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Kamalahmadi N, Moharrari F, Soltanifar A, Khaniki SH, Mohaddes H, Noorbakhsh G, Salehabadi R. Hot and cold executive function among pediatric attention deficit hyperactivity disorder with and without coexisting oppositional defiant disorder. Int J Dev Neurosci 2024; 84:446-453. [PMID: 38831728 DOI: 10.1002/jdn.10346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 05/03/2024] [Accepted: 05/13/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Executive function is a high-level set of cognitive processes related to goal-directed behaviors including two conceptual subtypes of hot (emotional) and cold (cognitive) executive function (to abbreviate EF). EF deficits in attention deficit hyperactivity disorder (ADHD) leads to significant social impairments in the home, school, and community. Today the type and the extent of executive function defects in ADHD are still debated in studies. We aimed to evaluate hot and cold executive function among medication-naive children with ADHD, with and without oppositional defiant disorder (ODD). METHODS Forty-five children including suffering ADHD with ODD (n = 15), without ODD (n = 15), or typically developed (TD, n = 15) participated in this cross-sectional study (the age of children was between 7 and 12 years old). The Child Symptom Inventory-4 (CSI-4) was used to screen behavioral and emotional symptoms. Wechsler Adult Intelligence Scale-Revised-Digit Span Task (WAIS-R-DST), Corsi Block Task (CBT), and Wisconsin Card Sorting Test (WCST) were used for assessing cold executive function. Assessing hot executive function was done with Delay Discounting Task (DDT) and Iowa Gambling Task (IGT). RESULTS Evaluating the cold executive function, total WAIS-R-DST score, Backward DST, total CBT score, and Backward CBT were significantly lower among ADHD than TD groups (p < 0.05). Assessing the hot executive function showed that the score of DDT and IGT was significantly lower among ADHD than TD groups (p < 0.05). CONCLUSION Both hot and cold executive functions are defective in children with ADHD, while the comorbid of ODD has no significant effect. We suggest the clinicians to consider cognitive rehabilitation interventions as a necessary treatment modality for ADHD patients.
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Affiliation(s)
- Nasim Kamalahmadi
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Science, Mashhad, Iran
- Clinical Research Development Unit of Imam Reza Hospital, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Fatemeh Moharrari
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Science, Mashhad, Iran
| | - Atefeh Soltanifar
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Science, Mashhad, Iran
| | - Saeedeh Hajebi Khaniki
- Department of Mathematical Sciences, University of Nevada, Las Vegas, Nevada, USA
- Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossein Mohaddes
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Science, Mashhad, Iran
| | - Ghazaleh Noorbakhsh
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Science, Mashhad, Iran
| | - Razie Salehabadi
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Science, Mashhad, Iran
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Smith JN, Jusko ML, Fosco WD, Musser ED, Raiker JS. A critical review of hot executive functioning in youth attention-deficit/hyperactivity disorder: Methodological limitations, conceptual considerations, and future directions. Dev Psychopathol 2024; 36:601-615. [PMID: 36734223 DOI: 10.1017/s0954579422001432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Hot executive functioning (EF) - EF under emotionally or motivationally salient conditions - is a putative etiology of attention-deficit/hyperactivity disorder (ADHD), disruptive behavior problems (DBPs), and their related impairments. Despite two decades of research, the present study is the first review of the construct in youth ADHD, with a particular focus on the role of task design, age, and DBPs, as well as relevant conceptual and methodological considerations. While certain hot EF tasks have been investigated extensively (e.g., choice impulsivity), substantial inconsistency in measurement of the broader construct remains, severely limiting conclusions. Future research should a) consider the extent to which various hot EF tasks relate to one another, a higher order factor, and other related constructs; b) further investigate task design, particularly the elicitation of emotion or motivation and its anticipated effect on EF; and c) incorporate multiple levels of analysis to validate similarities and differences among tasks with regard to the affective experiences and cognitive demands they elicit. With improved measurement and conceptual clarity, hot EF has potential to advance the literature on etiological pathways to ADHD, DBPs and associated impairments and, more broadly, may represent a useful tool for understanding the influence of emotion and motivation on cognition.
