voluntary attention orienting remained immature. Independent of age, task-irrelevant sounds induced distraction, phasic arousal, and impulsivity. There was no relationship between SES and children's distraction. Finally, children from lower SES backgrounds showed reduced sustained attention abilities and increased impulsivity. Taken together, these findings suggest that distractibility is still developing during the preschool period and is likely to vary depending on the SES background of a child's family.

Mindfulness Training Improves Attention: Evidence from Behavioral and Event-related Potential Analyses

Mindfulness meditation helps to improve attentional capacity. However, the neural correlates that indicate the mechanism through which mindfulness improves attention are unclear. To address this gap, we aimed to assess the effects of mindfulness training on sustained attentional capacity. Event-related potentials (ERPs) associated with the modified sustained attention response task (mSART) were used in this study. A total of 45 college students were randomly assigned to either the mindfulness group (n = 21) or the control group (n = 24). Participants in the mindfulness group received a three-week mindfulness training. The self-report results showed that the mindfulness group reported higher mindfulness scores (observing and non-judgment of inner experiences) after the training. The mindfulness group also scored lower on the state anxiety than the control group. Behavioral results also showed that self-caught mind wandering in the mindfulness group significantly decreased after the training, and the mindfulness group showed a faster response after the training. The ERP results showed that N2 amplitudes in the post-test were significantly greater than those in the pre-test in the mindfulness group. We did not find any interactions between group and time for P3. The findings suggest that mindfulness training can effectively improve sustained attentional capacity, as indicated by reduced mind wandering and increased N2 responses.

Measurement properties of the Brain Balance® multidomain developmental survey: validated factor structure, internal reliability, and measurement invariance

This study aimed to refine and validate a multidomain developmental survey (MDS) used by the Brain Balance® (BB) program. Data were analyzed on 47,571 participants (68.5% male; 4–18 years) whose parents completed the survey before/after 3 months of in-center BB participation. Exploratory Factor Analysis was applied to a training sample (n = 28,254), reducing the original item pool from 98 to 31 items and suggesting a six-factor solution. The six factors were labeled as negative emotionality, reading/writing difficulties, hyperactive-disruptive, academic disengagement, motor/coordination problems, and social communication problems. Exploratory Structural Equation Modeling was applied to two validation samples (n = 9394 and 9923), and the factor structure demonstrated strong goodness-of-fit. Test–retest reliability coefficients (per Pearson correlations) were high for each of the subscales. Finally, the survey’s factor structure appeared equivalent across four groups stratified by reported gender and adolescent status. Overall, the BB-MDS demonstrated strong measurement properties, including validated factor structure, internal reliability, test–retest reliability, and measurement invariance.

A randomized controlled trial of a 14-day mindfulness ecological momentary intervention (MEMI) for generalized anxiety disorder

BACKGROUND

Little is known about whether brief mindfulness ecological momentary interventions (MEMIs) yield clinically beneficial effects. This gap exists despite the rapid growth of smartphone mindfulness applications. Specifically, no prior brief MEMI has targeted generalized anxiety disorder (GAD). Moreover, although theories propose that MEMIs can boost executive functioning (EF), they have largely gone untested. Thus, this randomized controlled trial (RCT) aimed to address these gaps by assessing the efficacy of a 14-day smartphone MEMI (versus self-monitoring placebo [SMP]).

METHOD

Participants with GAD were randomly assigned to either condition (68 MEMI and 42 SMP). MEMI participants exercised multiple core mindfulness strategies and were instructed to practice mindfulness continually. Comparatively, SMP participants were prompted to practice self-monitoring and were not taught any mindfulness strategies. All prompts occurred five times a day for 14 consecutive days. Participants completed self-reports and neuropsychological assessments at baseline, posttreatment, and 1-month follow-up (1MFU). Piecewise hierarchical linear modeling analyses were conducted.

