The effect of environmental distractors incorporation into a CPT on sustained attention and ADHD diagnosis among adolescents

Data-driven profiles of attention-deficit/hyperactivity disorder using objective and ecological measures of attention, distractibility, and hyperactivity

In the past two decades, the traditional nosology of attention-deficit/hyperactivity disorder (ADHD) has been criticized for having insufficient discriminant validity. In line with current trends, in the present study, we combined a data-driven approach with the advantages of virtual reality aiming to identify novel behavioral profiles of ADHD based on ecological and performance-based measures of inattention, impulsivity, and hyperactivity. One hundred and ten Spanish-speaking participants (6-16 years) with ADHD (medication-naïve, n = 57) and typically developing participants (n = 53) completed AULA, a continuous performance test embedded in virtual reality. We performed hybrid hierarchical k-means clustering methods over the whole sample on the normalized t-scores of AULA main indices. A five-cluster structure was the most optimal solution. We did not replicate ADHD subtypes. Instead, we identified two clusters sharing clinical scores on attention indices, susceptibility to distraction, and head motor activity, but with opposing scores on mean reaction time and commission errors; two clusters with good performance; and one cluster with average scores but increased response variability and slow RT. DSM-5 subtypes cut across cluster profiles. Our results suggest that latency of response and response inhibition could serve to distinguish among ADHD subpopulations and guide neuropsychological interventions. Motor activity, in contrast, seems to be a common feature among ADHD subgroups. This study highlights the poor feasibility of categorical systems to parse ADHD heterogeneity and the added value of data-driven approaches and VR-based assessments to obtain an accurate characterization of cognitive functioning in individuals with and without ADHD.

Neurophysiological Patterns of Attention and Distraction during Realistic Virtual-Reality Classroom Learning in Adults with and without ADHD

Many people, and particularly those diagnosed with ADHD, report difficulties maintaining attention and proneness to distraction during classroom learning. However, the behavioral, neural and physiological basis of attention in realistic learning contexts is not well understood, since current clinical and scientific tools used for evaluating and quantifying the constructs of "distractibility" and "inattention", are removed from the real-life experience in organic classrooms. Here we introduce a novel Virtual Reality (VR) platform for studying students' brain activity and physiological responses as they immerse in realistic frontal classroom learning. Using this approach, we studied whether adults with and without ADHD (N=49) exhibit differences in neurophysiological metrics associated with sustained attention, such as speech-tracking of the teacher's voice, power of alpha-oscillations and levels of arousal, as well as responses to potential disturbances by background sound-events in the classroom. Under these ecological conditions, we find that adults with ADHD exhibit higher auditory neural response to background sounds relative to their control-peers, which also contributed to explaining variance in the severity of ADHD symptoms, together with higher power of alpha-oscillations and more frequent gaze-shifts around the classroom. These results are in-line with higher sensitivity to irrelevant stimuli in the environment and increased mind-wandering/boredom. At the same time, both groups exhibited similar learning outcomes and showed similar neural tracking of the teacher's speech. This suggests that in this context, attention may not operate as a zero-sum game and that allocating some resources to irrelevant stimuli does not always detract from performing the task at hand. Given the dire need for more objective, dimensional and ecologically-valid measures of attention and its real-life deficits, this work provides new insights into the neurophysiological manifestations of attention and distraction experienced in real-life contexts, while challenging some prevalent notions regarding the nature of attentional challenges experienced by those with ADHD.

Impact of Distractors on Sustained Attention and Inhibition in Children With ADHD

OBJECTIVE

This study examines the impact of visual and auditory distractors on attention and inhibition in children with and without ADHD.

METHOD

The study used the MOXO d-CPT child version. The sample consisted of 208 children aged 8 to 12 years, including 64 with ADHD and 144 controls.

RESULTS

Children with ADHD and controls differed in their reaction to distracting stimuli; visual distractors cause a higher decrease in sustained attention and inhibitory control in the ADHD group. Moreover, auditory distractors generate improved performance in the control group but not in the ADHD group. In addition, age-related effects were found in both sustained attention and inhibitory control in all children, regardless of whether the ADHD condition was present.

CONCLUSIONS

The findings indicate that children with ADHD performed poorer compared to controls, and that distractors differently affected the performance of the two groups.

Systematic Review and Meta-Analysis: Clinical Utility of Continuous Performance Tests for the Identification of Attention-Deficit/Hyperactivity Disorder

OBJECTIVE

We aimed to quantify the clinical utility of continuous performance tests (CPTs) for the diagnosis of attention-deficit/hyperactivity disorder (ADHD) compared to a clinical diagnosis in children and adolescents.

METHOD

Four databases (MEDLINE, PsycINFO, EMBASE, and PubMed) were screened until January 2023. Risk of bias of included results was judged with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). We statistically pooled the area under the curve, the sensitivity, and the specificity of 3 commonly used CPTs subscales: omission/inattention, commission/impulsivity, and total number of errors/ADHD subscales (PROSPERO registration: CRD42020168091).

RESULTS

A total of 19 studies using commercially available CPTs were identified. Results from up to 835 control individuals and 819 cases were combined in the summary receiver operating characteristic (ROC) curve analyses (sensitivity and specificity pooling), and up to 996 cases and 1,083 control individuals in the area under the curve (AUC) analyses. Clinical utility as measured by AUCs could be considered as barely acceptable (between 0.7 and 0.8) for the most part, with the best results for the total/ADHD score, followed by omissions/inattention, and poorest for commission/impulsivity scores. A similar pattern was found when pooling sensitivity and specificity: 0.75 (95% CI = 0.66-0.82) and 0.71 (0.62-0.78) for the total/ADHD score; 0.63 (0.49-0.75) and 0.74 (0.65-0.81) for omissions; and 0.59 (0.38-0.77) and 0.66 (CI = 0.50-0.78) for commissions.

CONCLUSION

At the clinical level, CPTs as a stand-alone tool have only a modest to moderate ability to differentiate ADHD from non-ADHD samples. Hence, they should be used only within a more comprehensive diagnostic process.

STUDY PREREGISTRATION INFORMATION

A systematic review of screening tools for ADHD in children and adolescents; https://www.crd.york.ac.uk/prospero/; CRD42020168091.

Is the Conners' continuous performance test helpful for assessing attention deficit hyperactivity disorder in a clinical setting?

BACKGROUND

Despite lacking validation for Norwegian populations, the Conners Continuous Performance Test II (CCPT-II) is applied to almost one-third of children receiving an ADHD diagnosis. However, evidence of the CCPT-II's ability to differentiate between children with and without ADHD is contradictory. Thus, this study examines how CCPT-II results correlate with ADHD symptoms reported by mothers and teachers in a sample representing ordinary child and adolescent mental health services and explores the extent to which the CCPT-II influences the diagnostic result.

METHODS

Correlations between CCPT-II results and ADHD Rating Scale scores and a clinical diagnosis of ADHD were analysed in children aged 6-15 years (N = 69) referred to a child and adolescent psychiatric outpatient clinic.

RESULTS

Total ADHD symptom scores rated by mothers correlated with hit reaction time (HRT) block change (.260), HRT inter-stimulus interval (ISI) change (.264) and CCPT-II overall index (.263), while hyperactivity subscale scores correlated with omissions (.285), HRT (.414) and variability (.400). In teachers' ratings, total ADHD and both subscale scores correlated with commissions (.280-.382), while hyperactivity scores correlated with variability (.265). A higher number of commissions was the only significant difference in CCPT-II performance between children diagnosed with and children without ADHD.

CONCLUSIONS

Correlations between CCPT-II results and ADHD symptoms were all small to moderate. As such, CCPT-II results should be interpreted with caution, because they correspond to a limited degree with other sources of information.