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Affiliation(s)
| | | | | | - Erica D Musser
- Florida International University (FIU), USA
- FIU Center for Children and Families, USA
- FIU Embrace, USA
| | - Joseph S Raiker
- Florida International University (FIU), USA
- FIU Center for Children and Families, USA
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3
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Elahi H, Iosif AM, Mukherjee P, Hinshaw SP, Schweitzer JB. Using Hot and Cool Measures to Phenotype and Predict Functional Outcomes Across Dimensions of ADHD and Typical Development in Adolescents. Res Child Adolesc Psychopathol 2024; 52:579-593. [PMID: 38038753 DOI: 10.1007/s10802-023-01149-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/02/2023]
Abstract
Multiple pathway models propose that attention deficit hyperactivity disorder (ADHD) arises from dysfunction in separate systems comprised of a "cool" or cognitive pathway versus a "hot" or emotional/reward pathway. Interactions between these pathways and the degree of maturation may further determine functional outcomes for adolescents ranging from those diagnosed with ADHD to typical development (TD). We used a latent profile analysis on rating scales and behavioral task performance assessing emotion, irritability, impulsivity, risk-taking, future orientation, and processing speed (PS) to identify subgroups of TD adolescents and adolescents with ADHD (N = 152) based on the hot and cool pathway model. We identified four classes: 1) High-Complex Challenges; 2) Moderate-Mixed Challenges; 3) Non-Emotive Impulsivity; and 4) High Regulation and Control. A multiple pathway model of ADHD is supported with classes differing in degree of emotional lability and irritability, types of impulsivity, and ability to use future consequences to modulate impulsivity and PS. The classes differed regarding functional behavior, with the High-Complex class demonstrating the most severe functional challenges in academic-related functioning. The Moderate-Mixed class also displayed significant functional challenges but with moderate emotional lability and irritability ratings. The Non-Emotive Impulsivity class exhibited low emotionality and low irritability, yet high impulsivity with limited negative functional consequences, and was composed of a mix of ADHD and TD adolescents. Differences between classes suggest ADHD symptomatology may represent both categorical and dimensional differences. Precision health interventions may be more effective in addressing the specific challenges associated with the classes rather than a one-size-fits-all approach to treating ADHD.
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Affiliation(s)
- Heather Elahi
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, 95817, USA
- MIND Institute, University of California, Davis, Sacramento, CA, USA
| | - Ana-Maria Iosif
- Department of Public Health Sciences, Division of Biostatistics, University of California, Davis, Davis, CA, USA
| | - Prerona Mukherjee
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, 95817, USA
- MIND Institute, University of California, Davis, Sacramento, CA, USA
| | - Stephen P Hinshaw
- Department of Psychology, University of California, Berkeley, Berkeley, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Julie B Schweitzer
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, 95817, USA.
- MIND Institute, University of California, Davis, Sacramento, CA, USA.
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Manoli A, Liversedge SP, Sonuga-Barke EJS, Hadwin JA. The Differential Effect of Anxiety and ADHD Symptoms on Inhibitory Control and Sustained Attention for Threat Stimuli: A Go/No-Go Eye-Movement Study. J Atten Disord 2021; 25:1919-1930. [PMID: 32513052 PMCID: PMC8427811 DOI: 10.1177/1087054720930809] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: This study examined the synergistic effects of ADHD and anxiety symptoms on attention and inhibitory control depending on the emotional content of the stimuli. Method: Fifty-four typically developing individuals (27 children/adolescents and 27 adults) completed an eye-movement based emotional Go/No-Go task, using centrally presented (happy, angry) faces and neutral/symbolic stimuli. Sustained attention was measured through saccade latencies and saccadic omission errors (Go trials), and inhibitory control through saccadic commission errors (No-Go trials). ADHD and anxiety were assessed dimensionally. Results: Elevated ADHD symptoms were associated with more commission errors and slower saccade latencies for angry (vs. happy) faces. In contrast, angry faces were linked to faster saccade onsets when anxiety symptoms were high, and this effect prevailed when both anxiety and ADHD symptoms were high. Conclusion: Social threat impacted performance in individuals with sub-clinical anxiety and ADHD differently. The effects of anxiety on threat processing prevailed when both symptoms were high.
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Affiliation(s)
- Athina Manoli
- Queen Mary University of London, London, UK,Athina Manoli, Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, Old Anatomy Building, London EC1M 6BQ, UK.
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Leroy A, Spotorno S, Faure S. Emotional scene processing in children and adolescents with attention deficit/hyperactivity disorder: a systematic review. Eur Child Adolesc Psychiatry 2021; 30:331-346. [PMID: 32034554 DOI: 10.1007/s00787-020-01480-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 01/23/2020] [Indexed: 10/25/2022]
Abstract
"Impairments in emotional information processing are frequently reported in attention deficit hyperactivity disorder (ADHD) at a voluntary, explicit level (e.g., emotion recognition) and at an involuntary, implicit level (e.g., emotional interference). Most of previous studies have used faces with emotional expressions, rarely examining other important sources of information usually co-occurring with faces in our every day experience. Here, we examined how the emotional content of an entire visual scene depicting real-world environments and situations is processed in ADHD. We systematically reviewed in PubMed, SCOPUS and ScienceDirect, using the PRISMA guidelines, empirical studies published in English until March 2019, about processing of visual scenes, with or without emotional content, in children and adolescents with ADHD. We included 17 studies among the 154 initially identified. Fifteen used scenes with emotional content (which was task-relevant in seven and irrelevant in eight studies) and two used scenes without emotional content. Even though the interpretation of the results differed according to the theoretical model of emotions of the study and the presence of comorbidity, differences in scene information processing between ADHD and typically developing children and adolescents were reported in all but one study. ADHD children and adolescents show difficulties in the processing of emotional information conveyed by visual scenes, which may stem from a stronger bottom-up impact of emotional stimuli in ADHD, increasing the emotional experience, and from core deficits of the disorder, decreasing the overall processing of the scene".