RESULTS

MEMI (versus SMP) produced greater pre-1MFU reductions in GAD severity and perseverative cognitions (between-group d = 0.393-0.394) and stronger improvements in trait mindfulness and performance-based inhibition (d = 0.280-0.303). Further, MEMI (versus SMP) led to more considerable pre- to posttreatment reduction in state-level depression and anxiety and more mindfulness gains (d = 0.50-1.13). Overall, between-treatment effects were stronger at pre-1MFU than pre- to posttreatment for trait-level than state-level treatment outcome measures.

CONCLUSIONS

Preliminary findings suggest that the beneficial effect of an unguided brief MEMI to target pathological worry, trait mindfulness, and EF is modest yet potentially meaningful. Other theoretical and clinical implications were discussed.

Enhancing Chinese preschoolers' executive function via mindfulness training: An fNIRS study

Mindfulness training has been found to enable cognitive and emotional awareness and diminish emotional distraction and cognitive rigidity. However, the existing intervention studies have largely focused on school children, adolescents, and adults, leaving young children unexplored. This study examined the influence of mindfulness training on young children using the one-group pretest-posttest design. Altogether 31 Chinese preschoolers (M age = 67.03 months, SD = 4.25) enrolled in a 5-week, twice-per-week mindfulness training. Their cognitive shifting, inhibitory control, and working memory were examined using a battery of executive function tasks. And their brain activations in the region of interest during the tasks were measured using fNIRS before and after the intervention. Results showed that their cognitive shifting and working memory tasks performance significantly improved, and their activation in the DLPFC significantly changed. Implications for this study were also included.

Funcionamiento de las redes atencionales en la adultez joven y el nivel de educación

El objetivo del presente estudio fue observar el efecto de las variables nivel de estudios y adultez joven en la tarea de redes atencionales. Para ello, participaron 58 personas de población general separados en grupos de estudiantes y no estudiantes, y en adultez emergente y temprana, con los cuales se llevó a cabo un diseño experimental, utilizando como paradigma principal la tarea de redes atencionales. Los resultados mostraron que los grupos de estudiantes y no estudiantes no difirieron en rendimiento en ninguna de las condiciones de las redes, pero que, en cuanto a la variable adultez joven, hubo un efecto de interacción entre el tipo de adultez y la red de orientación, siendo el grupo adulto emergente más rápido que el grupo adulto temprano. Además, un análisis correlacional demostró que la edad correlacionó moderada y positivamente con el tiempo de reacción de todas las condiciones de la tarea atencional. Al final se discute la importancia del nivel de educación superior y la adultez joven sobre el funcionamiento de las redes atencionales en el campo de la psicología diferencial, y se mencionan las implicaciones de estos resultados en el ámbito clínico.

Attention-Setting and Human Mental Function

This article provides an introduction to experimental research on top-down human attention in complex scenes, written for cognitive scientists in general. We emphasize the major effects of goals and intention on mental function, measured with behavioral experiments. We describe top-down attention as an open category of mental actions that initiates particular task sets, which are assembled from a wide range of mental processes. We call this attention-setting. Experiments on visual search, task switching, and temporal attention are described and extended to the important human time scale of seconds.

Popular interventions to enhance sustained attention in children and adolescents: A critical systematic review

There are a myriad of interventions promoting activities designed to help enhance sustained attention in children and adolescents. In this systematic review, we critically evaluate the evidence behind three popular sustained attention training approaches - cognitive attention training, meditation, and physical activity. Seven databases were searched in addition to secondary searches. Cognitive attention training, meditation training or physical activity intervention studies aimed at improving sustained attention (randomised-controlled or non-randomised-controlled designs) in samples of children and adolescents (3-18 years) were included. We screened 3437 unique articles. Thirty-seven studies satisfied inclusion criteria. In general, cognitive attention training (n = 14) did not reliably improve sustained attention. Physical activity (n = 15) and meditation interventions (n = 8) demonstrated somewhat more potential in enhancing sustained attention, but these effects should be considered preliminary and need to be replicated with greater methodological rigour. Cognitive attention training demonstrated very limited transfer to other aspects of attention. Notably, mindfulness training had rather consistent positive effects on selective attention. Across all three intervention types, there was very weak evidence for transfer to other aspects of cognition, behaviour, and academic achievement. The paper concludes with methodological recommendations for future studies to strengthen the evidence base.

