Event- and time-triggered remembering: the impact of attention deficit hyperactivity disorder on prospective memory performance in children

Prospective memory instruments for the assessment of children and adolescents: a systematic review

BACKGROUND

Prospective memory is the ability to engage in an intention to be performed in the future. The main objective of this study was to identify instruments that assess both time-based and event-based prospective memory in children and adolescents and that have the potential to be clinically applicable.

METHOD

Three databases (PubMed, Scopus, and PsycINFO) were searched to identify existing PM measures in original articles published until 2022. Literature searches were conducted using the following terms: (prospective memor* OR memor* for intentions) AND (neuropsychological assessment) AND (test* OR instrument* OR questionnaire* OR task*) AND (psychometric properties) AND (child* OR adolescen*). Relevant studies identified in the reference lists were also included in the review.

RESULTS

Ten instruments were identified and classified into three categories: (a) test batteries, (b) experimental procedures, and (c) questionnaires. All the instruments identified were described concerning their content and the psychometric properties available. Some of the instruments presented empirical evidence regarding validity and reliability, but no one provided normative data.

CONCLUSION

Besides the recent progress regarding studies publishing the development of a variety of novel measures, there are still many limitations surrounding the assessment of PM in the youth population because of the yet incipient psychometric properties presented by the majority of the PM instruments. Recommendations for a gold-standard PM instrument for assessing children and adolescents are provided.

The Parent and Child Memory Questionnaires: Convergent validity, factor structure, internal consistency, and cross-informant reliability in typically developing children

The Parent Memory Questionnaire (PMQ) and Child Memory Questionnaire (Child MQ) assess children's memory functioning in daily activities. Their psychometric properties are largely unknown. Hence, this study aimed to establish the psychometric properties of the PMQ and Child MQ. A sample included 239 neurotypical children (113 females; Mage = 12.3 years) from Australia and Canada and their parents (n = 306; 149 females). Children also completed standardized and experimental verbal memory tests that assessed working memory, immediate recall, and recall after short (2 min, 30 min) and long (7 day) delays. Convergent validity with memory tests was low for both questionnaires, with significant, albeit small, correlations found for the WISC IV Digit Span Forward only. Exploratory factor analysis (Principal Axis Factoring with Promax rotation) of the PMQ and Child MQ yielded two (Forgetting and Remembering) and four factors (Forgetting, Remembering, Retrieval, and Episodic Memory) accounting for 49.3% and 40.6% of the variance, respectively, and reduced the number of items from 28 to 17. Both PMQ factors showed good internal consistency. Inter-rater reliability was adequate but children rated their memory as significantly poorer than their parents. The present study revealed different factorial structures for the PMQ and Child MQ. Our findings highlighted that memory questionnaires assess several aspects of memory and may complement objective memory tests in children's memory evaluation.

The Queensland Twin Adolescent Brain Project, a longitudinal study of adolescent brain development

We describe the Queensland Twin Adolescent Brain (QTAB) dataset and provide a detailed methodology and technical validation to facilitate data usage. The QTAB dataset comprises multimodal neuroimaging, as well as cognitive and mental health data collected in adolescent twins over two sessions (session 1: N = 422, age 9-14 years; session 2: N = 304, 10-16 years). The MRI protocol consisted of T1-weighted (MP2RAGE), T2-weighted, FLAIR, high-resolution TSE, SWI, resting-state fMRI, DWI, and ASL scans. Two fMRI tasks were added in session 2: an emotional conflict task and a passive movie-watching task. Outside of the scanner, we assessed cognitive function using standardised tests. We also obtained self-reports of symptoms for anxiety and depression, perceived stress, sleepiness, pubertal development measures, and risk and protective factors. We additionally collected several biological samples for genomic and metagenomic analysis. The QTAB project was established to promote health-related research in adolescence.

Disturbed relationship between glucocorticoid receptor and 5-HT1AR/5-HT2AR in ADHD rats: A correlation study

Objective

This work is to investigate the alterations of the central 5-hydroxytryptamine (5-HT) system in spontaneously hypertensive rats (SHR) and the correlation with the behaviors of SHR, and to explore the effects of glucocorticoid intervention on the central 5-HT system and SHR behaviors.