BOLD Activation During the Application of MOXO-CPT in School Patients With and Without Attention Deficit Hyperactivity Disorder

INTRODUCTION

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects 3% of children in the world.

OBJECTIVE

In this work, we seek to compare the different brain activations of pediatric patients with and without ADHD.

METHODS

A functional resonance examination with BOLD contrast was applied using the MOXO-CPT test (Continuous Performance test with single and double visual-auditory distractors).

RESULTS

Differences in BOLD activation were observed indicating that control children regularly presented negative BOLD activations that were not found in children with ADHD. Inhibitory activity in audiovisual association zones in control patients was greater than in patients with ADHD. The inhibition in the frontal and motor regions in the controls contrasted with the overactivation of the motor areas in patients with ADHD, this, together with the detection of cerebellar activation which attempted to modulate the responses of the different areas that lead to executive failure in patients with ADHD.

CONCLUSIONS

In view of these results, it can be argued that the lack of inhibition of ADHD patients in their executive functions led to a disorganization of the different brain systems.

Advancing ecological validity and clinical utility in virtual reality-based continuous performance test: exploring the effects of task difficulty and environmental distractors

Introduction

Researchers have highlighted concerns regarding the limited diagnostic utility and ecological validity of the Continuous Performance Test (CPT). Recent advancements in VR-based CPTs have attempted to address these concerns by simulating real-life scenarios and enhancing attention deficit hyperactivity disorder (ADHD) diagnosis; however, certain areas require improvement for obtaining reliable data from both healthy individuals and those with ADHD. To tackle these issues, we developed an enhanced VR-based CPT program featuring four distinct difficulty levels, advancing toward home-based assessment.

Method

Our feasibility study involved subjects without ADHD to establish a normative profile for VR-based CPT before extending it to ADHD assessment. Our sample included 20 Korean adults. They received a VR device with the VR-based CPT program installed and were asked to perform 1-2 blocks per day at home. Participants were instructed to complete 12 blocks over the subsequent 2 weeks. Psychological assessments and electroencephalograms (EEGs) were administered before and after the program. Post-study usability measures were also collected.

Result

Higher commission errors were notably evident in the "very high" difficulty level which featured complex stimuli and increased distraction. A notable correlation emerged between the overall distraction level and CPT accuracy, along with a significant link between intensity scores and commission errors. No significant differences were found in psychological assessment and there were no significant changes in the Theta-Beta Ratio (TBR) index before and after the program. The usability of our program was fair.

Discussion

The study reveals that the newly designed VR-CPT program, simulating diverse real-life environments and offering varying task difficulty levels, proved acceptable and feasible. The key point of our study was that the adjustment and segmentation of difficulty levels in the VR-based CPT were achieved, and that this effort was validated by examining the impact of different levels of difficulty on CPT measures. Implementing this experimental setup in a home-based environment increased ecological validity, as well as clinical utility. Limitations and suggested directions for further investigation are described in detail.

Evidence for Overlapping Visual Processing Difficulties in Adult ADHD and Visual Stress

We investigated the viability of spectral filters as an adjunctive treatment for adults with both ADHD and visual processing difficulties. Fifty-nine adults (age 18-50), diagnosed with both ADHD and visual stress received either spectral filters (n = 39) or no intervention (n = 20) to address visual processing difficulties. We administered the MOXO d-CPT, a computer based continuous performance test, before the intervention and one hour after the intervention to assess any short-term change in the participants' attention profile. We used the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) before and 3-6 months after the intervention to assess any long-term intervention impact after 3-6 months. The intervention group had significant short- and long-term improvements in overall attention compared to the control group (X2(1, N = 59) = 20.10, p < .001). On the DSM-5, 49% of participants with short term and 64% with long-term intervention no longer met criteria for an ADHD diagnosis. Findings suggest that spectral filters may be an adjunctive treatment for many adults suffering from perceptually-based attention issues common to visual stress and ADHD.

Weekly Calendar Planning Activity (WCPA): Validating a Measure of Functional Cognition for Adolescents With Attention Deficit Hyperactivity Disorder

IMPORTANCE

Adolescents with attention deficit hyperactivity disorder (ADHD) often experience difficulties with executive function and participation in life roles. Ecologically valid performance-based tests (PBTs) are needed to assess functional cognition in this population.

OBJECTIVE

To examine the known-groups, concurrent, and ecological validity of a functional cognition PBT, the Hebrew version of the Weekly Calendar Planning Activity (WCPA) Middle/High School Version, among adolescents with and without ADHD.

DESIGN

Cross-sectional between-groups design.

SETTING

Community.

PARTICIPANTS

One hundred two adolescents (ages 12-18 yr), with (n = 52) and without (n = 50) ADHD.

OUTCOMES AND MEASURES

The Hebrew version of the WCPA Middle/High School Version, MOXO™-Continuous Performance Test (MOXO-CPT), Behavior Rating Inventory of Executive Function (BRIEF) parent form, and Child and Adolescent Scale of Participation (CASP).

RESULTS

The results showed significant between-groups differences with medium to large effect sizes for scores on most WCPA measures, with the ADHD group receiving significantly lower scores. Significant correlations in the expected direction were found between scores on the MOXO-CPT Attention and Hyperactivity indices and WCPA measures. Significant correlations were also found between most WCPA measures and the BRIEF Global Executive Composite (GEC) and the CASP. Multiple linear regression on the CASP indicated that the WCPA strategy score and the BRIEF GEC were significant predictors in the model.

CONCLUSIONS AND RELEVANCE

Results support the known-groups validity of the WCPA Middle/High School Version between adolescents with and without ADHD. Concurrent and ecological validity were supported by significant associations with measures of cognition and participation. What This Article Adds: These results reinforce the premise that the WCPA Middle/High School Version can be implemented as a valid measure of functional cognition among adolescents with ADHD.

Clinical Utility of Eye Tracking in Assessing Distractibility in Children with Neurological Disorders or ADHD: A Cross-Sectional Study

This study aims to investigate distractibility quantified by recording and analyzing eye movements during task-irrelevant distraction in children with and without ADHD and in children with and without neurological disorders. Gaze behavior data and press latencies of 141 participants aged 6−17 that were collected during a computerized distraction paradigm with task-irrelevant stimuli (IDistrack) were analyzed. Children using attention-regulating medication were excluded from participation. Data were analyzed for subgroups that were formed based on the presence of neurological disorders and the presence of ADHD separately. Participants with ADHD and participants with neurological disorders spent less time fixating on the target stimuli compared to their peers without ADHD (p = 0.025) or their peers without neurological disorders (p < 0.001). Participants with and without ADHD had equal press latencies (p = 0.79). Participants with neurological disorders had a greater press latency compared to their typically developing peers (p < 0.001). Target fixation duration shows a significant association with parent-reported attention problems (r = −0.39, p < 0.001). We conclude that eye tracking during a distraction task reveals potentially valid clinical information that may contribute to the assessment of dysfunctional attentional processes. Further research on the validity and reliability of this paradigm is recommended.

Callous-Unemotional Traits and Face-Emotion Recognition as Mediators in Conduct Problems of Children With ADHD

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is associated with increased risk for conduct problems (CP), as well as with callous-unemotional traits (CUt) and lower accuracy in face emotional recognition (FER). It is unclear, however, whether CUt and low accuracy in FER contribute to the risk for CP in ADHD. The present study investigated the possibility of such contribution.