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Affiliation(s)
- Anaïs Leroy
- Laboratoire D'Anthropologie Et de Psychologie Cliniques, Cognitives Et Sociales (LAPCOS), MSHS Sud Est, Université Côte D'Azur, Pôle Universitaire Saint Jean D'Angely, 24 avenue des Diables Bleus, 06357, Nice Cédex 4, France. .,CERTA, Reference Centre for Learning Disabilities, Fondation Lenval, Hôpitaux Pédiatriques de Nice CHU-Lenval, Nice, France.
| | | | - Sylvane Faure
- Laboratoire D'Anthropologie Et de Psychologie Cliniques, Cognitives Et Sociales (LAPCOS), MSHS Sud Est, Université Côte D'Azur, Pôle Universitaire Saint Jean D'Angely, 24 avenue des Diables Bleus, 06357, Nice Cédex 4, France
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Wijngaarde RO, Hein I, Daams J, Van Goudoever JB, Ubbink DT. Chronically ill children's participation and health outcomes in shared decision-making: a scoping review. Eur J Pediatr 2021; 180:2345-2357. [PMID: 33821341 PMCID: PMC8285312 DOI: 10.1007/s00431-021-04055-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/22/2021] [Accepted: 03/24/2021] [Indexed: 11/20/2022]
Abstract
Based on the United Nations Conventions on the Rights of the Child (CRC), it is a child's right to participate in all matters concerning its wellbeing. Little is known about chronically and/or critically ill children's participation in pediatric shared decision-making (SDM). We explored medical literature to see if and how these children participate in pediatric SDM. We searched relevant medical databases published between January 2008 and January 2020 for studies targeting children aged 4-18 years old, suffering from a chronic and/or critical disease. We found 9 relevant studies. SDM interventions mostly used were decision aids (n=8), questionnaires for caretakers/parents and children (n=4), and a SDM toolkit (n=2). Perceived involvement in SDM and knowledge increased amongst children, adolescents, and caretakers following these interventions. Decisional conflict measured using the 0-100 point DCS scale (higher scores indicate more decisional conflict) was reduced by 15.9 points in one study (p<0.01) and 17.8 points in another (95%CI: 13.3-22.9). Lower scores were associated with higher satisfaction with the decision aid by children, caretakers, and clinicians.Conclusion: Stakeholders should advocate initiatives to facilitate a child's participation preferences regarding pediatric SDM since decision support tools help chronically ill children to be more involved in SDM as they increase the children's knowledge and satisfaction and reduce decisional conflicts. What is Known: • Decision aids can help improve participation, knowledge, satisfaction, and health outcomes. • Quality and consistency of the information exchange impact quality and outcome of SDM. What is New: • Depending on a child's age, evolving capacities, and communication and participation preferences, more evidence is needed on which tools are suitable for chronically ill children to ensure their preferred participation in pediatric SDM. • Pediatricians adopt healthcare SDM tools and techniques that do not always take into account that a child's right to participate in pediatric SDM including the tendency to use interventions that are not specifically designed for pediatrics.
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Affiliation(s)
- R. O. Wijngaarde
- grid.7177.60000000084992262Amsterdam UMC, University of Amsterdam, Emma Children’s Hospital, Room H8-247, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - I. Hein
- grid.5650.60000000404654431Child and Adolescent Psychiatry and de Bascule, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - J. Daams
- grid.5650.60000000404654431Medical Library, Amsterdam University Medical Centers, AMC, Amsterdam, The Netherlands
| | - J. B. Van Goudoever
- grid.7177.60000000084992262Amsterdam UMC, University of Amsterdam, Emma Children’s Hospital, Room H8-247, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - D. T. Ubbink
- grid.5650.60000000404654431Department of Surgery, Amsterdam University Medical Centers, AMC, Amsterdam, The Netherlands
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7
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Shakehnia F, Amiri S, Ghamarani A. The comparison of cool and hot executive functions profiles in children with ADHD symptoms and normal children. Asian J Psychiatr 2021; 55:102483. [PMID: 33271479 DOI: 10.1016/j.ajp.2020.102483] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 11/01/2020] [Accepted: 11/16/2020] [Indexed: 01/10/2023]
Abstract
The study aimed to compare cool and hot executive functions profiles in children with ADHD symptoms and normal children. The statistical population consisted of all boys with ADHD symptoms and normal children in elementary school in Isfahan. In causal-comparative study, 200 participants were selected by multi-stage random sample method. Data were collected from Children Symptoms Inventory (CSI-4), Behavior Rating Inventory of Executive Function (BRIEF) and demographic inventory. Data were analyzed by using an analysis of covariance and Kruskal-Wallis test. There is significant difference between groups mean in variable of executive functions and all of their subscales (P < 0.05). Results from paired comparisons showed that in comparison with both subgroups of predominantly inattentive and predominantly hyperactive/ impulsive, combined subgroup indicate more damage to executive functions and all of subscales. In addition, subgroups of HD and AD are damaged more than normal group in executive functions and their subscales. Subgroups of HD and AD did not show any significant difference in inhibition, shifting and emotional control subscales (BRI). However, there were significant differences in initiation, monitoring, planning/organizing of materials subscales and total executive function. Negative mean difference in some variables indicates that in comparison with HD, AD has more problems in these subscales (MCI) and total executive function. Performing such studies can help to understand the underlying causes of treatment that has not been addressed so far in relation to this disorder and facilitate the establishment of optimal mechanisms and methods in treatment and standardization of psychological treatments.