A Systematic Review on Serious Games in Attention Rehabilitation and Their Effects

Attention is a basic and main mental task and can play an important role in the functioning of other brain abilities such as intelligence, memory, learning, and perception, and its deficit occurs in 80% of patients with traumatic brain injury. The use of game-based tools for rehabilitation is rapidly expanding. Cognitive rehabilitation via video games is an emerging hot topic in cognitive science. Serious games serve a specific purpose in addition to entertainment. They can be more engaging than exercises since they replace reward and motivation systems with real-world motivations as a complement for rehabilitation activities. This study was aimed at identifying and categorizing serious computer games used for attention rehabilitation and evaluating their effects. Six electronic databases (Scopus, PubMed, ISI, Embase, IEEE, and Cochrane) were searched in August 2021. The search strategy consisted of three main concepts of “serious game”, “cognitive deficits”, and “cognitive rehabilitation”. The inclusion criteria were (1) journal articles, (2) English language, (3) being published in the last 10 years, (4) human participants, and (5) game-based intervention. In the 30 included studies, 22 unique games were utilized for attention rehabilitation. Lumosity (20%), Brain Age (Dr. Kawashima's Brain Training) (10%), and MoHRS (6.66%) were the most common games among the studies. There were (57%) casual, (23%) action, (10%) simulation, and (10%) multiple genres. Of the 47 tools used in the studies, 5 utilized cross-modal oddball attention tasks, 4 utilized game performance, 3 utilized the paced auditory serial additional test (PASAT), and the rest employed other tools. A total of 73 outcome measures were related to attention, 42 measures did not have significant results, 30 were significantly improved, 1 was significantly deteriorated, and 4 articles did not have any specific measures for attention evaluation. Thus, the results revealed the positive effect of serious games on attention. However, issues such as absence of scientific teams, the variety of the disorders that cause defects, the variety of criteria, differences in measurements, lack of long-term follow-up, insufficient RCT studies, and small sample sizes should be considered when designing, developing, and using game-based systems to prevent bias.

Add Bilingualism to the Mix: L2 Proficiency Modulates the Effect of Cognitive Reserve Proxies on Executive Performance in Healthy Aging

We investigated the contribution of bilingual experience to the development of cognitive reserve (CR) when compared with other, traditionally more researched, CR proxies, in a sample of cognitively healthy senior (60 +) bilingual speakers. Participants performed in an online study where, in addition to a wide inventory of factors known to promote CR, we assessed several factors related to their second language (L2) use. In addition, participants’ inhibitory executive control was measured via the Flanker Task. We used Structural Equation Modeling to derive a latent composite measure of CR informed by traditional CR proxies (i.e., occupational complexity, marital status, current and retrospective socio-economic status, physical exercise, perceived positive support, maximal educational attainment, frequency of leisure activities and extent of social network). We examined whether bilingualism may act as a mediator of the effects of such proxies on cognitive performance therefore assessing the unique contribution of dual language use to CR. First, our analyses revealed facilitatory effects of both L2 age of acquisition and L2 proficiency on the executive performance. Second, our analyses confirmed the moderating role of bilingual experience on the relationship between other factors known to promote CR and cognitive integrity, revealing a strong contribution by bilingualism to CR development. Our findings provide further support to the notion that bilingualism plays an important role in mitigating cognitive decline and promoting successful aging.