Materials and methods

Three weeks old SHR were chosen as the attention-deficit hyperactivity disorder (ADHD) model and treated with glucocorticoid receptor (GR) agonist or inhibitor, whereas Wista Kyoto rats (WKY) were chosen as the normal control group. Open-field test and Làt maze test were used to evaluate the spontaneous activities and non-selective attention. The levels of 5-HT in the extracellular fluid specimens of the prefrontal cortex of rats were analyzed by high-performance liquid chromatography. The expressions of GR, 5-HT1A receptor (5-HT1AR), and 5-HT2A receptor (5-HT2AR) in the prefrontal cortex were analyzed through immunohistochemistry.

Results

Our study demonstrated that the 5-HT level was lower in the prefrontal cortex of SHR compared to that of WKY. The Open-field test and Làt maze test showed that GR agonist (dexamethasone, DEX) intervention ameliorated attention deficit and hyperactive behavior, whereas GR inhibitor (RU486) aggravated the disorders. With DEX, the expression levels of 5-HT and 5-HT2AR in the prefrontal cortex of SHR were significantly higher than those in the control group, whereas the expression level of 5-HT1AR was lower. However, the expression levels of 5-HT and 5-HT2AR were significantly decreased after the intervention with RU486, while the expression level of 5-HT1AR increased. Results showed that glucocorticoid was negatively correlated with 5-HT1AR and positively correlated with 5-HT2AR.

Conclusion

In the prefrontal cortex of ADHD rats, the down-regulation of 5-HT and 5-HT2AR expressions and the up-regulation of 5-HT1AR, compared with WYK rats, suggested a dysfunctional central 5-HT system in ADHD rats. The GR agonist can upregulate the expression of 5-HT and 5-HT2AR and downregulate the expression of 5-HT1AR in the prefrontal cortex of SHR as well as reduce the hyperactivity and attention deficit behavior in SHR, while the opposite was true for the GR inhibitor. It is suggested that the dysfunction of the 5-HT system in ADHD rats is closely related to glucocorticoid receptor activity.

Attention-Deficit/Hyperactivity Disorder (ADHD) and Time Perception in Adults: Do Adults with Different ADHD Symptomatology Severity Perceive Time Differently? Findings from the National Czech Study

BACKGROUND Studies show neurological differences between patients with attention-deficit/hyperactivity disorder (ADHD) and healthy controls. Furthermore, it is possible that poor timing is linked with impairments in neural circuitry. This study aimed to test the hypothesis that there is a difference in time perception between adults with severe ADHD symptomatology and adults with no ADHD symptomatology. MATERIAL AND METHODS Previously, we collected data from a more extensive set of participants (n=1518) concerning the prevalence of ADHD in adulthood. We recruited participants from 3 groups defined by increasing ADHD severity out of this participant pool. Each participant was presented with 2 experimental tasks (in counterbalanced order): duration estimation and duration discrimination. RESULTS In general, we did not find any specific differences in time perception related to the severity of ADHD. Regarding duration estimation, we found that the difference between the actual and estimated durations increased with the actual duration (F(1, 7028.00)=2685.38, P<0.001). Although the differences between groups were not significant, the group×duration interaction was (F[1, 7028.00]=10.86, P<0.001), with a very small effect size (ηp²<0.001, 95% CI [0.00, 0.01]). CONCLUSIONS The results suggest that although individuals may demonstrate increased ADHD symptomatology, they may not have objectively more significant difficulties in time perception tasks than their counterparts with mild symptomatology. Nonetheless, time perception should be further studied because, as qualitative research suggests, participants with more severe ADHD symptomatology subjectively perceive more significant differences in time management in real life.

Meta-analysis: Altered Perceptual Timing Abilities in Attention-Deficit/Hyperactivity Disorder

OBJECTIVE

We meta-analyzed studies comparing perceptual timing abilities in the range of milliseconds to several seconds in persons with attention-deficit/hyperactivity disorder (ADHD) and neurotypical participants, using the well-established time discrimination, time estimation, time production, and time reproduction paradigms.