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Affiliation(s)
| | - Shole Amiri
- Department of Psychology, University of Isfahan, Isfahan, Iran.
| | - Amir Ghamarani
- Department of Psychology and Education of Children with Special Needs, University of Isfahan, Isfahan, Iran.
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8
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Salehinejad MA, Ghanavati E, Rashid MHA, Nitsche MA. Hot and cold executive functions in the brain: A prefrontal-cingular network. Brain Neurosci Adv 2021; 5:23982128211007769. [PMID: 33997292 PMCID: PMC8076773 DOI: 10.1177/23982128211007769] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/15/2021] [Indexed: 12/12/2022] Open
Abstract
Executive functions, or cognitive control, are higher-order cognitive functions needed for adaptive goal-directed behaviours and are significantly impaired in majority of neuropsychiatric disorders. Different models and approaches are proposed for describing how executive functions are functionally organised in the brain. One popular and recently proposed organising principle of executive functions is the distinction between hot (i.e. reward or affective-related) versus cold (i.e. purely cognitive) domains of executive functions. The prefrontal cortex is traditionally linked to executive functions, but on the other hand, anterior and posterior cingulate cortices are hugely involved in executive functions as well. In this review, we first define executive functions, their domains, and the appropriate methods for studying them. Second, we discuss how hot and cold executive functions are linked to different areas of the prefrontal cortex. Next, we discuss the association of hot versus cold executive functions with the cingulate cortex, focusing on the anterior and posterior compartments. Finally, we propose a functional model for hot and cold executive function organisation in the brain with a specific focus on the fronto-cingular network. We also discuss clinical implications of hot versus cold cognition in major neuropsychiatric disorders (depression, schizophrenia, anxiety disorders, substance use disorder, attention-deficit hyperactivity disorder, and autism) and attempt to characterise their profile according to the functional dominance or manifest of hot-cold cognition. Our model proposes that the lateral prefrontal cortex along with the dorsal anterior cingulate cortex are more relevant for cold executive functions, while the medial-orbital prefrontal cortex along with the ventral anterior cingulate cortex, and the posterior cingulate cortex are more closely involved in hot executive functions. This functional distinction, however, is not absolute and depends on several factors including task features, context, and the extent to which the measured function relies on cognition and emotion or both.
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Affiliation(s)
- Mohammad Ali Salehinejad
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Elham Ghanavati
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
- Department of Neuropsychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Md Harun Ar Rashid
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Michael A. Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
- Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany
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Kofler MJ, Irwin LN, Soto EF, Groves NB, Harmon SL, Sarver DE. Executive Functioning Heterogeneity in Pediatric ADHD. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 47:273-286. [PMID: 29705926 DOI: 10.1007/s10802-018-0438-2] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Neurocognitive heterogeneity is increasingly recognized as a valid phenomenon in ADHD, with most estimates suggesting that executive dysfunction is present in only about 33%-50% of these children. However, recent critiques question the veracity of these estimates because our understanding of executive functioning in ADHD is based, in large part, on data from single tasks developed to detect gross neurological impairment rather than the specific executive processes hypothesized to underlie the ADHD phenotype. The current study is the first to comprehensively assess heterogeneity in all three primary executive functions in ADHD using a criterion battery that includes multiple tests per construct (working memory, inhibitory control, set shifting). Children ages 8-13 (M = 10.37, SD = 1.39) with and without ADHD (N = 136; 64 girls; 62% Caucasian/Non-Hispanic) completed a counterbalanced series of executive function tests. Accounting for task unreliability, results indicated significantly improved sensitivity and specificity relative to prior estimates, with 89% of children with ADHD demonstrating objectively-defined impairment on at least one executive function (62% impaired working memory, 27% impaired inhibitory control, 38% impaired set shifting; 54% impaired on one executive function, 35% impaired on two or all three executive functions). Children with working memory deficits showed higher parent- and teacher-reported ADHD inattentive and hyperactive/impulsive symptoms (BF10 = 5.23 × 104), and were slightly younger (BF10 = 11.35) than children without working memory deficits. Children with vs. without set shifting or inhibitory control deficits did not differ on ADHD symptoms, age, gender, IQ, SES, or medication status. Taken together, these findings confirm that ADHD is characterized by neurocognitive heterogeneity, while suggesting that contemporary, cognitively-informed criteria may provide improved precision for identifying a smaller number of neuropsychologically-impaired subtypes than previously described.