The Multiple Object Avoidance (MOA) task measures attention for action: Evidence from driving and sport

Performance in everyday tasks, such as driving and sport, requires allocation of attention to task-relevant information and the ability to inhibit task-irrelevant information. Yet there are individual differences in this attentional function ability. This research investigates a novel task for measuring attention for action, called the Multiple Object Avoidance task (MOA), in its relation to the everyday tasks of driving and sport. The aim in Study 1 was to explore the efficacy of the MOA task to predict simulated driving behaviour and hazard perception. Whilst also investigating its test-retest reliability and how it correlates to self-report driving measures. We found that superior performance in the MOA task predicted simulated driving performance in complex environments and was superior at predicting performance compared to the Useful Field of View task. We found a moderate test-retest reliability and a correlation between the attentional lapses subscale of the Driving Behaviour Questionnaire. Study 2 investigated the discriminative power of the MOA in sport by exploring performance differences in those that do and do not play sports. We also investigated if the MOA shared attentional elements with other measures of visual attention commonly attributed to sporting expertise: Multiple Object Tracking (MOT) and cognitive processing speed. We found that those that played sports exhibited superior MOA performance and found a positive relationship between MOA performance and Multiple Object Tracking performance and cognitive processing speed. Collectively, this research highlights the utility of the MOA when investigating visual attention in everyday contexts.

The ANT Executive Control Index: No Evidence for Temporal Decrement

OBJECTIVE

This study tested whether indices of executive control, alertness, and orienting measured with Attention Network Test (ANT) are vulnerable to temporal decrement in performance.

BACKGROUND

Developing the resource theory of sustained attention requires identifying neurocognitive processes vulnerable to decrement. Executive control processes may be prone to impairment in fatigue states. Such processes are also highlighted in alternative theories. Determining the role of executive control in vigilance can both advance theory and contribute to practical countermeasures for decrement in human factors contexts.

METHOD

In Study 1, 80 participants performed the standard ANT for an extended duration of about 55 to 60 min. Study 2 (160 participants) introduced manipulations of trial blocking and stimulus degradation intended to increase resource depletion. Reaction time and accuracy measures were analyzed. Subjective stress and workload were assessed in both studies.

RESULTS

In both studies, the ANT induced levels of subjective workload and task disengagement consistent with previous sustained attention studies. No systematic decrement in any performance measure was observed.

CONCLUSION

Executive control assessed by the ANT is not highly vulnerable to temporal decrement, even when task demands are elevated. Future work should differentiate executive control processes; proactive control may be more implicated in sustained attention decrement than in reactive control.

APPLICATION

Designing systems and interfaces to reduce executive control demands may be generally beneficial but will not directly mitigate temporal performance decrement. Enhancing design guidelines and neuroergonomic methods for monitoring operator attention requires further work to identify key neurocognitive processes for decrement.

Immediate Attention Enhancement and Restoration From Interactive and Immersive Technologies: A Scoping Review

Interactive and immersive technologies such as video games, exergames, and virtual reality are typically regarded as entertainment mediums. They also offer a multitude of health and well-being benefits. They have the capacity to incorporate established well-being techniques (e.g., mindfulness, exercise, and play) and expose users to beneficial environment settings with greater ease, improved access, and a broader appeal. The authors conducted a scoping review to explore whether these technologies could be used to benefit attention in healthy adults, that is, in a regulatory sense such as during periods of cognitive fatigue or attention-critical tasks. Research efforts have typically focused on long-term practice methods for attention enhancement with these technologies. Instead, this review provides the first attempt to unify a broad range of investigations concerned with their immediate impact on attention through state-change mechanisms. This applies the concept of attention state training and a growing evidence base, which suggests that meditative practices, exercise bouts, and nature exposures can provide short-term improvements in attentional performance following brief interactions. A systematic search of MEDLINE, Embase, and PsycINFO databases resulted in 11 peer-reviewed articles (13 experimental trials) each including at least one objective measure of attention directly following the use of an interactive or immersive technology. Most studies involved interactive technologies (i.e., video games and exergames), whereas there were three immersive interventions in the form of virtual reality. The comparisons between baseline and postintervention showed mostly no effect on attention, although there were five cases of improved attention. There were no instances of negative effects on attention. The results are significant considering mounting concerns that technology use could be detrimental for cognitive functioning. The positive effects reported here indicate a need to specify the type of technology in question and bring attention to positive vs. negative technology interactions. Implications for the literature concerning attention state training are discussed considering promising effects of technology exposures geared toward flow state induction. Significant gaps in the literature are identified regarding the implementation of traditional attention state training practices.