METHOD

We searched PubMed, OVID databases, and Web of Knowledge through September 17, 2020. From 2,266 records, 55 studies were retained and meta-analyzed with random effects models. We conducted meta-regression analyses to explore moderating effects of task parameters and neuropsychological measures of working memory, attention, and inhibition on timing performance.

RESULTS

Compared with persons without ADHD, those with ADHD had significantly more severe difficulties in discriminating stimuli of very brief durations, especially in the sub-second range. They also had more variability in estimating the duration of stimuli lasting several seconds. Moreover, they showed deficits in time estimation and time production accuracy, indicative of an accelerated internal clock. Additional deficits in persons with ADHD were also found in the time reproduction paradigm, involving attentional (slower counting at short time intervals due to distraction) and motivational (faster counting at long time intervals due to increased delay aversion) functions.

CONCLUSION

There is meta-analytic evidence of a broad range of timing deficits in persons with ADHD. Results have implications for advancing our knowledge in the field (eg, for refinement of recent timing models in ADHD) and clinical practice (eg, testing timing functions to characterize the clinical phenotype of the patient and implementation of interventions to improve timing abilities).

Validity and normative data of the Chinese Prospective and Retrospective Memory Questionnaire (PRMQ) across adolescence, adults and elderly people

The Prospective and Retrospective Memory Questionnaire (PRMQ) is a widely-used questionnaire for evaluating individuals' memory failures in everyday life. However, whether the scale is valid for different age groups and gender, and how memory complaints change with age and gender remains less clear. This study aimed to validate the self-report PRMQ in a large Chinese sample across adolescence and adulthood and investigate age-related changes and gender differences in self-report prospective memory (PM) and retrospective memory (RM). A total of 2528 healthy individuals aged from 13 to 96 completed the Chinese version of the PRMQ. Results revealed that the PM-RM correlated factor model was the best fit model with satisfactory reliability and had measurement invariance across gender and adjacent age groups. Adolescents and adults reported similar memory complaints, while older people stated more memory difficulties. Female participants reported more PM errors than male participants, but this gender difference only showed in adolescents and adults. Taken together, these findings not only support the Chinese version of the PRMQ as a valid tool for evaluating prospective and retrospective memory difficulties across gender and adjacent age groups, but also reveal age-related changes and gender difference on self-report memory.

The Geneva Space Cruiser: a fully self-administered online tool to assess prospective memory across the adult lifespan

The current study aimed to examine whether the Geneva Space Cruiser - a new online adaptation of the Cruiser - represents a valid, reliable and useful tool to assess prospective memory (PM) across the adult lifespan via fully self-administered online testing. Therefore, an adult lifespan sample of 252 adults (19-86 years old) performed the Geneva Space Cruiser in the laboratory and online, at home, and also performed a more traditional laboratory PM task. A second sample of 224 young adults (19-35 years old) participated in a test-retest online assessment of the Geneva Space Cruiser. Bayesian analyses showed that the Geneva Space Cruiser yielded similar results when administered in the laboratory versus online, both in terms of data distribution as well as of key outcome measures (i.e., PM performance and monitoring). Results further showed very good test-retest reliability and acceptable construct validity. Finally, the online tool was sensitive for detecting age-differences similar to those typically observed in laboratory studies. Together, our findings suggest that the Geneva Space Cruiser represents a rather valid, moderately to highly reliable, and generally useful tool to assess PM in online testing across wide ranges of the adult lifespan, with certain limitations for the oldest participants and for women.