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Affiliation(s)
- Michael J Kofler
- Department of Psychology, Florida State University, 1107 W. Call Street, Tallahassee, FL, 32306-4301, USA.
| | - Lauren N Irwin
- Department of Psychology, Florida State University, 1107 W. Call Street, Tallahassee, FL, 32306-4301, USA
| | - Elia F Soto
- Department of Psychology, Florida State University, 1107 W. Call Street, Tallahassee, FL, 32306-4301, USA
| | - Nicole B Groves
- Department of Psychology, Florida State University, 1107 W. Call Street, Tallahassee, FL, 32306-4301, USA
| | - Sherelle L Harmon
- Department of Psychology, Florida State University, 1107 W. Call Street, Tallahassee, FL, 32306-4301, USA
| | - Dustin E Sarver
- Departments of Pediatrics and Psychiatry, Center for Advancement of Youth, University of Mississippi Medical Center, Jackson, MS, USA
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Self-Regulation in Children with Neurodevelopmental Disorders "SR-MRehab: Un Colegio Emocionante": A Protocol Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124198. [PMID: 32545534 PMCID: PMC7345694 DOI: 10.3390/ijerph17124198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/09/2020] [Accepted: 06/09/2020] [Indexed: 12/20/2022]
Abstract
Self-regulation refers to the ability to control and modulate behavior, and it can include both emotional and cognitive modulation. Children with neurodevelopmental disorders may show difficulties in self-regulation. The main objective of this study is to improve self-regulation skills in children between 6 and 11 years of age with neurodevelopmental disorders. Methodology: A randomized controlled trial will be conducted with the use of “SR-MRehab: Un colegio emocionante”, based on a non-immersive virtual reality system where virtual objects can be managed by children in a natural way using their hands. Children will be recruited from several schools of Granada (Spain) and they will be randomly allocated to two groups. An assessment will be conducted before and after the intervention and 24 weeks after the end of the intervention process. The experimental group will receive the intervention using virtual reality. The control group will receive a standard self-regulation program. Both interventions will be performed once a week for a total of 10 sessions. Changes in self-regulation, as well as the acceptability of technology with the use of SR-MRehab, will be evaluated. The results will be published and will provide evidence regarding the use of this type of intervention in children with neurodevelopmental disorders. Trial registration: Registered with code NCT04418921.
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Weibel S, Micoulaud-Franchi JA, Brandejsky L, Lopez R, Prada P, Nicastro R, Ardu S, Dayer A, Lançon C, Perroud N. Psychometric Properties and Factor Structure of the Short Form of the Affective Lability Scale in Adult Patients With ADHD. J Atten Disord 2019; 23:1079-1089. [PMID: 28152669 DOI: 10.1177/1087054717690808] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective: Affective lability is an important dimension of adult ADHD, associated with marked impairments and worse outcomes. A valid and quick tool to measure affective lability may therefore be of interest. Method: In 187 adult ADHD patients, we explored psychometric properties of the Affective Lability Scale-Short Form (ALS-18 items). We analyzed the construct validity and the external validity of the scale. Patients were compared with 48 healthy adult controls. Results: The three-factor structure of the ALS-18 presented a good fit and a good internal consistency. The correlations between the ALS-18 and ADHD symptoms and other psychological dimensions were, respectively, low and moderate. ALS-18 scores were higher in patients than in healthy adults. Conclusion: ALS-18 showed good psychometric properties in ADHD adult patients, allowing us to recommend the implementation of ALS-18 in assessing affective lability for clinical and research purposes. Use of ALS-18 should improve the clinical assessment of affective lability in adult ADHD patients.
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Affiliation(s)
| | | | - Laura Brandejsky
- 4 Centre Hospitalier Universitaire de Sainte-Marguerite, Marseille, France
| | - Régis Lopez
- 5 Service de Neurologie, Unité des Troubles du Sommeil, Hôpital Gui-de-Chauliac Montpellier, France.,6 Inserm U1061, Montpellier, France
| | - Paco Prada
- 1 University Hospital of Geneva, Switzerland
| | | | | | - Alexandre Dayer
- 1 University Hospital of Geneva, Switzerland.,7 University of Geneva, Switzerland
| | - Christophe Lançon
- 4 Centre Hospitalier Universitaire de Sainte-Marguerite, Marseille, France.,8 Université de la Méditerranée, Marseille, France
| | - Nader Perroud
- 1 University Hospital of Geneva, Switzerland.,7 University of Geneva, Switzerland
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Hirsch O, Chavanon ML, Christiansen H. Emotional dysregulation subgroups in patients with adult Attention-Deficit/Hyperactivity Disorder (ADHD): a cluster analytic approach. Sci Rep 2019; 9:5639. [PMID: 30948735 PMCID: PMC6449354 DOI: 10.1038/s41598-019-42018-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 03/21/2019] [Indexed: 12/12/2022] Open
Abstract
Emotion regulation deficits (ERD) are evident in about 34–70% of the adults with ADHD. In contrast to this, they are not considered in the diagnostic criteria of the disorder. In a recent study of our research group using confirmatory factor analysis, we modeled positive and negative emotion as well as emotion regulation skills along with the classical ADHD-core symptoms. We showed that negative affect and the failure to apply adaptive emotion regulation skills were distinct and indicative dimensions in adult ADHD. In this study, we used a person-centered approach based on cluster analysis to subtype patients on the presence or relative absence of ERD. This results in important information to individualize treatment decisions. We found two clusters, with cluster 2 showing high ERD that were associated with higher impairments indicated by depressive mood, negative affect and elevated psychological distress. There were also higher rates of comorbidity in cluster 2 such as somatoform disorders which were associated with ERD. Women were overrepresented in this cluster 2. Neuropsychological variables did not contribute significantly to cluster formation. In conclusion, ADHD in adults is a heterogeneous disorder with specific subgroups that need differential treatment approaches.