METHODS

This pilot study's participants included 31 children aged 7-17 years, diagnosed with ADHD, and treated in a psychiatric outpatient clinic. The parents rated their children on the ADHD Rating Scale, Inventory of Callous-Unemotional Traits, and the Child Behavior Checklist-Conduct Problems scale. Participants completed the Hebrew version of the children's Reading the Mind in the Eyes Test (cRMET)-a Theory of Mind measure. A bootstrapped multiple mediator model was used, adjusting for age and gender.

RESULTS

ADHD symptoms were associated with CP. This association was not mediated by CUt or cRMET. CUt was associated with CP independent of ADHD symptom severity.

CONCLUSIONS

ADHD symptoms and CUt both should be considered when assessing risk for CP and devising a treatment plan, in children with ADHD. Current results did not confirm the hypothesis that cRMET and CUt mediate between ADHD symptoms and CP. More studies employing larger samples, longitudinal design, and other emotion recognition measures are needed.

Factors associated with texting and walking performance in children with ADHD: The role of age, environment, and symptom severity

BACKGROUND

Children with ADHD show deficits in executive function, as well as motor symptoms such as difficulties in gross and fine motor skills and gait stability. Texting while walking is becoming increasingly common and is a significant health risk among people of all ages.

RESEARCH QUESTION

The objective of this work was to compare texting and walking performance between children with ADHD and controls and between two environments (indoors and outdoors), and evaluate the role of age and symptom severity in dual-task performance.

METHODS

Nineteen children with ADHD and 30 healthy children walked across an indoors corridor and an outdoors street, with and without texting on a mobile phone. Walking and texting performance were measured using inertial measurement units and a custom-made mobile app.

RESULTS

No between-group differences were found in texting or walking performance. Walking and texting were similar across environments. In both groups, older children had smaller dual-task performance deficits for both gait and texting speed. Children with ADHD who had more severe symptoms of hyperactivity had larger dual task costs for gait speed outdoors (r = 0.69, p = 0.002), and those with more motor symptoms typed faster under dual-task conditions indoors (r = 0.6, p = 0.007) but were less accurate (r = - 0.60, p = 0.009).

SIGNIFICANCE

Children with ADHD do not demonstrate deficits in dual-task performance of a texting and walking task indoors or outdoors. The relationship of age, hyperactivity and motor symptoms with texting and walking performance supports a more personalized approach for examination of dual-task performance in children with ADHD.

Sweet but sour: Impaired attention functioning in children with type 1 diabetes mellitus

Children diagnosed with type 1 diabetes mellitus (T1DM) are at risk for neurocognitive sequelae, including impaired attention functioning. The specific nature of the cognitive deficit varies; current literature underscores early age of diabetes diagnosis and increased disease duration as primary risk factors for this neurocognitive decline. Forty-three children with T1DM were evaluated for Attention Deficit/Hyperactivity Disorder (ADHD) symptomatology using the MOXO continuous performance test (MOXO-CPT) performed during a routine outpatient evaluation. The study cohort demonstrated a significant decline in all four domains of attention functioning. The effect was most pronounced with early age at T1DM diagnosis, a longer disease duration and with poorer glycemic control (represented by higher HbA1c values). With increased disease duration (of 5 plus years), acute hyperglycemia was associated with inattention in the real-time setting. These findings highlight the need for routine screening of neurocognitive function in children with T1DM so that early intervention can be employed during this crucial period of cognitive development.

Efficacy of Continuous Performance Testing in Adult ADHD in a Clinical Sample Using QbTest

OBJECTIVE

Continuous performance tests are widely used to aid diagnostic decision making and measure symptom reduction in adult ADHD clinical populations. The diagnostic accuracy of the Quantified Behavior Test plus (QbTest+), developed to identify ADHD populations as an objective measure of ADHD symptoms, was explored.

METHODS

The utility of the QbTest+ was investigated in a clinical cohort of 69 adult patients referred to a specialist ADHD clinic in the UK.

RESULTS

Scores from the QbTest+ failed to differentiate between patients diagnosed with ADHD and those who did not receive a diagnosis after full clinical assessment.

CONCLUSIONS

Based on our findings, we recommend clinicians are cautious when interpreting results of the QbTest+ in clinical populations. This study highlights the need for investigation into the lack of validation of commonly used objective measures in ADHD populations.

Examining the Effect of Transcranial Electrical Stimulation and Cognitive Training on Processing Speed in Pediatric Attention Deficit Hyperactivity Disorder: A Pilot Study

Objective

Processing Speed (PS), the ability to perceive and react fast to stimuli in the environment, has been shown to be impaired in children with attention deficit hyperactivity disorder (ADHD). However, it is unclear whether PS can be improved following targeted treatments for ADHD. Here we examined potential changes in PS following application of transcranial electric stimulation (tES) combined with cognitive training (CT) in children with ADHD. Specifically, we examined changes in PS in the presence of different conditions of mental fatigue.

Methods

We used a randomized double-blind active-controlled crossover study of 19 unmedicated children with ADHD. Participants received either anodal transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex (dlPFC) or transcranial random noise stimulation (tRNS), while completing CT, and the administration order was counterbalanced. PS was assessed before and after treatment using the MOXO-CPT, which measures PS in the presence of various conditions of mental fatigue and cognitive load.

Results

tRNS combined with CT yielded larger improvements in PS compared to tDCS combined with CT, mainly under condition of increased mental fatigue. Further improvements in PS were also seen in a 1-week follow up testing.

Conclusion

This study provides initial support for the efficacy of tRNS combined with CT in improving PS in the presence of mental fatigue in pediatric ADHD.

Neural Mechanisms Underlying the Effects of Novel Sounds on Task Performance in Children With and Without ADHD

Distractibility is one of the key features of attention deficit hyperactivity disorder (ADHD) and has been associated with alterations in the neural orienting and alerting networks. Task-irrelevant stimuli are thus expected to have detrimental effects on the performance of patients with ADHD. However, task-irrelevant presentation of novel sounds seems to have the opposite effect and improve subsequent attentional performance particularly in patients with ADHD. Here, we aimed to understand the neural modulations of the attention networks underlying these improvements. Fifty boys (25 with ADHD) participated in a functional magnetic resonance imaging (fMRI) study in which unique (novel) or repeatedly presented (familiar) sounds were placed before a visual flanker task in 2/3 of the trials. We found that presenting any sound improved task performance in all participants, but the underlying neural mechanisms differed for the type of sound. Familiar sounds led to a stronger increase in activity in the left posterior insula in patients with ADHD compared to typically developing peers. Novel sounds led to activations of the fronto-temporoparietal ventral attention network, likewise in ADHD and TD. These changes in signaling by novelty in the right inferior frontal gyrus were directly related to improved response speed showing that neural orienting network activity following novel sounds facilitated subsequent attentional performance. This mechanism of behavioral enhancement by short distractions could potentially be useful for cognitive trainings or homework situations.

Measuring Attentional Distraction in Children With ADHD Using Virtual Reality Technology With Eye-Tracking

Objective

Distractions inordinately impair attention in children with Attention-Deficit Hyperactivity Disorder (ADHD) but examining this behavior under real-life conditions poses a challenge for researchers and clinicians. Virtual reality (VR) technologies may mitigate the limitations of traditional laboratory methods by providing a more ecologically relevant experience. The use of eye-tracking measures to assess attentional functioning in a VR context in ADHD is novel. In this proof of principle project, we evaluate the temporal dynamics of distraction via eye-tracking measures in a VR classroom setting with 20 children diagnosed with ADHD between 8 and 12 years of age.

Method

We recorded continuous eye movements while participants performed math, Stroop, and continuous performance test (CPT) tasks with a series of "real-world" classroom distractors presented. We analyzed the impact of the distractors on rates of on-task performance and on-task, eye-gaze (i.e., looking at a classroom whiteboard) versus off-task eye-gaze (i.e., looking away from the whiteboard).