Enhancing Attention by Synchronizing Respiration and Fingertip Pressure: A Pilot Study Using Functional Near-Infrared Spectroscopy

Sustained attention is a fundamental ability ensuring effective cognitive processing and can be enhanced by meditation practice. However, keeping a focused meditative state is challenging for novices because involuntary mind-wandering frequently occurs during their practice. Inspired by the potential of force-control tasks in invoking internal somatic attention, we proposed a haptics-assisted meditation (HAM) to help reduce mind-wandering and enhance attention. During HAM, participants were instructed to maintain awareness on the respiration and meanwhile adjust bimanual fingertip pressures to keep synchronized with the respiration. This paradigm required somatosensory attention as a physiological foundation, aiming to help novices meditate starting with the body and gradually gain essential meditation skills. A cross-sectional study on 12 novices indicated that the participants reported less mind-wandering during HAM compared with the classic breath-counting meditation (BCM). In a further longitudinal study, the experimental group with 10 novices showed significantly improved performance in several attentional tests after 5 days' practice of HAM. They tended to show more significant improvements in a few tests than did the control group performing the 5-day BCM practice. To investigate the brain activities related to HAM, we applied functional near-infrared spectroscopy (fNIRS) to record cerebral hemodynamic responses from the prefrontal and sensorimotor cortices when performing HAM, and we assessed the changes in cerebral activation and functional connectivity (FC) after the 5-day HAM practice. The prefrontal and sensorimotor regions demonstrated a uniform activation when performing HAM, and there was a significant increase in the right prefrontal activation after the practice. We also observed significant changes in the FC between the brain regions related to the attention networks. These behavioral and neural findings together provided preliminary evidence for the effectiveness of HAM on attention enhancement in the early stage of meditation learning.

Effects of a Computerized Training on Attentional Capacity of Young Soccer Players

The purpose of this work was to analyze the effects of a computerized training on attentional capacity in a group of young soccer players. Seventy-five male adolescents from two soccer clubs in the city of Malaga (Spain) and aged between 14 and 18 (15.45 ± 1.43 years) participated in the investigation. A quasi-experimental design was used, and the adolescents were divided into control (n = 38) and experimental (n = 37) groups. The experimental group underwent a computerized training (Rejilla 1.0) of their attention during 9 weeks and 27 sessions. In addition, the D2 attention test was used to analyze the evolution of participants after the intervention program. The results showed positive effects of the computerized intervention program on selective attention, observing changes both in the executions of the software used (p < 0.001, Cohen's d = 1.58, 95% CI [1.06, 2.11]) and in the main measures of the D2 test, total effectiveness (p < 0.001, Cohen's d = 0.62, 95% CI [0.15, 1.08]) and concentration (p < 0.01, Cohen's d = 0.48, 95% CI [0.02, 0.94]).

The Construction and Evaluation of Executive Attention Training to Improve Selective Attention, Focused Attention, and Divided Attention for Older Adults With Mild Cognitive Impairment: A Randomized Controlled Trial

OBJECTIVES

To examine the immediate and long-term effects of executive attention training on selective attention, focused attention, and divided attention in older adults with mild cognitive impairment.

METHODS

A double-blind, multisite randomized controlled trial at five sites. Seventy participants (mean age: 78.19 ± 7.22 years) were assigned to an experimental group (executive attention training, n = 35) or an active control group (n = 35). The training duration was the same for both groups (45 minutes per session, 3 times per week, 18 sessions in total). Primary outcome measure was selective attention (Digit Span Task). Secondary outcome measures included focused attention (Stroop Color Word Test) and divided attention (Trail-Making Test Part B). Data were collected at pretest, post-test, 3-month follow-up, and 6-month follow-up.

RESULTS

In GEE analysis, findings indicated a significant improvement in selective attention at post-test, whereas divided attention showed significant reducing omission error at 3-month follow-up. There was no significant effect of group in focused attention associated with the executive attention training compared with active control group.