[Formula: see text]Systematic review of pediatric memory questionnaires

Memory disturbances are common in children with neurological and developmental conditions. One way to measure memory disturbances and their functional implications is via a memory questionnaire. Several pediatric memory questionnaires have been published but no systematic review has been conducted to establish their psychometric properties. This review evaluated currently available pediatric memory questionnaires using the Evidence-Based Assessment (EBA) criteria developed by the American Psychological Association Task force. A systematic search of CINAHL, EMBASE, Medline, and PsychINFO was completed on June 2019. The selection process was guided by pre-defined inclusion and exclusion criteria, followed by full manuscript reviews, and hand-search of reference lists of relevant papers. Selected questionnaires were evaluated by two independent raters against the EBA criteria and classified into "well established", "approaching well-established", and "promising" categories. The electronic searches yielded 9888 articles, 24 of which met the inclusion criteria. Hand searches identified additional 21 studies. The 45 identified studies reported on 24 versions of 10 memory questionnaires assessed working memory, everyday memory, prospective and retrospective memory, and self-awareness of memory functions. Based on EBA criteria, only one memory questionnaire (The Working Memory Rating Scale - 20 item version) was classified as "well-established", 3 as "approaching well-established", and 20 as "promising". Most (n = 19) had good reliability but lacked concurrent validity; had low or no correlations with objective memory tests, and low predictive power. In conclusion, this review highlights an urgent need for the development and validation of pediatric memory questionnaires to increase the evidence base and improve questionnaires' clinical utility.

Event-Based Prospective Memory Deficit in Children with ADHD: Underlying Cognitive Factors and Association with Symptoms

Event-based prospective memory (PM) was investigated in children with Attention deficit/hyperactivity disorder (ADHD), using a novel experimental procedure to evaluate the role of working memory (WM) load, attentional focus, and reward sensitivity. The study included 24 children with ADHD and 23 typically-developing controls. The experimental paradigm comprised one baseline condition (BC), only including an ongoing task, and four PM conditions, varying for targets: 1 Target (1T), 4 Targets (4T), Unfocal (UN), and Reward (RE). Children with ADHD were slower than controls on all PM tasks and less accurate on both ongoing and PM tasks on the 4T and UN conditions. Within the ADHD group, the accuracy in the RE condition did not differ from BC. A significant relationship between ADHD-related symptoms and reduced accuracy/higher speed in PM conditions (PM and ongoing trials), but not in BC, was detected. Our data provide insight on the adverse role of WM load and attentional focus and the positive influence of reward in the PM performance of children with ADHD. Moreover, the relation between PM and ADHD symptoms paves the road for PM as a promising neuropsychological marker for ADHD diagnosis and intervention.

Back to the future: relating the development of episodic future thinking to cognitive and affective individual differences and to motivational relevance in preschoolers

Episodic future thinking (EFT) represents the ability to mentally simulate scenarios that will occur in our personal future. In the current study, we used the item choice paradigm, which puts chidren in a problematic situation and requires them to envision a solution by selecting one of various items. This ability was assessed in a sample of 92 preschoolers (3-6 years old), taking into account individual differences in age, gender, cognitive (verbal abilities, EFT memory) and affective (anxiety) factors, as well as contextual factors (motivational relevance). Findings indicate developmental progress in preschoolers' foresight and in their retrospective memory for the item choice problems. The motivational valence of the EFT task played a significant role, as children performed better in the motivationally positive condition, as compared to the neutral and negative ones. However, older children had better performance than younger ones on the motivationally aversive tasks, becoming comparable to their performance in the motivationally appetitive condition. Finally, higher social anxiety was negatively related to children's EFT performance in the aversive condition, when they anticipated negative social exposure. In conclusion, EFT was explained by age-related improvements, the motivational valence of the situation and by individual differences in social anxiety, which is highly relevant for educational and therapeutic practices.

Assessing prospective memory in children using the Memory for Intentions Screening Test for Youth (MISTY)

OBJECTIVE

Prospective memory (PM) is defined as the ability to remember to complete an intention in the future. The first aim of this study was to address the need for clinically useful measures of PM in children, by assessing the psychometric properties of a new measure of PM in children and adolescents, the Memory for Intentions Screening Test for Youth (MISTY). The second aim was to assess the relationship between prospective memory and age, particularly the relationships between age and the impact of different PM task demands. The third aim was to examine children's performance on different aspects of PM, such as time-based versus event-based cues.

METHOD

One-hundred twenty-four children between the ages of 4 and 15 were given the MISTY.

RESULTS

Analyses revealed good internal consistency among the eight individual MISTY trials and among the six MISTY subscales which included two different cue types (event-based and time-based), two different time delays (2 minutes and 10 minutes), and two different response types (action and verbal). Results also revealed good split-half and inter-rater reliability. Findings highlighted significant correlations between age and the MISTY total score and all subscales, consistent with PM lifespan research. On the MISTY, children overall performed better on event-based cues than on time-based cues, and on shorter time delays than longer ones; there was no effect of response type (i.e. action vs. verbal response).