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Affiliation(s)
- Oliver Hirsch
- FOM University of Applied Sciences, Siegen, Germany.
| | - Mira Lynn Chavanon
- Department of Clinical Child and Adolescent Psychology and Psychotherapy, Philipps University Marburg, Marburg, Germany
| | - Hanna Christiansen
- Department of Clinical Child and Adolescent Psychology and Psychotherapy, Philipps University Marburg, Marburg, Germany
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13
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Abstract
PURPOSE OF REVIEW Emotional symptoms are common and persistent in youth and adults with attention-deficit/hyperactivity disorder (ADHD) and cause clinically significant impairments. We review recent neuropsychological, neurophysiological, and peripheral psychophysiological evidence for emotion and emotion regulation deficits in ADHD across youth and adults. RECENT FINDINGS Central and autonomous nervous system correlates argue in favor of more general self-regulation deficits and also specific emotional deficits in ADHD. These include general performance deficits in executive functions, and structural as well as functional impairments in neuronal networks associated with top-down self-regulation. Specific deficits with bottom-up emotional activation in the amygdala and emotion evaluation associated with the orbitofrontal cortex have also been described. Furthermore, vagally mediated, high-frequency heart rate variability is associated with emotional self-regulation deficits throughout the life span. The current evidence is based on multilevel studies that assess associations of emotion regulation. However, further studies that adequately consider the processual recursive character of emotion generation and regulation may give important new insights into emotional regulation of ADHD. Emotion regulation deficits in ADHD are associated with specific as well as general self-regulation deficits traceable on the level of neuropsychological, neurophysiological, and psychophysiological assessments. The temporal dynamics of the interplay of those different systems need further study in order to optimize and personalize treatment of emotion regulation difficulties, including emotional reactivity, in patients with ADHD.
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14
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Wiersema JR, Godefroid E. Interoceptive awareness in attention deficit hyperactivity disorder. PLoS One 2018; 13:e0205221. [PMID: 30312308 PMCID: PMC6185835 DOI: 10.1371/journal.pone.0205221] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 09/21/2018] [Indexed: 11/19/2022] Open
Abstract
ADHD is considered a disorder of self-regulation. Recent research has shown that awareness of bodily states, referred to as interoceptive awareness, crucially contributes to self-regulatory processes. Impaired self-regulation in ADHD has been explained in terms of arousal regulation deficits in ADHD (the state regulation deficit (SRD) account). There is now ample support for the SRD account, however the exact reason for arousal regulation difficulties is not yet known. The SRD account explicitly refers to the ability to monitor one's momentary bodily state as a prerequisite for effective state regulation. However, surprisingly, no study to date has tested the ability to become aware of bodily signals, i.e. interoceptive awareness, in ADHD. In the current study, we therefore compared interoceptive awareness between 24 adults with ADHD and 23 controls by means of both an objective (heartbeat perception task) and subjective measure (questionnaire) of interoceptive awareness. Results revealed a strikingly similar performance for both groups on both measures, suggesting preserved interoceptive awareness in adult ADHD.
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Affiliation(s)
- Jan R. Wiersema
- Department of Experimental Clinical and Health psychology, Faculty of Psychology and educational sciences, Ghent University, Ghent, Belgium
- * E-mail:
| | - Elke Godefroid
- Department of Experimental Clinical and Health psychology, Faculty of Psychology and educational sciences, Ghent University, Ghent, Belgium
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15
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Vetter NC, Buse J, Backhausen LL, Rubia K, Smolka MN, Roessner V. Anterior insula hyperactivation in ADHD when faced with distracting negative stimuli. Hum Brain Mapp 2018; 39:2972-2986. [PMID: 29569801 PMCID: PMC6866282 DOI: 10.1002/hbm.24053] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 03/08/2018] [Accepted: 03/12/2018] [Indexed: 01/30/2023] Open
Abstract
Patients with attention deficit hyperactivity disorder (ADHD) suffer from poor emotion regulation that might arise from problems in the distribution of attentional resources when confronted with emotional distractors. Previous studies investigating the neurocognitive basis of these problems remain inconclusive. Moreover, most of these studies did not exclude participants with comorbidity, particularly of conduct or oppositional defiant disorder. The aim of this study was to assess alterations in fronto-limbic activation in ADHD adolescents specifically during negative distractors in an emotional attention task. For this purpose, we used functional magnetic resonance imaging to assess 25 boys with noncomorbid ADHD and 25 typically developing (TD) boys while they performed an emotional attention task with positive, negative, and neutral emotional distractors. Boys with ADHD had increased activation relative to TD boys specifically during the negative valenced stimuli in an emotional processing network comprising left anterior insula reaching into the inferior frontal gyrus. The findings suggest altered salience processing in ADHD of negative valenced emotional stimuli that may lead to higher distractibility in ADHD specifically when faced with negative emotional distractors.