CONCLUSION

The executive attention training significantly improved selective attention and divided attention performance. Future studies should identify transfer effects of attention training, and that can employ early screening to provide integrated attention training, and decrease its relevant risks on competency in performing daily activities, such as falling and driving.

Mindfulness meditators show altered distributions of early and late neural activity markers of attention in a response inhibition task

Attention is vital for optimal behavioural performance in every-day life. Mindfulness meditation has been shown to enhance attention. However, the components of attention altered by meditation and the related neural activities are underexplored. In particular, the contributions of inhibitory processes and sustained attention are not well understood. To address these points, 34 meditators were compared to 28 age and gender matched controls during electroencephalography (EEG) recordings of neural activity during a Go/Nogo response inhibition task. This task generates a P3 event related potential, which is related to response inhibition processes in Nogo trials, and attention processes across both trial types. Compared with controls, meditators were more accurate at responding to Go and Nogo trials. Meditators showed a more frontally distributed P3 to both Go and Nogo trials, suggesting more frontal involvement in sustained attention rather than activity specific to response inhibition. Unexpectedly, meditators also showed increased positivity over the right parietal cortex prior to visual information reaching the occipital cortex (during the pre-C1 window). Both results were positively related to increased accuracy across both groups. The results suggest that meditators show altered engagement of neural regions related to attention, including both higher order processes generated by frontal regions, and sensory anticipation processes generated by poster regions. This activity may reflect an increased capacity to modulate a range of neural processes in order to meet task requirements. This increased capacity may underlie the improved attentional function observed in mindfulness meditators.

A dual-process psychobiological model of temperament predicts liking and wanting for food and trait disinhibition

A dual-process model of temperament, incorporating the Behavioural Inhibition System (BIS), Behavioural Activation System (BAS) and effortful control (EC), may help to predict hedonic responses to palatable food and trait disinhibition.

PURPOSE

This study aimed to determine if the BIS, BAS and EC predicted liking and wanting for high-fat, sweet foods in adults with overweight and obesity, and if collectively, these variables predicted the eating behaviour trait of Disinhibition.

METHODS

168 adults (104 females, mean BMI = 33.3 kg/m²) completed the Three Factor Eating Questionnaire, the Carver and White BIS/BAS scales, the Adult Temperament Questionnaire-Effortful Control Scale - Short Form and the Leeds Food Preference Questionnaire. The strength of the BIS, BAS and EC in predicting wanting and liking for high-fat sweet foods, and trait Disinhibition was assessed using hierarchical multiple regression.

RESULTS

Both the BIS and EC predicted liking, F (6, 161) = 5.05, p < .001, R² = 0.16, and EC inversely predicted wanting, F (6, 161) = 3.28, p = .005, R² = 0.11. The BIS, EC and liking predicted, F (8, 159) = 11.0, p < .001, R² = 0.36, and explained 36% of Disinhibition. The BAS did not predict wanting, liking or Disinhibition.

CONCLUSIONS

These results demonstrate that a sensitive BIS and a lower level of effortful control predicts food reward and Disinhibition in overweight and obese adults. Consequently, interventions that aim to increase effortful control and reduce BIS reactivity may be beneficial for reducing hedonically motivated, disinhibited eating behaviour.

The Role of Attention in Therapy for Children and Adolescents Who Stutter: Cognitive Behavioral Therapy and Mindfulness-Based Interventions

METHOD

This clinical discussion paper will explore two aspects of attention in relation to young people who stutter and their parents: (a) what we attend to as human beings and (b) how we attend. It will draw on research and clinical practice informed by CBT and MBIs. Specifically, information-processing theory in CBT explains psychological well-being partly in terms of what individuals focus their attention on, whereas MBIs focus on the relationship between how individuals attend to their internal experiences and their psychological well-being.

CONCLUSIONS

Although a nascent field, MBIs may be useful as a part of therapy for children and adolescents who stutter. The concepts highlighted by MBIs may also help to resolve some clinical issues.