Results

We found that while children did not always look at distractors themselves for long periods of time, the presence of a distractor disrupted on-task gaze at task-relevant whiteboard stimuli and lowered rates of task performance. This suggests that children with attention deficits may have a hard time returning to tasks once those tasks are interrupted, even if the distractor itself does not hold attention. Eye-tracking measures within the VR context can reveal rich information about attentional disruption.

Conclusions

Leveraging virtual reality technology in combination with eye-tracking measures is well-suited to advance the understanding of mechanisms underlying attentional impairment in naturalistic settings. Assessment within these immersive and well-controlled simulated environments provides new options for increasing our understanding of distractibility and its potential impact on the development of interventions for children with ADHD.

Attention-Deficit/Hyperactivity Disorder Symptoms, Sensation-Seeking, and Sensory Modulation Dysfunction in Substance Use Disorder: A Cross Sectional Two-Group Comparative Study

Background: Attention-deficit/hyperactivity disorder (ADHD) and sensation-seeking, a trait characterized by risk-related behaviors, have been recognized as risk factors in substance use disorder (SUD). Though ADHD co-occurs with sensory modulation dysfunction (SMD), SMD has scarcely been explored in SUD. Thus, this study aimed to characterize ADHD symptomology, sensation-seeking, and SMD, as well as to explore their contribution to SUD likelihood. Methods: A cross sectional two-group comparative study including therapeutic community residents with SUD (n = 58; study group) and healthy individuals (n = 62; comparison group) applying the MOXO continuous performance test (MOXO-CPT) evaluating ADHD-related symptoms. In addition, participants completed the ADHD Self-Report Scale—Version 1.1 for ADHD screening; the Brief Sensation Seeking Scale quantifying risk-taking behaviors; and the Sensory Responsiveness Questionnaire-Intensity Scale for identifying SMD. Results: The study group demonstrated higher SMD incidence (53.57% vs. 14.52%) and lower performance in three MOXO-CPT indexes: Attention, Impulsivity, and Hyperactivity, but not in Timing, compared to the comparison group. Sensory over-responsiveness had the strongest relationship with SUD, indicating 27-times increased odds for SUD (95% CI = 5.965, 121.216; p ≤ 0.0001). A probability risk index is proposed. Conclusion: We found SMD with the strongest relation to SUD exceeding that of ADHD, thus contributing a new perspective for developing future therapeutic modalities. Our findings highlight the need to address SMD above and beyond ADHD symptomology throughout the SUD rehabilitation.

Primary School Children’s Self-Reports of Attention Deficit Hyperactivity Disorder-Related Symptoms and Their Associations With Subjective and Objective Measures of Attention Deficit Hyperactivity Disorder

Background

The diagnosis of Attention deficit hyperactivity disorder (ADHD) is primarily dependent on parents’ and teachers’ reports, while children’s own perspectives on their difficulties and strengths are often overlooked.

Goal

To further increase our insight into children’s ability to reliably report about their ADHD-related symptoms, the current study examined the associations between children’s self-reports, parents’ and teachers’ reports, and standardized continuous performance test (CPT) data. We also examined whether the addition of children’s perceptions of ADHD-symptoms to parents’ and teachers’ reports would be reflected by objective and standardized data.

Methods

The study included 190 children with ADHD, aged 7–10 years, who were referred to a pediatric neurologic clinic. A retrospective analysis was conducted using records of a clinical database. Obtained data included children’s self-reports of their attention level and ADHD-related symptoms, parent, and teacher forms of the Conners ADHD rating scales, Child Behavior Checklist (CBCL), Teacher’s Report Form (TRF), and CPT scores.

Results

Children’s self-evaluations of their functioning were globally associated with their teachers’ and parents’ evaluations, but not uniquely. Children’s self-reports of ADHD symptoms were not uniquely linked to a specific CPT impairment index, but to a general likelihood of having an impaired CPT. The CPT performance successfully distinguished between the group of children who defined themselves as inattentive and those who did not.

Conclusion

Primary school children with ADHD are able to identify their limitations and needs difficulties and that their perspectives should inform clinical practice and research. The clinical and ethical imperative of taking children’s perspectives into account during ADHD diagnosis and treatment is highlighted.

Effect of Distractors on Sustained Attention and Hyperactivity in Youth With Attention Deficit Hyperactivity Disorder Using a Mobile Virtual Reality School Program

OBJECTIVE

This study examined whether distractors in virtual reality (VR) environment affected the attention and hyperactivity in children and adolescents with ADHD.

METHOD

A total of 40 students (21 ADHD, 19 controls) aged between 9 and 17 years participated in this study. A rapid visual information processing task utilizing VR (VR-RVP) was performed under two conditions (no-distractor and distractor condition). Task performance and head movement during each condition were compared, and additional analyses were conducted after grouping participants into two developmental stages.

RESULTS

Children with ADHD performed comparably to the controls under the distractor condition, but had poorer performance under the no-distractor condition. They displayed more head movement under the distractor condition than in the no-distractor condition.

CONCLUSION

VR is possibly a useful tool for investigating the effect of distractors on individuals with ADHD, and children with ADHD are more vulnerable to a low-level stimulation situation than normal children in VR.

Eye Tracking During a Continuous Performance Test: Utility for Assessing ADHD Patients

OBJECTIVE

The use of continuous performance tests (CPTs) for assessing ADHD related cognitive impairment is ubiquitous. Novel psychophysiological measures may enhance the data that is derived from CPTs and thereby improve clinical decision-making regarding diagnosis and treatment. As part of the current study, we integrated an eye tracker with the MOXO-dCPT and assessed the utility of eye movement measures to differentiate ADHD patients and healthy controls.

METHOD

Adult ADHD patients and gender/age-matched healthy controls performed the MOXO-dCPT while their eye movements were monitored (n = 33 per group).

RESULTS

ADHD patients spent significantly more time gazing at irrelevant regions, both on the screen and outside of it, than healthy controls. The eye movement measures showed adequate ability to classify ADHD patients. Moreover, a scale that combined eye movement measures enhanced group prediction, compared to the sole use of conventional MOXO-dCPT indices.

CONCLUSIONS

Integrating an eye tracker with CPTs is a feasible way of enhancing diagnostic precision and shows initial promise for clarifying the cognitive profile of ADHD patients. Pending replication, these findings point toward a promising path for the evolution of existing CPTs.

Predictors of Future Walking Speed: A 12-Month Monitoring Program

The purpose of the current study was to identify significant predictors of walking speed (WS) among community-dwelling older adults, as it is one of the most representative measures of functioning in their daily lives. Seventy-seven (24 adult men, 26 adult women, and 27 older-adult women) community-dwelling older adults (73.7 ± 4.9 years) performed two assessments, over a 12-month period. Several physical, cognitive, and psychological tests were performed, as well as assessing the preferred WS. Multiple linear regression, stratified by gender, was used to identify significant predictors of future WS. For the adult men, walking and functional performances at the first assessment predicted 71.9%; for adult women, reaction time, walking, and balance performance predicted 64.4%; and, for the older-adult women, fast walking and reaction time predicted 48.2% of the variance of future WS. Clinicians should consider including different exercises for each group of older adults to evaluate and preserve functional abilities.

Increased prevalence of attention-deficit hyperactivity disorder symptomatology in patients with familial Mediterranean fever

OBJECTIVES

Previous studies suggest that exposure to inflammation in infancy may increase the risk for attention-deficit and hyperactivity disorder (ADHD). We studied the ADHD manifestations among 124 familial Mediterranean fever (FMF) patients and examined the relationship between FMF patient characteristics and ADHD.