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Affiliation(s)
- Nora C. Vetter
- Department of Psychiatry and Neuroimaging CenterTechnische Universität DresdenDresdenGermany
- Department of Child and Adolescent PsychiatryFaculty of Medicine of the TU DresdenDresdenGermany
| | - Judith Buse
- Department of Child and Adolescent PsychiatryFaculty of Medicine of the TU DresdenDresdenGermany
| | - Lea L. Backhausen
- Department of Child and Adolescent PsychiatryFaculty of Medicine of the TU DresdenDresdenGermany
| | - Katya Rubia
- Department of Child & Adolescent PsychiatryInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUnited Kingdom
| | - Michael N. Smolka
- Department of Psychiatry and Neuroimaging CenterTechnische Universität DresdenDresdenGermany
| | - Veit Roessner
- Department of Child and Adolescent PsychiatryFaculty of Medicine of the TU DresdenDresdenGermany
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16
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Shushakova A, Ohrmann P, Pedersen A. Exploring deficient emotion regulation in adult ADHD: electrophysiological evidence. Eur Arch Psychiatry Clin Neurosci 2018; 268:359-371. [PMID: 28770370 DOI: 10.1007/s00406-017-0826-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 07/24/2017] [Indexed: 12/29/2022]
Abstract
Emotional dysregulation (ED) is being increasingly recognized as a core feature of attention-deficit/hyperactivity disorder (ADHD), but the pathophysiological underpinnings remain unclear. In this study, we provide meaningful electrophysiological evidence of ED in adult patients with ADHD (n = 39) compared to healthy controls (n = 40) by exploring the electrophysiological correlates of the emotion regulation strategies reappraisal, distraction, and expressive suppression. Event-related potentials (ERPs) were recorded during passive viewing of neutral and negative images, as well as during emotion regulation. The patients with ADHD exhibited increased frontal late positive potential (LPP) amplitudes during passive viewing of the aversive images and during emotion regulation. Compared with the healthy controls, a subgroup of medication-naïve patients with ADHD (n = 25) also exhibited larger centroparietal LPP amplitudes and provided more negative ratings of the aversive and neutral images. Both the frontal and centroparietal LPP amplitudes were associated with ADHD symptom severity. However, no significant deficit in LPP modulation during emotion regulation was found. These findings strongly support the clinical observation of increased emotional responsivity toward negative stimuli and difficulty during the implementation of emotion regulation strategies and thus encourage the implementation of emotion regulation modules in the treatment of adult patients with ADHD.
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Affiliation(s)
- Anna Shushakova
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Kiel, Olshausenstr. 62, 24118, Kiel, Germany.,Clinical Psychology and Psychotherapy, Department of Psychology, University of Münster, Fliednerstr. 21, 48149, Münster, Germany
| | - Patricia Ohrmann
- Department of Psychiatry, School of Medicine, University of Münster, Albert-Schweitzer-Straße 11, 48149, Münster, Germany
| | - Anya Pedersen
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Kiel, Olshausenstr. 62, 24118, Kiel, Germany.
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17
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Schneidt A, Jusyte A, Rauss K, Schönenberg M. Distraction by salient stimuli in adults with attention-deficit/hyperactivity disorder: Evidence for the role of task difficulty in bottom-up and top-down processing. Cortex 2018. [DOI: 10.1016/j.cortex.2018.01.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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18
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Villemonteix T, Marx I, Septier M, Berger C, Hacker T, Bahadori S, Acquaviva E, Massat I. Attentional control of emotional interference in children with ADHD and typically developing children: An emotional N-back study. Psychiatry Res 2017; 254:1-7. [PMID: 28437666 DOI: 10.1016/j.psychres.2017.04.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 02/28/2017] [Accepted: 04/15/2017] [Indexed: 10/19/2022]
Abstract
Emotional interference control refers to the ability to remain focused on goal-oriented processes when confronted with disrupting but irrelevant emotional stimuli, a process that may be impaired in children and adults with attention deficit/hyperactivity disorder (ADHD). However, emotional interference levels are known to be associated with trait anxiety, and patients with ADHD often display elevated levels of trait anxiety, such as these may have confounded previous findings of decreased emotional interference control in this population. In the present study, male and female 8-13 years old (mean =11.0 years) children with ADHD (n=33) and typically developing (TD) children (n=24) performed a visual emotional working memory (n-back) task with 2 memory loads and three different background pictures (neutral/positive/negative), and trait anxiety measures were obtained. Children with ADHD performed less well, and displayed increased emotional interference in the presence of aversive distractors when compared with TD children. Contrary to our expectations, trait anxiety did not mediate the association between diagnostic group membership and the degree of emotional interference control; however, co-morbid ODD was associated with decreased levels of emotional interference in ADHD. Future research should aim at characterizing the mechanisms subtending decreased emotional interference control in the ADHD population.