Dopamine D2 Receptors Enhance Population Dynamics in Primate Prefrontal Working Memory Circuits

Working memory is associated with persistent activity in the prefrontal cortex (PFC). The neuromodulator dopamine, which is released by midbrain neurons projecting into the frontal lobe, influences PFC neurons and networks via the dopamine D1 (D1R) and the D2 receptor (D2R) families. Although behavioral, clinical and computational evidence suggest an involvement of D2Rs in working memory, a neuronal explanation is missing. We report an enhancement of persistent working memory responses of PFC neurons after iontophoretically stimulating D2Rs in monkeys memorizing the number of items in a display. D2R activation improved working memory representation at the population level and increased population dynamics during the transition from visual to mnemonic representations. Computational modeling suggests that D2Rs act by modulating interneuron-to-pyramidal signaling. By increasing the population's response dynamics, D2Rs might put PFC networks in a more flexible state and enhance the neurons' working memory coding, thereby controlling dynamic cognitive control.

High-intensity training enhances executive function in children in a randomized, placebo-controlled trial

Background:

Exercise-induced cognitive improvements have traditionally been observed following aerobic exercise interventions; that is, sustained sessions of moderate intensity. Here, we tested the effect of a 6 week high-intensity training (HIT) regimen on measures of cognitive control and working memory in a multicenter, randomized (1:1 allocation), placebo-controlled trial.

Methods:

318 children aged 7-13 years were randomly assigned to a HIT or an active control group matched for enjoyment and motivation. In the primary analysis, we compared improvements on six cognitive tasks representing two cognitive constructs (N = 305). Secondary outcomes included genetic data and physiological measurements.

Results:

The 6-week HIT regimen resulted in improvements on measures of cognitive control [BFM = 3.38, g = 0.31 (0.09, 0.54)] and working memory [BFM = 5233.68, g = 0.54 (0.31, 0.77)], moderated by BDNF genotype, with met66 carriers showing larger gains post-exercise than val66 homozygotes.

Conclusions:

This study suggests a promising alternative to enhance cognition, via short and potent exercise regimens.

Funding:

Funded by Centre for Brain Research.

Clinical trial number:

NCT03255499.

Exercise has beneficial effects on the body and brain. People who perform well on tests of cardiovascular fitness also do well on tests of learning, memory and other cognitive skills. So far, studies have suggested that moderate intensity aerobic exercise that lasts for 30 to 40 minutes produces the greatest improvements in these brain abilities.

Recently, short high-intensity workouts that combine cardiovascular exercise and strength training have become popular. Studies have shown that these brief bouts of strenuous exercise improve physical health, but do these benefits extend to the brain? It would also be helpful to know if the effect that exercise has on the brain depends on an individual’s genetic makeup or physical health. This might help to match people to the type of exercise that will work best for them.

Now, Moreau et al. show that just 10 minutes of high-intensity exercise a day over six weeks can boost the cognitive abilities of children. In the experiments, over 300 children between 7 and 13 years of age were randomly assigned to one of two groups: one that performed the high-intensity exercises, or a ‘control’ group that took part in less active activities – such as quizzes and playing computer games – over the same time period. The children who took part in the high-intensity training showed greater improvements in cognitive skills than the children in the control group. Specifically, the high-intensity exercise boosted working memory and left the children better able to focus on specific tasks, two skills that are important for academic success.

Moreau et al. further found that the high-intensity exercises had the most benefit for the children who needed it most – those with poor cardiovascular health and those with gene variants that are linked to poorer cognitive skills. This suggests that genetic differences do alter the effects of exercise on the brain, but also shows that targeted exercise programs can offer everyone a chance to thrive.

Moreau et al. suggest that exercise need not be time consuming to boost brain health; the key is to pack more intense exercise in shorter time periods. Further work could build on these findings to produce effective exercise routines that could ultimately form part of school curriculums, as well as proving useful to anyone who wishes to improve their cognitive skills.

