Individual differences in subcortical microstructure organization reflect reaction time performances during a flanker task: a diffusion tensor imaging study in children with and without ADHD

A quantitative analysis of fidgeting in ADHD and its relation to performance and sustained attention on a cognitive task

Introduction

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder where hyperactivity often manifests as fidgeting, a non-goal-directed motoric action. Many studies demonstrate fidgeting varies under different conditions as a self-regulating mechanism for attention and alertness during cognitively demanding tasks. Fidgeting has also been associated with reaction time variability. However, a lack of standard variables to define and quantify fidgeting can lead to discrepancies in data and interpretability issues across studies. Furthermore, little is known about fidgeting in adults with ADHD compared to youth. This study aims to design a framework to quantify meaningful fidgeting variables and to apply them to test the relation between fidgeting and performance on a cognitive task, the Flanker, in adults with ADHD.

Method

Our study included 70 adult participants diagnosed with ADHD, aged 18-50 years (30.5 ± 7.2 years). Screening included a structured clinical interview, childhood, current self and current observer ratings of ADHD symptoms. Actigraphy devices were attached to the left wrist and right ankle during completion of a cognitive control, attention task (the Flanker). Laboratory testing was subsequently completed on a single day. The relation between task performance, reaction time variability and fidgeting was examined.

Results and Discussion

Our analysis revealed increased fidgeting during correct trials as defined by our new variables, consistent with previous observations. Furthermore, differences in fidgeting were observed between early and later trials while the percentage of correct trials were not significantly different. This suggests a relation between the role of fidgeting and sustaining attention. Participants with low reaction time variability, that is, those with more consistent reaction times, fidgeted more during later trials. This observation supports the theory that fidgeting aids arousal and improves sustained attention. Finally, a correlation analysis using ADHD-symptom rating scales validated the relevance of the fidget variables in relation to ADHD symptom severity. These findings suggest fidgeting may be a compensatory mechanism that aids in sustained attention for those with ADHD, although alternative explanations exist.

Conclusion

Our study suggests that fidgeting may aid in sustained attention during the attention-demanding, cognitive control processes for adults with ADHD, with more fidgeting observed during correct trials and among participants with lower reaction time variability. Furthermore, the newly defined fidget variables were validated through a significant correlation with ADHD rating scales. By sharing our implementation of fidget variables, we hope to standardize and encourage further quantitative research into the role of fidgeting in ADHD.

White matter microstructure in children and adolescents with ADHD

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A systematic review of diffusion MRI studies in children and adolescents with ADHD.

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46 studies included, encompassing multiple diffusion MRI techniques.

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Reduced white matter microstructure was reported in several studies.

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Mixed evidence linking white matter differences with specific cognitive processes.

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Common limitations included sample size, head motion and medication status.

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder. Advances in diffusion magnetic resonance imaging (MRI) acquisition sequences and analytic techniques have led to growing body of evidence that abnormal white matter microstructure is a core pathophysiological feature of ADHD. This systematic review provides a qualitative assessment of research investigating microstructural organisation of white matter amongst children and adolescents with ADHD. This review included 46 studies in total, encompassing multiple diffusion MRI imaging techniques and analytic approaches, including whole-brain, region of interest and connectomic analyses. Whole-brain and region of interest analyses described atypical organisation of white matter microstructure in several white matter tracts: most notably in frontostriatal tracts, corpus callosum, superior longitudinal fasciculus, cingulum bundle, thalamic radiations, internal capsule and corona radiata. Connectomic analyses, including graph theory approaches, demonstrated global underconnectivity in connections between functionally specialised networks. Although some studies reported significant correlations between atypical white matter microstructure and ADHD symptoms or other behavioural measures there was no clear pattern of results. Interestingly however, many of the findings of disrupted white matter microstructure were in neural networks associated with key neuropsychological functions that are atypical in ADHD. Limitations to the extant research are outlined in this review and future studies in this area should carefully consider factors such as sample size, sex balance, head motion and medication status.

No support for white matter connectivity differences in the combined and inattentive ADHD presentations

Evidence from functional neuroimaging studies support neural differences between the Attention Deficit Hyperactivity Disorder (ADHD) presentation types. It remains unclear if these neural deficits also manifest at the structural level. We have previously shown that the ADHD combined, and ADHD inattentive types demonstrate differences in graph properties of structural covariance suggesting an underlying difference in neuroanatomical organization. The goal of this study was to examine and validate white matter brain organization between the two subtypes using both scalar and connectivity measures of brain white matter. We used both tract-based spatial statistical (TBSS) and tractography analyses with network-based Statistics (NBS) and graph-theoretical analyses in a cohort of 35 ADHD participants (aged 8-17 years) defined using DSM-IV criteria as combined (ADHD-C) type (n = 19) or as predominantly inattentive (ADHD-I) type (n = 16), and 28 matched neurotypical controls. We performed TBSS analyses on scalar measures of fractional anisotropy (FA), mean (MD), radial (RD), and axial (AD) diffusivity to assess differences in WM between ADHD types and controls. NBS and graph theoretical analysis of whole brain inter-regional tractography examined connectomic differences and brain network organization, respectively. None of the scalar measures significantly differed between ADHD types or relative to controls. Similarly, there were no tractography connectivity differences between the two subtypes and relative to controls using NBS. Global and regional graph measures were also similar between the groups. A single significant finding was observed for nodal degree between the ADHD-C and controls, in the right insula (corrected p = .029). Our result of no white matter differences between the subtypes is consistent with most previous findings. These findings together might suggest that the white matter structural architecture is largely similar between the DSM-based ADHD presentations is similar to the extent of being undetectable with the current cohort size.