METHODS

Clinical, demographic, and genetic data were abstracted from patients' medical records and supplemented by information obtained during clinic visits. ADHD manifestations were assessed using the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) questionnaire.

RESULTS

ADHD was diagnosed in 42 (32.8%) FMF patients, a rate significantly higher than in unselected populations (∼8%). A majority (n = 27, 64.3%) had combined inattentive, hyperactive-impulsive manifestations. Eight (19%) had predominantly hyperactive-impulsive, and seven (16.6%) had predominantly inattentive symptoms. FMF patients with severe manifestations reported more ADHD symptoms. FMF patients with ADHD symptoms were less adherent to their treatment regimen, with only 61.9% of the patients with ADHD symptoms adhering to colchicine therapy compared to 92.7% of the patients without ADHD symptoms.

CONCLUSION

The high prevalence of ADHD characteristics in children with FMF may support the neuroimmune hypothesis that chronic inflammation increases the risk for ADHD. Children with FMF should be screened for ADHD as its presence may adversely affect adherence to treatment.

Detection of Feigned ADHD Using the MOXO-d-CPT

Objective: The objective of this study was to assess the MOXO-d-CPT utility in detecting feigned ADHD and establish cutoffs with adequate specificity and sensitivity. Method: The study had two phases. First, using a prospective design, healthy adults who simulated ADHD were compared with healthy controls and ADHD patients who performed the tasks to the best of their ability (n = 47 per group). Participants performed the MOXO-d-CPT and an established performance validity test (PVT). Second, the MOXO-d-CPT classification accuracy, employed in Phase 1, was retrospectively compared with archival data of 47 ADHD patients and age-matched healthy controls. Results: Simulators performed significantly worse on all MOXO-d-CPT indices than healthy controls and ADHD patients. Three MOXO-d-CPT indices (attention, hyperactivity, impulsivity) and a scale combining these indices showed adequate discriminative capacity. Conclusion: The MOXO-d-CPT showed promise for the detection of feigned ADHD and, pending replication, can be employed for this aim in clinical practice and ADHD research.

Clinical presentations of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents: comparison of neurocognitive performance

This study aimed to compare performance in working memory (WM), processing speed (PRS), and attention measures in children and adolescents with typical development (TD) and with Attention deficit hyperactivity disorder (inattentive [ADHD-I] or combined [ADHD-C]) presentations, and to determine the predictive ability of the measures mentioned to discriminate between ADHD presentations and TD. 260 children and adolescents, 138 with ADHD (70 ADHD-I and 68 ADHD-C) and 122 TD in two age cohorts (8-12 years; 13-16 years), were assessed with WM and PRS indexes of Wechsler Intelligence Scale for Children (WISC-IV) and the d2 attention test. Significant differences between ADHD and TD groups in the WISC-IV GAI scores were found in children but not in adolescents. Children and adolescents with both ADHD presentations performed poorly on the PRS index, while on the WM index only children exhibited difficulties. In the attention test, children with ADHD-C showed more impulsivity and more difficulties for processing speed, concentration and accuracy than ADHD-I and TD. In addition, both ADHD presentations had higher inattention scores than TD. ADHD adolescents performed worse than TD in processing speed, concentration and accuracy. ADHD groups showed more impulsivity and inattention than TD. Digit Span and Symbol Search (WISC-IV) and processing speed and accuracy (d2) successfully classified ADHD and TD in children, but in adolescents, only coding (WISC-IV) and accuracy (d2) successfully classified ADHD presentations and TD. The WISC-IV and d2 yield neuropsychological profiles which reflect age-related cognitive changes and may allow the adaptation of more tailored early interventions for ADHD.

Associations Between ADHD Subtype Symptomatology and Social Functioning in Children With ADHD, Autism Spectrum Disorder, and Comorbid Diagnosis: Utility of Diagnostic Tools in Treatment Considerations

Objective: To assess associations between objective-/caregiver-report measures of attention functioning and social impairment among children with ADHD, autism spectrum disorder (ASD), and co-occurring ASD + ADHD. Method: Patients with ADHD (N = 27), ASD (N = 23), and ASD + ADHD (N = 44) completed measures of intellectual functioning (Wechsler tests) and attention functioning (Continuous Performance Test-Second Edition [CPT-II]) as part of a neurocognitive assessment. Caregivers completed the Conners Third Edition to assess day-to-day inattentiveness, hyperactivity/impulsivity, and the Social Responsiveness Scale (SRS) to assess social functioning. Results: Among patients with ADHD, attention measures contributed to 48% of the variance in total SRS scores, with caregiver-reported hyperactivity/impulsivity as the strongest factor. In contrast, among those with ASD + ADHD, attention measures accounted for 40% of the variance, largely due to inattention problems. No associations between domains were observed among patients with ASD. Conclusion: Differential ADHD symptoms are associated with social impairment among children with ADHD versus ASD + ADHD; whereas, no associations were observed among those with ASD.

Comparison of the Effect of Cognitive Rehabilitation and Neurofeedback on Sustained Attention Among Elementary School Students With Specific Learning Disorder: A Preliminary Randomized Controlled Clinical Trial

Introduction:

Sustained Attention (SA) failure is one of the main characteristics of Specific Learning Disorders (SLD). Recent studies have reported a positive effect of Cognitive Rehabilitation (CR) and Neurofeedback (NFB) on SA in SLD. Thus, the effectiveness of CR and NFB is well understood. This preliminary study aimed to compare the effects of CR and NFB on SA among the elementary school students with SLD, using a randomized controlled clinical trial.

Methods:

In this preliminary randomized controlled clinical trial, 53 eligible students with SLD (based on DSM-5) within the age range of 7 to 10 years were randomly assigned in the NFB (n=18), CR (n=18), and control group (n=17). All the participants were evaluated for SA using the Continuous Performance Test (CPT), at the time of entry to the study, and one month later. The intervention groups participated in 20 sessions of CR and 20 sessions of NFB, while the control group was evaluated without any intervention.

Results:

A total number of 24 boys and 36 girls in four groups (n=15) completed the study. The Mean±SD age of the participants in the CR, NFB, and control groups were 8.66±1.48 years, 8.40±1.73 years, and 8.53±1.63 years, respectively. Results showed a significant difference in the variables of the CPT between the study groups (P<0.05). Also, the CPT scores of the CR group were higher than that of the NFB group (P<0.001).

Conclusion:

This study supports that CR is more effective than NFB on SA in students with SLD.

Acute and chronic sleep deprivation in residents: Cognition and stress biomarkers

OBJECTIVES

Insufficient sleep affects circadian hormonal profiles and inflammatory markers and may modulate attention, executive functioning and decision-making. Medical professionals and specifically resident physicians, who are involved in long-term nightshift schedules during their post-graduate training, are prone to acute and chronic sleep deprivation and disruption, putting them at risk for making medical errors. The aim of the study was to evaluate the impact of chronic and acute-on-chronic sleep deprivation and disruption among residents on selected physiological and cognitive measures.

METHODS

Thirty-three medical and surgical residents were evaluated twice - at baseline and after a 26-hour shift. Eighteen young attending physicians who did not engage in nightshift schedules served as controls and were evaluated once. Measures included morning cortisol and high-sensitivity C-reactive protein (hs-CRP), computerised tests of attention and behaviour, the Behaviour Rating Inventory of Executive Function, a risk-taking questionnaire and the Pittsburgh Sleep Quality Index.