CONCLUSIONS

The MISTY is a promising instrument with sound psychometric properties that could be useful in both clinical and research settings. Additionally, this study highlights the age-related process of PM development in children.

Event-, Time- and Activity-Based Prospective Memory in Children with ADHD

We examined prospective memory (PM) function in children with attention deficit hyperactivity disorder (ADHD). A group of 28 children with ADHD and 28 typically developing children completed event-, time- and activity-based PM tasks and attention tests. ADHD children had impaired attention but intact PM performance. Both groups performed best in activity-based PM tasks, followed by event-based PM tasks, and performed worst in time-based PM tasks. ADHD children had lower ongoing task performance in the event-based PM task. The findings indicate that children with ADHD may have an intact PM, but this may be at the cost of ongoing task performance.

Prospective memory (partially) mediates the link between ADHD symptoms and procrastination

Individuals with attention deficit hyperactivity disorder (ADHD) often show poor planning and poor organization of tasks and activities which has been related to reduced memory for delayed intentions (prospective memory) and procrastination-in addition to other cognitive or motivational factors. This study set out to bring the fields of prospective memory and procrastination research together and to explore possible relations between the two constructs in ADHD. Twenty-nine adults with ADHD and 24 healthy controls performed several laboratory-based and real-life prospective memory tasks and filled in questionnaires measuring their symptom severity and procrastination behaviour. Overall, individuals' with ADHD showed clear deficits in everyday prospective memory performance. Individuals with ADHD recalled and executed less of their own real-life intentions. Moreover, there were clear links between everyday prospective memory performance and reported procrastination behaviour, and everyday prospective memory performance mediated the link between ADHD symptoms and procrastination behaviour.

Reinforcing the prospective remembering of children with autism spectrum disorder

Prospective memory is remembering to carry out a behavior on a particular occasion or at a specific time in the future. This form of remembering is critical for the daily functioning of children with autism spectrum disorder (ASD) and their functional independence from caregivers. We used a single-subject design to investigate whether reinforcement increased the accuracy of prospective remembering in the context of a computerized board game, Virtual Week, of four 6- to 7-year-old children diagnosed with ASD. Reinforcement increased accuracy for all participants compared to baseline performance and effects were maintained after reinforcement was discontinued for three of four children. This is the first study of which we are aware to use a reinforcement-based behavioral intervention to improve the prospective remembering of children with ASD. Limitations and areas for future research are discussed.

Weekly Calendar Planning Activity for University Students: Comparison of Individuals With and Without ADHD by Gender

OBJECTIVE

To introduce a revised version of the Weekly Calendar Planning Activity (WCPA) adapted for university students (Weekly Calendar Performance Activity for students [WCPA-S]) and compare the performance of this activity between students with and without ADHD and across gender groups.

METHOD

Participants included a total of 157 students, ages 20 to 30, enrolled in universities/colleges and divided into two groups: students with ADHD (male = 23, female = 38) and without ADHD (male = 33, female = 63). A two-way ANOVA was used for data analyses. The WCPA-S was administered to each student individually.

RESULTS

Significant differences were found between students with and without ADHD and across genders in performance, duration of performance, and in the number of strategies used.

CONCLUSION

The WCPA-S proved to be an effective performance-based diagnostic tool for the utilization of executive functions in the daily life of university students. This instrument can be used to predict success in higher education and to support learning among university students with ADHD.

Prospective memory in children with attention deficit hyperactivity disorder: a review

OBJECTIVE

The objective of the paper is to synthesize the research on prospective memory (PM) in children with attention-deficit/hyperactivity disorder (ADHD).

METHOD

Research on PM and ADHD in youth was synthesized according to the PRISMA guidelines and a summary of the types of PM deficits typically seen in these children, as well as the methods currently available to assess and treat these deficits is provided. Suggestions on ways to better manage PM deficits in children's everyday lives are also discussed.