The COMT rs4680 polymorphism, family functioning and preschoolers' attentional control indexed by intraindividual reaction time variability

Trial-to-trial intraindividual reaction time variability (IIRTV) serves as an index of attentional control and related endogenous brain function. What determinants contribute to preschoolers' attentional control indexed by IIRTV remains unknown. The present study examined how catechol-o-methyltransferase (COMT) rs4680 polymorphism interacted with family functioning (cohesion and adaptability) to impact on preschoolers' attentional control indexed by IIRTV. One hundred forty-four preschool children (M_age  = 4.19, SD = 0.63) completed the flanker task to assess their IIRTV. Their parents were asked to fill out the Family Adaptability and Cohesion Evaluation Scale II to assess family functioning. After controlling for age, socioeconomic status (SES) and mean reaction time, results showed that the COMT rs4680 polymorphism was positively associated with preschoolers' IIRTV at the 5% significance level (p = .02) but not after multiple testing adjustment (p = .08). Moreover the COMT rs4680 polymorphism significantly interacted with family functioning to impact on preschoolers' IIRTV and the interaction effects remained significant after correction for multiple testing (p = .01, ΔR²  = 0.06 in congruent conditions; p = .04, ΔR²  = 0.04 in combined conditions). In addition, the significant interaction between SES and COMT rs4680 polymorphism was also found in the present study (p = .01, ΔR²  = 0.05 in congruent conditions; p = .05, ΔR²  = 0.03 in combined conditions). No sex differences were found in the present sample. The findings of the present study expand our knowledge about the gene × environment underpinnings of children's attentional control and endogenous brain function, and provide evidence for the Vantage Sensitivity model on children's development.

Reduced axonal caliber and structural changes in a rat model of Fragile X syndrome with a deletion of a K-Homology domain of Fmr1

Fragile X syndrome (FXS) is a neurodevelopmental disorder that is caused by mutations in the FMR1 gene. Neuroanatomical alterations have been reported in both male and female individuals with FXS, yet the morphological underpinnings of these alterations have not been elucidated. In the current study, we found structural changes in both male and female rats that model FXS, some of which are similarly impaired in both sexes, including the superior colliculus and periaqueductal gray, and others that show sex-specific changes. The splenium of the corpus callosum, for example, was only impaired in males. We also found reduced axonal caliber in the splenium, offering a mechanism for its structural changes. Furthermore, we found that overall, male rats have higher brain-wide diffusion than female rats. Our results provide insight into which brain regions are vulnerable to a loss of Fmr1 expression and reveal an impairment at the level of the axon that could cause structural changes in white matter regions.

A Systematic Review of Imaging Studies in the Combined and Inattentive Subtypes of Attention Deficit Hyperactivity Disorder

Objective: Insights to underlying neural mechanisms in attention deficit hyperactivity disorder (ADHD) have emerged from neuroimaging research; however, the neural mechanisms that distinguish ADHD subtypes remain inconclusive.

Method: We reviewed 19 studies integrating magnetic resonance imaging [MRI; structural (sMRI), diffusion, functional MRI (fMRI)] findings into a framework exploring pathophysiological mechanisms underlying the combined (ADHD-C) and predominantly inattentive (ADHD-I) ADHD subtypes.

Results: Despite equivocal structural MRI results, findings from fMRI and DTI imaging modalities consistently implicate disrupted connectivity in regions and tracts involving frontal striatal thalamic in ADHD-C and frontoparietal neural networks in ADHD-I. Alterations of the default mode, cerebellum, and motor networks in ADHD-C and cingulo-frontoparietal attention and visual networks in ADHD-I highlight network organization differences between subtypes.

Conclusion: Growing evidence from neuroimaging studies highlight neurobiological differences between ADHD clinical subtypes, particularly from a network perspective. Understanding brain network organization and connectivity may help us to better conceptualize the ADHD types and their symptom variability.

Prefrontal Cortex Dopamine Transporter Gene Network Moderates the Effect of Perinatal Hypoxic-Ischemic Conditions on Cognitive Flexibility and Brain Gray Matter Density in Children

BACKGROUND

Genetic polymorphisms of the dopamine transporter gene (DAT1) and perinatal complications associated with poor oxygenation are risk factors for attentional problems in childhood and may show interactive effects.

METHODS

We created a novel expression-based polygenic risk score (ePRS) reflecting variations in the function of the DAT1 gene network (ePRS-DAT1) in the prefrontal cortex and explored the effects of its interaction with perinatal hypoxic-ischemic-associated conditions on cognitive flexibility and brain gray matter density in healthy children from two birth cohorts-MAVAN from Canada (n = 139 boys and girls) and GUSTO from Singapore (n = 312 boys and girls).