RESULTS

Residents, but not attendings, reported chronic sleep disruption and deprivation. Residents at baseline exhibited reduced morning cortisol levels and elevated hs-CRP levels, compared to attendings. Residents at baseline had impaired global executive function compared to attendings. A nightshift with acute sleep deprivation further reduced residents' executive function. Residents at baseline and after a nightshift demonstrated increased impulsivity and slower processing time than attendings. Residents and attendings did not differ in risk-taking tendencies which were assessed in a separate cohort.

CONCLUSIONS

In a real-life setting, resident physicians exhibit increased low-grade systemic inflammation (hs-CRP) and impaired HPA-axis function. Their chronic sleep curtailment is associated with greater impulsivity, slower cognitive processing, and impaired executive function. Future research is warranted to understand how improving working schedule by increasing sleep duration may minimise the short-term and potential long-term risks to physicians in training.

Attention-Deficit/Hyperactivity Disorder (ADHD): Integrating the MOXO-dCPT with an Eye Tracker Enhances Diagnostic Precision

Clinical decision-making may be enhanced when combining psychophysiological sensors with computerized neuropsychological tests. The current study explored the utility of integrating an eye tracker with a commercially available continuous performance test (CPT), the MOXO-dCPT. As part of the study, the performance of adult attention-deficit/hyperactivity disorder (ADHD) patients and healthy controls (n = 43, n = 42, respectively) was compared in the integrated system. More specifically, the MOXO-dCPT has four stages, which differ in their combinations of ecological visual and auditory dynamic distractors. By exploring the participants' performance in each of the stages, we were able to show that: (a) ADHD patients spend significantly more time gazing at irrelevant areas of interest (AOIs) compared to healthy controls; (b) visual distractors are particularly effective in impacting ADHD patients' eye movements, suggesting their enhanced utility in diagnostic procedures; (c) combining gaze direction data and conventional CPT indices enhances group prediction, compared to the sole use of conventional indices. Overall, the findings indicate the utility of eye tracker-integrated CPTs and their enhanced diagnostic precision. They also suggest that the use of attention-grabbing visual distractors may be a promising path for the evolution of existing CPTs by shortening their duration and enhancing diagnostic precision.

The Effects of Different Types of Environmental Noise on Academic Performance and Perceived Task Difficulty in Adolescents With ADHD

Objective: To examine the effects of environmental noises (speech and white noise) relative to a no noise control condition on the performance and difficulty ratings of youth with ADHD (N = 52) on academic tasks. Method: Reading performance was measured by an oral retell (reading accuracy) and the time spent reading. Writing performance was measured through the proportion of correct writing sequences (writing accuracy) and the total words written on an essay. Results: Participants in the white noise condition took less time to read the passage and wrote more words on the essay compared with participants in the other conditions, though white noise did not improve academic accuracy. The participants in the babble condition rated the tasks as most difficult. Conclusion: Although white noise appears to improve reading time and writing fluency, the findings suggest that white noise does not improve performance accuracy. Educational implications are discussed.

Attentional profile of adolescents with ADHD in virtual-reality dual execution tasks: A pilot study. APPLIED NEUROPSYCHOLOGY-CHILD 2020;11:81-90. [PMID: 32400210 DOI: 10.1080/21622965.2020.1760103]

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that is highly prevalent in children and adolescents, with estimated prevalence ranges from 5.9 to 7.1% globally and 1 to 6.8% in Spain. This has commonly been associated with deficits in attention threads and executive functions. This paper aims to study the cognitive-executive performance of adolescents between the ages of 17 and 23 with an ADHD diagnosis, relative to a control group. The total sample consisted of 120 male participants who were given the Nesplora Aquarium test. Dual execution tasks assessed attention, response speed, and inhibition capability. When comparing the experimental and control groups, statistically significant differences were detected in processing speed, selective attention, and cognitive inhibition [general execution (T_correct_n) (p = 0.008), attention arousal (T_omission_n) (p = 0.008), and processing speed (T_correctreactime_mean) (p = 0.008)]. We demonstrate that a new virtual reality tool, designed to measure attention in people over the age of 16 years, is effective at measuring attention and working memory. In addition, item difficulty and discrimination values were also acceptable.

Processing speed as a marker to stimulant effect in clinical sample of children with high functioning autism spectrum disorder

Background: Patients with co-occurring Attention-Deficit/Hyperactivity Disorder (ADHD) and ASD might benefit from stimulants. There is a progressive increase in prescribing ADHD aimed medications for children diagnosed with Autism Spectrum Disorder (ASD), despite scarce knowledge and no distinct clinical guidelines for that matter.Aim: This study aims to analyze the effect of stimulant on processing speed performance and attention indices in children with ASD and ADHD.Methods: Forty children aged 6-18 years diagnosed with ASD who also met the criteria for ADHD were recruited. All children performed a computerized performance test for the assessment of cognitive attention performance three times: twice while they are drug naïve and once an hour after taking a single dose of 10 mg. methylphenidate (MPH). This performance was compared to a group of children diagnosed with 'ADHD only' without ASD.Results: A significant difference (p < 0.001) was found only in the parameter of measuring cognitive processing speed. This effect is significantly different from the response of the 'ADHD only' group.Conclusions: The reaction to MPH among ASD children is different than among ADHD children. In ASD, MPH significantly improved cognitive processing speed without changing other measured attention parameters. Improving processing speed, might improve every day functioning in children with ASD who also met the criteria for ADHD, in other means than expected. This unique response suggests new research targets for treatment with stimulants in ASD and ADHD children and its influence on cognitive parameters.

Individualized Neurofeedback Training May Help Achieve Long-Term Improvement of Working Memory in Children With ADHD

Background. Children with attention deficit hyperactivity disorder (ADHD) may suffer from working memory deficits, which can adversely affect their academic performance. Neurofeedback training may enhance working memory and provide a solution to this problem. Aim. To investigate the effect of frequency-neurofeedback on working memory in children with ADHD and to check if the effect is long-lasting. Method. Forty-eight children with ADHD (aged 6-12 years) were randomly assigned either to a neurofeedback with training parameters chosen to take into account each child's peak alpha frequency (PAF) or to a waiting list control group. Each trained child underwent 19-channel electroencephalography (EEG). All children had average intelligence and none were receiving treatment, such as medications, for ADHD. Prior to the training, MOXO and n-back tests were performed. Next, neurofeedback training sessions with frequency bands for theta and beta ranges determined using each child's PAF were carried out for 10 weeks. Training parameters were set to increase amplitudes in the low beta range and to decrease amplitudes in the theta and high beta frequency ranges. The n-back test was performed again right after the training and then a year later. Results. During the first n-back test, children from both groups responded correctly to more than 43% of the stimuli. During the second test, children from the waiting list responded correctly to an average of 49% of the stimuli, while children who underwent the neurofeedback training were correct, on average, 69% of the time (significant difference, P < .001). During the third n-back test a year later, children from the waiting list responded correctly to 53% of the stimuli, while those who underwent the neurofeedback training responded correctly to nearly 71%. Conclusion. This study found a statistically significant improvement in a measure of working memory in children who did 10 to 12 sessions of neurofeedback training with training frequency ranges for theta and beta defined according to each child's PAF. The beneficial effects were still present a year after training.