Peripheral hearing loss reduces the ability of children to direct selective attention during multi-talker listening

Restoring normal hearing requires knowledge of how peripheral and central auditory processes are affected by hearing loss. Previous research has focussed primarily on peripheral changes following sensorineural hearing loss, whereas consequences for central auditory processing have received less attention. We examined the ability of hearing-impaired children to direct auditory attention to a voice of interest (based on the talker's spatial location or gender) in the presence of a common form of background noise: the voices of competing talkers (i.e. during multi-talker, or "Cocktail Party" listening). We measured brain activity using electro-encephalography (EEG) when children prepared to direct attention to the spatial location or gender of an upcoming target talker who spoke in a mixture of three talkers. Compared to normally-hearing children, hearing-impaired children showed significantly less evidence of preparatory brain activity when required to direct spatial attention. This finding is consistent with the idea that hearing-impaired children have a reduced ability to prepare spatial attention for an upcoming talker. Moreover, preparatory brain activity was not restored when hearing-impaired children listened with their acoustic hearing aids. An implication of these findings is that steps to improve auditory attention alongside acoustic hearing aids may be required to improve the ability of hearing-impaired children to understand speech in the presence of competing talkers.

Distinguishing the cognitive processes of mindfulness: Developing a standardised mindfulness technique for use in longitudinal randomised control trials

A capacity model of mindfulness is adopted to differentiate the cognitive faculty of mindfulness from the metacognitive processes required to cultivate this faculty in mindfulness training. The model provides an explanatory framework incorporating both the developmental progression from focussed attention to open monitoring styles of mindfulness practice, along with the development of equanimity and insight. A standardised technique for activating these processes without the addition of secondary components is then introduced. Mindfulness-based interventions currently available for use in randomised control trials introduce components ancillary to the cognitive processes of mindfulness, limiting their ability to draw clear causative inferences. The standardised technique presented here does not introduce such ancillary factors, rendering it a valuable tool with which to investigate the processes activated in mindfulness practice.

Enhancing Visual Perception and Motor Accuracy among School Children through a Mindfulness and Compassion Program

The present study assessed the effects of the mindfulness/compassion cultivating program: "Call to Care-Israel" on the performance in visual perception (VP) and motor accuracy, as well as on anxiety levels and self-reported mindfulness among 4th and 5th grade students. One hundred and thirty-eight children participated in the program for 24 weekly sessions, while 78 children served as controls. Repeated measures ANOVA's yielded significant interactions between time of measurement and group for VP, motor accuracy, reported mindfulness, and anxiety. Post hoc tests revealed significant improvements in the four aforementioned measures in the experimental group only. In addition, significant correlations were obtained between the improvement in motor accuracy and the reduction in anxiety and the increase in mindfulness. Since VP and motor accuracy are basic skills associated with quantifiable academic characteristics, such as reading and mathematical abilities, the results may suggest that mindfulness practice has the ability to improve academic achievements.

Serious games for health: three steps forwards

Serious games are educational tools which are more and more used in patient and health professional education. In this article, we discuss three main points that developers and educators need to address during the development of a serious game for health. We first explain how to develop motivating serious games by finding a point where the intrinsic and extrinsic motivations of end users can converge. Then, we propose to identify the features of serious games which enhance their learning effectiveness on the basis of a framework derived from cognitive science and called "the four pillars of learning." Finally, we discuss issues and solutions related to the evaluation of serious games.

Mindfulness in cultural context

Mindfulness meditation and other techniques drawn from Buddhism have increasingly been integrated into forms of psychotherapeutic intervention. In much of this work, mindfulness is understood as a mode of awareness that is present-centered and nonevaluative. This form of awareness is assumed to have intrinsic value in promoting positive mental health and adaptation by interrupting discursive thoughts that give rise to suffering. However, in the societies where it originated, mindfulness meditation is part of a larger system of Buddhist belief and practice with strong ethical and moral dimensions. Extracting techniques like mindfulness meditation from the social contexts in which they originate may change the nature and effects of the practice. The papers in this issue of Transcultural Psychiatry explore the implications of a cultural and contextual view of mindfulness for continued dialogue between Buddhist thought and psychiatry. This introductory essay considers the meanings of mindfulness meditation in cultural context and the uses of mindfulness as a therapeutic intervention in contemporary psychiatry and psychology.