RESULTS

A history of exposure to several perinatal hypoxic-ischemic-associated conditions was associated with impaired cognitive flexibility only in the high-ePRS group, suggesting that variation in the prefrontal cortex expression of genes involved in dopamine reuptake is associated with differences in this behavior. Interestingly, this result was observed in both ethnically distinct birth cohorts. Additionally, parallel independent component analysis (MAVAN cohort, n = 40 children) demonstrated relationships between single nucleotide polymorphism-based ePRS and gray matter density in areas involved in executive (cortical regions) and integrative (bilateral thalamus and putamen) functions, and these relationships differ in children from high and low exposure to hypoxic-ischemic-associated conditions.

CONCLUSIONS

These findings reveal that the impact of conditions associated with hypoxia-ischemia on brain development and executive functions is moderated by genotypes associated with dopamine signaling in the prefrontal cortex. We discuss the potential impact of innovative genomic and environmental measures for the identification of children at high risk for impaired executive functions.

Increased flanker task and forward digit span performance in caudate-nucleus-dependent response strategies

One of two memory systems can be used to navigate in a new environment. Hippocampus-dependent spatial strategy consists of creating a cognitive map of an environment and caudate nucleus-dependent response strategy consists of memorizing a rigid sequence of turns. Spontaneous use of the response strategy is associated with greater activity and grey matter within the caudate nucleus while the spatial strategy is associated with greater activity and grey matter in the hippocampus. The caudate nucleus is involved in executive functions such as working memory, cognitive control and certain aspects of attention such as attentional disengaging. This study therefore aimed to investigate whether response learners would display better performance on tests of executive and attention functioning compared to spatial learners. Fifty participants completed the 4/8 virtual maze to assess navigational strategy, the forward and backward visual digit span and the Attention Network Test - Revised to assess both attention disengagement and cognitive control. Results revealed that response learners showed significantly higher working memory capacity, more efficient attention disengagement and better cognitive control. Results suggest that response learners, who putatively display more grey matter and activity in the caudate nucleus, are associated with better working memory span, cognitive control and attentional disengagement.

Thalamic functional connectivity and its association with behavioral performance in older age

Introduction

Despite the thalamus' dense connectivity with both cortical and subcortical structures, few studies have specifically investigated how thalamic connectivity changes with age and how such changes are associated with behavior. This study investigated the effect of age on thalamo-cortical and thalamo-hippocampal functional connectivity (FC) and the association between thalamic FC and visual-spatial memory and reaction time (RT) performance in older adults.

Methods

Resting-state functional magnetic resonance images were obtained from younger (n = 20) and older (n = 20) adults. A seed-based approach was used to assess the FC between the thalamus and (1) sensory resting-state networks; (2) the hippocampus. Participants also completed visual-spatial memory and RT tasks, from the Cambridge Neuropsychological Test Automated Battery (CANTAB).

Results

Older adults exhibited a loss of specificity in the FC between sensory thalamic subregions and corresponding sensory cortex. Greater thalamo-motor FC in older adults was associated with faster RTs. Furthermore, older adults exhibited greater thalamo-hippocampal FC compared to younger adults, which was greatest for those with the poorest visual-spatial memory performance.

Conclusion

Although older adults exhibited poorer visual-spatial memory and slower reaction times compared to younger adults, "good" and "poorer" older performers exhibited different patterns of thalamo-cortical and thalamo-hippocampal FC. These results highlight the potential role of thalamic connectivity in supporting reaction times and memory in aging. Furthermore, these results highlight the importance of including the thalamus in studies of aging to fully understand how brain changes with age may be associated with behavior.

Construction and Characterization of a Population-Based Cohort to Study the Association of Anesthesia Exposure with Neurodevelopmental Outcomes

Exposure to general anesthesia at an early age has been associated with adverse neurodevelopmental outcomes in both animal and human studies, but some of these studies employed anesthetic agents that are no longer in clinical use. In this manuscript, we describe the methods used to construct a new population-based study cohort to study the association between early anesthetic exposure and subsequent neurodevelopmental outcomes. A birth cohort of all children born in Olmsted County, MN from January 1, 1996 to December 31, 2000 was identified. For each, school enrollment status in the Independent School District (ISD) 535 at age 5 or 6 and all episodes of anesthetic exposure before age 3 were identified. A study cohort was created by matching children enrolled in ISD 535 based on the propensity of receiving general anesthesia. Three analyses were performed to characterize the study cohort by comparing the birth and parental information, comorbidities, and socioeconomic status. The first analysis compared the characteristics of birth cohort children who were and were not enrolled in ISD 535. The second analysis evaluated the success of the propensity matching schemes in creating groups of children that were similar in measured characteristics except for anesthesia exposure. The third analysis compared the characteristics of children with anesthesia exposures who were and were not included in the final cohort based on propensity matching. Results of these analyses demonstrate only slight differences among the comparison groups, and therefore these are unlikely to compromise our future analysis of anesthetic exposure and neurodevelopmental outcomes.