Gender Differences in Objective and Subjective Measures of ADHD Among Clinic-Referred Children

Attention deficit hyperactivity disorder (ADHD), one of the most prevalent childhood disorders today, is generally more likely to be diagnosed and treated in boys than in girls. However, gender differences in ADHD are currently poorly understood, partly because previous research included only a limited proportion of girls and relied mainly on subjective measures of ADHD, which are highly vulnerable to reporter's bias. To further examine gender differences in ADHD and to address some of the shortcomings of previous studies, this study examined gender differences in subjective and objective measures of ADHD among clinic-referred children with ADHD. Participants were 204 children aged 6-17 years-old with ADHD (129 boys, 75 girls). A retrospective analysis was conducted using records of a clinical database. Obtained data included parent and teacher forms of the Conners ADHD rating scales, Child Behavior Checklist (CBCL), Teacher's Report Form (TRF), and child's continuous performance test (CPT) scores. Results showed that according to parents' and teachers' reports of ADHD-related symptoms (Conners ADHD rating scales), girls had more inattention problems than boys, but no differences were identified in the level of hyperactivity and impulsivity symptoms. CPT data, however, revealed higher impulsivity among boys. We did not find gender differences in the level of distractibility during CPT performance. Specifically, the effects of distractors type (visual environmental stimuli, auditory stimuli, or a combination of them) and distractors load (one or two distracting stimuli at a time) on CPT performance did not differ between boys and girls with ADHD. These findings suggest that gender effects on ADHD symptoms may differ between subjective and objective measures. Understanding gender differences in ADHD may lead to improved identification of girls with the disorder, helping to reduce the gender gap in diagnosis and treatment.

Comparison of the Effect of Cognitive Rehabilitation and Neurofeedback on Sustained Attention Among Elementary School Students with Specific Learning Disorder: A Preliminary Randomized Controlled Clinical Trial

Specific learning disorder (SLD) can occur along with the problems of attention performance and be complicated by them. Recent studies have reported the positive effects of cognitive rehabilitation (CR) and neurofeedback (NFB) on sustained attention (SA) in SLD. Nevertheless, it has not yet been determinedwhat kind of treatment may be the most appropriate option for this disorder in terms of the different functions of cognitive status, especially SA. This preliminary study aimed to compare CR and NFB effects on SA among elementary school students with SLD using a randomized controlled clinical trial (RCT). Fifty- three eligible students with a DSM-5 SLD diagnosis, aged 7-10, were randomly allocated in NFB (n = 18), CR (n = 18), and control groups (n = 17). All the participants were evaluated for SA by performing the continuous performance test (CPT) on the studied groups at the time of their inclusion in the study and 7 weeks after it. The intervention groups took part in 20 sessions of CR and 20 sessions of NFB. Conversely, the untreated group were evaluated without any intervention.15 boys and 30 girls in 3 groups completed the study (n = 15 per group). The mean and standard deviation of participants' age were (8.66 ± 1.48) years, (8.40 ± 1.73) years and (8.53 ± 1.63) years in CR, NFB and untreated groups, respectively. The results showed significant differences between the groups based on the variables of the CPT test (p < 0.05). Also, the significant effects of the variables represented the higher scores of the CR compared to the NFB group (p < 0.001). This study provides einitial evidence that CR is more effective than NFB on SA improvement among students with SLD.

Can Mindfulness-Based Training Improve Positive Emotion and Cognitive Ability in Chinese Non-clinical Population? A Pilot Study

OBJECTIVE

Based on eastern philosophy, mindfulness is becoming popular for human being's mental health and well-being in western countries. In this study, we proposed to explore the effectiveness and potential pathway of mindfulness-based training (MBT) on Chinese Non-clinical higher education students' cognition and emotion.

METHODS

A paired control design was used. 48 higher education students (24 in MBT group, 24 in control group) were recruited in the study. The MBT group engaged in a 12-week MBT. A package of measurements, including sustained attention tasks (The Continuous Performance Test, CPT), executive function task (Stroop) for cognitive functions, the self-reported mindfulness levels (The Mindful Attention Awareness Scale, MAAS) and emotion (The Profile of Mood States, POMS), were apply for all participants at baseline and every 4 weeks during next 12 weeks.

RESULTS

There were no differences in baseline demographic variables between two groups. Over the 12-week training, participants assigned to MBT group had a significantly greater reduction in CPT reaction time (Cohen's d 0.72), significantly greater improvement in positive emotion (Vigor-Activity, VA) (Cohen's d 1.08) and in MAAS (Cohen's d 0.49) than those assigned to control group. And, MAAS at 4th week could significantly predict the CPT RT and VA at 8th week in the MBT group. VA at 4th week could significantly predict the CPT RT at 8th week (B = 4.88, t = 2.21, p = 0.034, R2 = 0.35).

CONCLUSION

This study shows the efficiency of 12-week MBT on Chinese Non-clinical students' cognition and emotion. Mindfulness training may impact cognition and emotion through the improvement in mindfulness level, and may impact cognition through the improvement in positive emotion.

Does the education system serve as a persuasion agent for recommending ADHD diagnosis and medication uptake? A qualitative case study to identify and characterize the persuasion strategies of Israeli teachers and school counselors

BACKGROUND

There has been a steady rise in the use of medication by Israeli school children to treat ADHD, partly due to what seems like school teachers' and counselors' tendency to express positive attitudes towards its use. Therfore it is important to examine the involvement of the school teachers and counselors in the parents' decision-making about giving their children medication.

METHODS

This study used a qualitative constructivist research method of semi-structured interviews. It included individual interviews with 36 teachers and school counselors and 11 parents of students ages 9-14 from the Jewish and Arab populations.

RESULTS

Teachers and school counselors use different strategies to encourage parents to have their children diagnosed for ADHD and medicated. First they suggest diagnosis as a necessary step in the best interest of the child, distinguishing between diagnosis and medication to mitigate parents' concerns. In the second stage, teachers normalize the use of medication, as well as framing it as a drug that provides not only a medical treatment but also emotional wellbeing.

CONCLUSIONS

Teachers and counselors are involved in parents' decision-making process about medicating their children to treat ADHD, which contradicts the education system's guidelines. It is necessary to set clear and explicit limits and guidelines for education system employees so that they do not cross professional and ethical limits.

PANDAS: Paediatric Attention-Deficit/Hyperactivity Disorder Application Software

Attention-deficit/hyperactivity disorder (ADHD) is a common neuropsychiatric disorder that impairs social, academic and occupational functioning in children, adolescents and adults. In South Africa, youth prevalence of ADHD is estimated as 10%. It is therefore necessary to further investigate methods that objectively diagnose, treat and manage the disorder. The aim of the study was to develop a novel method that could be used as an aid to provide screening for ADHD. The study comprised of a beta-testing phase that included 30 children (19 non-ADHD and 11 ADHD) between the ages of 5 and 16 years old. The strategy was to use a tablet-based game that gathered real-time user data during game-play. This data was then used to train a linear binary support vector machine (SVM). The objective of the SVM was to differentiate between an ADHD individual versus a non-ADHD individual. A feature set was extracted from the gathered data and sequential forward selection (SFS) was performed to select the most significant features. The test set accuracy of 85.7% and leave-one-out cross-validation (LOOCV) accuracy of 83.5% were achieved. Overall, the classification accuracy of the trained SVM was 86.5%. Finally, the sensitivity of the model was 75% and this was seen as a moderate result. Since the sample size was fairly small, the results of the classifier were only seen as suggestive rather than conclusive. Therefore, the performance of the classifier was indicative that a quantitative tool could indeed be developed to perform screening for ADHD.

Age-Related Changes in Distractibility: Developmental Trajectory of Sustained Attention in ADHD

OBJECTIVE

This study investigated age-related changes in sustained attention in children with ADHD and in their typically developed peers.

METHOD

The study used a Continuous Performance Test (CPT) that includes visual and auditory stimuli serving as distractors. The rate of omission errors was used as a measurement of difficulty in sustained attention. Participants were children and adolescents aged 7 to 18 years (478 with ADHD and 361 without ADHD).

RESULTS

Both groups of adolescents (with and without ADHD) showed reduced distractibility than younger children from the same group. However, distractibility tended to diminish in non-ADHD adolescents, but not in adolescents with ADHD.