RESULTS

Six studies have investigated PM in children with ADHD. The majority of these studies found a deficit in time-based PM, but not event-based PM. The mechanisms underlying this deficit, however, are still unknown. There are currently no specific measures available to clinically assess PM in children and there are no specific evidence-based interventions available that specifically target PM deficits in children with ADHD.

CONCLUSION

Remediation strategies aimed at compensating for these PM deficits in daily life may be most useful. Nevertheless, more research is necessary to better understand PM in children with ADHD.

Influence of Ongoing Task Difficulty and Motivation Level on Children's Prospective Memory in a Chinese Sample

Prospective memory (PM) is the process associated with the task of realizing delayed intentions in the future. Researchers distinguish two types of PM, namely time-based PM (tbPM) and event-based PM (ebPM). Experiment 1 investigated the developmental trajectory of 3- to 5-year-old preschool children’s PM ability, and the occurrence of delayed retrieval (children execute the PM task in a larger window of opportunity) in both tbPM and ebPM tasks. Results revealed that the 5-year-old children outperformed the 3- and 4-year-old children in PM. Moreover, delayed retrieval was more likely to occur in tbPM task than in ebPM task. In Experiment 2, the influence of ongoing task (OT) difficulty on PM performance was investigated with a sample of 5-year-old children. Results revealed no significant effect of OT difficulty on PM performance. In Experiment 3, we improved children’s motivation level to complete the OT, then explored the influence of OT difficulty on children’s PM performance. Results revealed that the effect of OT difficulty on PM performance became significant after increasing the children’s motivation to complete the OT. These results provide insights into the mechanism of attentional resource allocation in PM tasks and have crucial educational and social implications.

Interplay between stress response genes associated with attention-deficit hyperactivity disorder and brain volume

The glucocorticoid receptor plays a pivotal role in the brain's response to stress; a haplotype of functional polymorphisms in the NR3C1 gene encoding this receptor has been associated with attention-deficit hyperactivity disorder (ADHD). The serotonin transporter (5-HTT) gene polymorphism 5-HTTLPR is known to influence the relation between stress exposure and ADHD severity, which may be partly because of its reported effects on glucocorticoid levels. We therefore investigated if NR3C1 moderates the relation of stress exposure with ADHD severity and brain structure, and the potential role of 5-HTTLPR. Neuroimaging, genetic and stress exposure questionnaire data were available for 539 adolescents and young adults participating in the multicenter ADHD cohort study NeuroIMAGE (average age: 17.2 years). We estimated the effects of genetic variation in NR3C1 and 5-HTT, stress exposure and their interactions on ADHD symptom count and gray matter volume. We found that individuals carrying the ADHD risk haplotype of NR3C1 showed significantly more positive relation between stress exposure and ADHD severity than non-carriers. This gene-environment interaction was significantly stronger for 5-HTTLPR L-allele homozygotes than for S-allele carriers. These two- and three-way interactions were reflected in the gray matter volume of the cerebellum, parahippocampal gyrus, intracalcarine cortex and angular gyrus. Our findings illustrate how genetic variation in the stress response pathway may influence the effects of stress exposure on ADHD severity and brain structure. The reported interplay between NR3C1 and 5-HTT may further explain some of the heterogeneity between studies regarding the role of these genes and hypothalamic-pituitary-adrenal axis activity in ADHD.

Time-based prospective memory difficulties in children with ADHD and the role of time perception and working memory

Time-based prospective memory (PM) is the ability to remember to perform an intended action at a given time in the future. It is a competence that is crucial for effective performance in everyday life and may be one of the main causes of problems for individuals who have difficulty in planning and organizing their life, such as children with attention deficit/hyperactivity disorder (ADHD). This study systematically examines different aspects of time-based PM performance in a task that involves taking an action at a given future time in a group of 23 children with ADHD who were compared with a matched group of typically-developing (TD) children. The children were asked to watch a cartoon and then answer a questionnaire about its content (ongoing task). They were also asked to press a key every 2 minutes while watching the cartoon (PM task). The relationships of time perception and verbal working memory with PM performance were examined by administering appropriate tasks. The results showed that the children with ADHD were less accurate than the TD children in the PM task and exhibited less strategic time-monitoring behavior. Time perception was found to predict PM accuracy, whereas working memory was mainly involved in time-monitoring behavior, but this applied more to the TD group than to the ADHD group, suggesting that children with ADHD are less able to use their cognitive resources when meeting a PM request.