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Affiliation(s)
- Thomas Villemonteix
- EA 2007, Psychopathology and Neuropsychology Lab., Université Paris 8, Saint-Denis, France; UR2NF - Neuropsychology and Functional Neuroimaging Research Unit, Centre de Recherche Cognition et Neurosciences, Université Libre de Bruxelles (ULB), Bruxelles, Belgium.
| | - Ivo Marx
- Department of Child and Adolescent Psychiatry, Neurology, Psychosomatics and Psychotherapy, University Medicine Rostock, Rostock, Germany
| | - Mathilde Septier
- Assistance Publique-Hôpitaux de Paris, Department of Child and Adolescent Psychiatry, Robert-Debré Hospital, Paris, France; Inserm, U894, Psychiatry and NeurosciXence Center, Paris, France
| | - Christoph Berger
- Department of Child and Adolescent Psychiatry, Neurology, Psychosomatics and Psychotherapy, University Medicine Rostock, Rostock, Germany
| | - Thomas Hacker
- Department of Psychiatry and Psychotherapy, University Medicine Rostock, Rostock, Germany
| | - Sara Bahadori
- Assistance Publique-Hôpitaux de Paris, Department of Child and Adolescent Psychiatry, Robert-Debré Hospital, Paris, France; Inserm, U894, Psychiatry and NeurosciXence Center, Paris, France
| | - Eric Acquaviva
- Assistance Publique-Hôpitaux de Paris, Department of Child and Adolescent Psychiatry, Robert-Debré Hospital, Paris, France
| | - Isabelle Massat
- UR2NF - Neuropsychology and Functional Neuroimaging Research Unit, Centre de Recherche Cognition et Neurosciences, Université Libre de Bruxelles (ULB), Bruxelles, Belgium; Laboratory of Experimental Neurology, ULB, Bruxelles, Belgium; National Fund of Scientific Research (FNRS) Belgium
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19
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To make a molehill out of a mountain: An ERP-study on cognitive reappraisal of negative pictures in children with and without ADHD. Clin Neurophysiol 2017; 128:529-537. [PMID: 28226287 DOI: 10.1016/j.clinph.2017.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 01/03/2017] [Accepted: 01/10/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We investigated cognitive reappraisal in children with ADHD by means of the late positive potential (LPP) and self-report ratings. We expected diminished LPP modulation following reappraisal and lower self-report scores in children with ADHD. METHODS Eighteen children with ADHD and 24 typically developing (TD) children (8-12years) performed a cognitive reappraisal task, while EEG was recorded, and filled out a questionnaire on cognitive reappraisal. RESULTS Despite the lack of main reappraisal effects on LPP, the LPP was less positively modulated during reappraisal in ADHD compared to TD children. CONCLUSIONS Children with ADHD reported less use of reappraisal and could be distinguished from TD children based on LPP modulation. However the lack of main effects of reappraisal on LPP in both groups hinders clear interpretation of this finding and questions the suitability of LPP modulation within the current paradigm as a neural index of reappraisal in children 8-12years old, and warrants further research on the inter-individual variability and sensitivity of LPP modulation as a neural index of emotion regulation in children. SIGNIFICANCE This is the first study investigating the LPP during cognitive reappraisal in children with ADHD.
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20
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Van Cauwenberge V, Sonuga-Barke EJS, Hoppenbrouwers K, Van Leeuwen K, Wiersema JR. Regulation of emotion in ADHD: can children with ADHD override the natural tendency to approach positive and avoid negative pictures? J Neural Transm (Vienna) 2016; 124:397-406. [PMID: 27744615 DOI: 10.1007/s00702-016-1631-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 10/06/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Valerie Van Cauwenberge
- Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium.
| | - Edmund J S Sonuga-Barke
- Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium
- School of Psychology, University of Southampton, Shackleton Building (B44), Highfield Campus, Southampton, SO17 1BJ, UK
| | - Karel Hoppenbrouwers
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35 Blok d-Bus 7001, 3000, Louvain, Belgium
| | - Karla Van Leeuwen
- Department of Parenting and Special Education, KU Leuven, Leopold Vanderkelenstraat 32-Bus 3765, 3000, Louvain, Belgium
| | - Jan R Wiersema
- Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium
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