CONCLUSION

Although part of the difficulties in ADHD could be explained by developmental delay that improves with time, other deficits, such as increased distractibility causing more omission errors, do not show a clear developmental trajectory. The results suggest that deficits in inhibitory control might be the core of ADHD.

Postural control and posture-unrelated attention control in advanced age-An exploratory study

OBJECTIVES

The link between postural control and cognition is under-studied, especially in healthy older adults. In the present study, we examined the link between postural control and posture-unrelated attention control.

STUDY DESIGN AND OUTCOME MEASURES

Healthy individuals (n = 112) - men aged 77.2 ± 5.5, and two groups of women, aged 78.6 ± 3.5 and 68.9 ± 3.7 - participated in this cross-sectional study. Postural control was assessed by static balance (SB) posturography in eight standing positions, and by two measures of dynamic balance (DB): the Timed Up-and-Go (TUG) test, and the Functional Reach Test (FRT). Attention control (inhibition) was assessed by the Continuous Performance Test (CPT) measuring Go/NoGo tasks with and without visual and audio distractors.

RESULTS

Men tended to perform better on DB and women on SB. In the men, significant correlations were observed between Go/NoGo tasks and DB (r range: 0.373 to 0.653 for TUG, and -0.342 to -0.530 for FRT). In the younger women, Go/NoGo tasks were correlated with SB (r range: 0.323 to 0.572), and no correlations were observed in the older women. Go/NoGo tasks without distractions followed by tasks with audio distractors explained postural control measures.

CONCLUSIONS

Posture-unrelated attention inhibition was associated with SB in the women and with DB in the men. Tasks with no distractions explained the variability in postural control in both genders. It is recommended to examine the effect of balance exercises on postural control and posture-unrelated attention control in both genders, and the contribution of the relationship between postural control and posture-unrelated attention control to falls in old age.

Comparison between two continuous performance tests for identifying ADHD: Traditional vs. virtual reality

Background/Objective: Continuous Performance Tests (CPTs) have demonstrated validity when differentiating children with ADHD from healthy controls. However, these CPTs have limitations such as low ecological validity. New CPTs based on the use of Virtual Reality (VR) have appeared as supposedly improved methods for assessing ADHD. This study aims to compare the discriminant value of attentional variables produced by a VR CPT (Aula Nesplora) with that of variables from a traditional CPT (Test of Variables of Attention; TOVA) for identifying ADHD. Method: A total of 338 children aged between 6 and 16 years old (M = 10.84, SD = 3.01) participated in the study: 31.95% correspond to the inattentive presentation, 15.38% to the impulsive-hyperactive presentation, 22.78% to the combined presentation, and the remaining 29.88% correspond to children without ADHD. Results: Results indicated that Aula Nesplora predicts ADHD presentations better than TOVA. It also differentiates better between ADHD and non-ADHD students. Conclusions: These findings show the potential advantages of using virtual reality in ADHD assessment, as it facilitates the diagnosis of ADHD and the differentiation of its presentations in a realistic environment.

Attention Deficit Hyperactivity Disorder in Neurofibromatosis Type 1: Evaluation with a Continuous Performance Test

Background and Purpose

The objective of this study was to determine if the MOXO visual- and vocal-distractors-based continuous performance test distinguishes patients with attention deficit hyperactivity disorder (ADHD) and neurofibromatosis type 1 (NF1) from those without NF1.

Methods

Thirty-five patients (16 males; mean age 9.91 years) attending a multidisciplinary NF1 clinic completed the MOXO test. The findings were compared to 532 healthy age-matched standardized control subjects (285 males) without ADHD.

Results

The overall performance in the MOXO text was significantly worse in the NF1 group than in controls (p<0.01), but no group-specific pattern was identified. Impulsivity and hyperactivity were significantly more prominent in males than females (p<0.01). Compared to controls, the NF1 group exhibited significantly more failures to respond to target stimuli in the presence of visual distractors.

Conclusions

MOXO scores are abnormal in patients with NF1, but the test cannot differentiate between NF1 with ADHD characteristics and ADHD. The test highlights sex differences in ADHD characteristics in NF1. Overreactivity to visual distractors may form part of the attention deficit in NF1.

Attention-Deficit Hyperactivity Disorder-Like Traits and Distractibility in the Visual Periphery

We examined the performance of nonclinical subjects with high and low levels of self-reported attention-deficit hyperactivity disorder (ADHD)-like traits in a novel distractibility paradigm with far peripheral visual distractors, the likely origin of many distractors in everyday life. Subjects were tested on a Sustained Attention to Response Task with distractors appearing before some of the target or nontarget stimuli. When the distractors appeared 80 ms before the targets or nontargets, participants with high levels of ADHD-like traits were less affected in their reaction times than those with lower levels. Reducing the distractor-target or nontarget interval to 10 ms removed the reaction time advantage for the high group. We suggest that at 80 ms, the distractors were cueing the arrival of the target or nontarget, and that those with high levels of ADHD-like traits were more sensitive to the cues. Increased sensitivity to stimuli in the visual periphery is consistent with hyperresponsiveness at the level of the superior colliculus.

Virtual-reality-based attention assessment of ADHD: ClinicaVR: Classroom-CPT versus a traditional continuous performance test

Virtual-reality-based assessment may be a good alternative to classical or computerized neuropsychological assessment due to increased ecological validity. ClinicaVR: Classroom-CPT (VC) is a neuropsychological test embedded in virtual reality that is designed to assess attention deficits in children with attention deficit hyperactivity disorder (ADHD) or other conditions associated with impaired attention. The present study aimed to (1) investigate the diagnostic validity of VC in comparison to a traditional continuous performance test (CPT), (2) explore the task difficulty of VC, (3) address the effect of distractors on the performance of ADHD participants and typically-developing (TD) controls, and (4) compare the two measures on cognitive absorption. A total of 33 children diagnosed with ADHD and 42 TD children, aged between 7 and 13 years, participated in the study and were tested with a traditional CPT or with VC, along with several cognitive measures and an adapted version of the Cognitive Absorption Scale. A mixed multivariate analysis of covariance (MANCOVA) revealed that the children with ADHD performed worse on correct responses had more commissions and omissions errors than the TD children, as well as slower target reaction times . The results showed significant differences between performance in the virtual environment and the traditional computerized one, with longer reaction times in virtual reality. The data analysis highlighted the negative influence of auditory distractors on attention performance in the case of the children with ADHD, but not for the TD children. Finally, the two measures did not differ on the cognitive absorption perceived by the children.

Task-Irrelevant Novel Sounds Improve Attentional Performance in Children With and Without ADHD

Task-irrelevant salient stimuli involuntarily capture attention and can lead to distraction from an ongoing task, especially in children with ADHD. However, there has been tentative evidence that the presentation of novel sounds can have beneficial effects on cognitive performance. In the present study, we aimed to investigate the influence of novel sounds compared to no sound and a repeatedly presented standard sound on attentional performance in children and adolescents with and without ADHD. We therefore had 32 patients with ADHD and 32 typically developing children and adolescents (8 to 13 years) execute a flanker task in which each trial was preceded either by a repeatedly presented standard sound (33%), an unrepeated novel sound (33%) or no auditory stimulation (33%). Task-irrelevant novel sounds facilitated attentional performance similarly in children with and without ADHD, as indicated by reduced omission error rates, reaction times, and reaction time variability without compromising performance accuracy. By contrast, standard sounds, while also reducing omission error rates and reaction times, led to increased commission error rates. Therefore, the beneficial effect of novel sounds exceeds cueing of the target display by potentially increased alerting and/or enhanced behavioral control.