Prospective Memory Impairment in Children with Prenatal Alcohol Exposure

BACKGROUND

Prenatal alcohol exposure (PAE) is linked to impaired performance on tests of retrospective memory, but prospective memory (PM; the ability to remember and act on delayed intentions) has not been examined in alcohol-exposed children. We investigated event-based PM in children with heavy PAE and the degree to which associations between PAE and PM are influenced by IQ, executive functioning (EF), retrospective memory, and attention deficit/hyperactivity disorder (ADHD).

METHODS

We administered a computerized PM task to 89 children (Mage = 11.1 years) whose mothers were recruited prenatally: 29 with fetal alcohol syndrome (FAS) or partial FAS (PFAS), 32 nonsyndromal heavily exposed (HE), and 28 Controls. We examined effects of diagnostic group, cue focality, and task difficulty on PM performance. The association between a continuous measure of alcohol exposure and PM performance was also examined after controlling for sociodemographic confounders. Mediation of alcohol effects on PM by IQ, EF, and retrospective memory scores was assessed as was the effect of ADHD on PM performance.

RESULTS

Children with FAS/PFAS made more PM errors than either HE or Control children. PAE was negatively related to PM performance even after adjusting for sociodemographic confounders, EF, and retrospective memory. This relation was only partially mediated by IQ. PAE was related to ADHD, but ADHD was not related to PM performance.

CONCLUSIONS

Fetal alcohol-related impairment in event-based PM was seen in children with FAS/PFAS. The effect of PAE on PM was not attributable to impaired EF and retrospective memory and was not solely attributable to lower IQ. Consistent with previous studies, we found no effect of ADHD on event-based PM performance at this age. This is the first study documenting PM impairment in children with heavy PAE and identifies a new domain of impairment warranting attention in diagnosis and management of fetal alcohol spectrum disorders.

Annual Research Review: Transdiagnostic neuroscience of child and adolescent mental disorders--differentiating decision making in attention-deficit/hyperactivity disorder, conduct disorder, depression, and anxiety

BACKGROUND

Ineffective decision making is a major source of everyday functional impairment and reduced quality of life for young people with mental disorders. However, very little is known about what distinguishes decision making by individuals with different disorders or the neuropsychological processes or brain systems underlying these. This is the focus of the current review.

SCOPE AND METHODOLOGY

We first propose a neuroeconomic model of the decision-making process with separate stages for the prechoice evaluation of expected utility of future options; choice execution and postchoice management; the appraisal of outcome against expectation; and the updating of value estimates to guide future decisions. According to the proposed model, decision making is mediated by neuropsychological processes operating within three domains: (a) self-referential processes involved in autobiographical reflection on past, and prospection about future, experiences; (b) executive functions, such as working memory, inhibition, and planning, that regulate the implementation of decisions; and (c) processes involved in value estimation and outcome appraisal and learning. These processes are underpinned by the interplay of multiple brain networks, especially medial and lateralized cortical components of the default mode network, dorsal corticostriatal circuits underpinning higher order cognitive and behavioral control, and ventral frontostriatal circuits, connecting to brain regions implicated in emotion processing, that control valuation and learning processes.

FINDINGS AND CONCLUSION

Based on clinical insights and considering each of the decision-making stages in turn, we outline disorder-specific hypotheses about impaired decision making in four childhood disorders: attention-deficit/hyperactivity disorder (ADHD), conduct disorder (CD), depression, and anxiety. We hypothesize that decision making in ADHD is deficient (i.e. inefficient, insufficiently reflective, and inconsistent) and impulsive (biased toward immediate over delayed alternatives). In CD, it is reckless and insensitive to negative consequences. In depression, it is disengaged, perseverative, and pessimistic, while in anxiety, it is hesitant, risk-averse, and self-deprecating. A survey of current empirical indications related to these disorder-specific hypotheses highlights the limited and fragmentary nature of the evidence base and illustrates the need for a major research initiative in decision making in childhood disorders. The final section highlights a number of important additional general themes that need to be considered in future research.