The consolidation of a motor skill in young adults with ADHD: Shorter practice can be better

Distinct reinforcement learning profiles distinguish between language and attentional neurodevelopmental disorders

BACKGROUND

Theoretical models posit abnormalities in cortico-striatal pathways in two of the most common neurodevelopmental disorders (Developmental dyslexia, DD, and Attention deficit hyperactive disorder, ADHD), but it is still unclear what distinct cortico-striatal dysfunction might distinguish language disorders from others that exhibit very different symptomatology. Although impairments in tasks that depend on the cortico-striatal network, including reinforcement learning (RL), have been implicated in both disorders, there has been little attempt to dissociate between different types of RL or to compare learning processes in these two types of disorders. The present study builds upon prior research indicating the existence of two learning manifestations of RL and evaluates whether these processes can be differentiated in language and attention deficit disorders. We used a two-step RL task shown to dissociate model-based from model-free learning in human learners.

RESULTS

Our results show that, relative to neurotypicals, DD individuals showed an impairment in model-free but not in model-based learning, whereas in ADHD the ability to use both model-free and model-based learning strategies was significantly compromised.

CONCLUSIONS

Thus, learning impairments in DD may be linked to a selective deficit in the ability to form action-outcome associations based on previous history, whereas in ADHD some learning deficits may be related to an incapacity to pursue rewards based on the tasks' structure. Our results indicate how different patterns of learning deficits may underlie different disorders, and how computation-minded experimental approaches can differentiate between them.

A failure of sleep-dependent consolidation of visuoperceptual procedural learning in young adults with ADHD

ADHD has been associated with cortico-striatal dysfunction that may lead to procedural memory abnormalities. Sleep plays a critical role in consolidating procedural memories, and sleep problems are an integral part of the psychopathology of ADHD. This raises the possibility that altered sleep processes characterizing those with ADHD could contribute to their skill-learning impairments. On this basis, the present study tested the hypothesis that young adults with ADHD have altered sleep-dependent procedural memory consolidation. Participants with ADHD and neurotypicals were trained on a visual discrimination task that has been shown to benefit from sleep. Half of the participants were tested after a 12-h break that included nocturnal sleep (sleep condition), whereas the other half were tested after a 12-h daytime break that did not include sleep (wakefulness condition) to assess the specific contribution of sleep to improvement in task performance. Despite having a similar degree of initial learning, participants with ADHD did not improve in the visual discrimination task following a sleep interval compared to neurotypicals, while they were on par with neurotypicals during the wakefulness condition. These findings represent the first demonstration of a failure in sleep-dependent consolidation of procedural learning in young adults with ADHD. Such a failure is likely to disrupt automatic control routines that are normally provided by the non-declarative memory system, thereby increasing the load on attentional resources of individuals with ADHD.

Second Graders' Grapho-Motor Skill Learning and Verbal Learning: The Effects of Socio-Educational Factors

Introduction: Children from low socioeconomic status (SES) families, and in particular, those with a lower level of maternal education, show lower fine-motor skills and lower vocabulary scores than their SES peers whose mothers have a higher level of education. Furthermore, low SES children frequently have difficulties in reading and spelling. These difficulties are attributed to deficits in the acquisition of skills through practice, such as those required for developing visual-motor routines, alongside deficits in the intentional acquisition of knowledge, such as those required in verbal learning. The aim of the current study was to test the effect of two background factors: low maternal education (ME) and risk of reading and spelling difficulties on practice-dependent learning of a motor task and intentional learning of a verbal task in second graders from low SES families. Methods: In 2016/17, 134 low-SES second graders with higher and lower ME (95 typical learners and 39 with reading and spelling difficulties) were assessed with (a) the Invented Letter Task (ILT; a grapho-motor skill learning task) across five time-points (initial- and end-training Day 1; initial- and end-training Day 2; and 2-weeks post-training), as well as an ILT transfer task; and (b) The Rey Auditory Verbal Learning Test (RAVLT; an intentional word-learning task in which a word list is read to children for five learning trials and is recalled 20 min later). Findings: Lower ME was associated with surplus segments in the performance of the motor task and its transfer to a novel condition as well as with lower recall on the verbal task, but not with the learning of both the motor and the verbal task. Having reading and spelling difficulties affected motor-task accuracy and also the way children learned the task, as evidenced by surplus segments at the beginning of Day 2, which were reduced with further practice. Conclusion: Low ME affected overall performance level. Reading and spelling difficulties resulted in atypical learning of the motor task. Future research on practice-dependent learning in the context of children coming from low SES families should focus on subgroups within this heterogeneous population.

Effects of daily training amount on visual motion perceptual learning

Perceptual learning has been widely used to study the plasticity of the visual system in adults. Owing to the belief that practice makes perfect, perceptual learning protocols usually require subjects to practice a task thousands of times over days, even weeks. However, we know very little about the relationship between training amount and behavioral improvement. Here, four groups of subjects underwent motion direction discrimination training over 8 days with 40, 120, 360, or 1080 trials per day. Surprisingly, different daily training amounts induced similar improvement across the four groups, and the similarity lasted for at least 2 weeks. Moreover, the group with 40 training trials per day showed more learning transfer from the trained direction to the untrained directions than the group with 1080 training trials per day immediately after training and 2 weeks later. These findings suggest that perceptual learning of motion direction discrimination is not always dependent on the daily training amount and less training leads to more transfer.

ADHD 24/7: Circadian clock genes, chronotherapy and sleep/wake cycle insufficiencies in ADHD

Objectives: The current paper addresses the evidence for circadian clock characteristics associated with attention-deficit hyperactivity disorder (ADHD), and possible therapeutic approaches based on chronomodulation through bright light (BL) therapy.Methods: We review the data reported in ADHD on genetic risk factors for phase-delayed circadian rhythms and on the role of photic input in circadian re-alignment.Results: Single nucleotide polymorphisms in circadian genes were recently associated with core ADHD symptoms, increased evening-orientation and frequent sleep problems. Additionally, alterations in exposure and response to photic input may underlie circadian problems in ADHD. BL therapy was shown to be effective for re-alignment of circadian physiology toward morningness, reducing sleep disturbances and bringing overall improvement in ADHD symptoms. The susceptibility of the circadian system to phase shift by timed BL exposure may have broad cost-effective potential implications for the treatment of ADHD.Conclusions: We conclude that further research of circadian function in ADHD should focus on detection of genetic markers (e.g., using human skin fibroblasts) and development of BL-based therapeutic interventions.

Multi-Source Interference Task paradigm to enhance automatic and controlled processes in ADHD

BACKGROUND

The role of automatic and controlled processes in children with Attention deficit hyperactivity disorder (ADHD) has recently been debated. Most theories on ADHD assume that core deficits are related to controlled processes and executive function.

AIMS

The main aim of the present study is to examine automatic and controlled attention in children with ADHD, compared to TD subjects.

METHODS AND PROCEDURES

Twenty ADHD-I children, 20 with ADHD-C and 20 typical developing children performed the Block-Formed Multi-Source Interference Task (MSIT) both in incongruent and congruent conditions.

OUTCOME AND RESULTS

Results show that clinical groups had a poorer performance than the TD group in both conditions.

CONCLUSIONS AND IMPLICATIONS

This study demonstrated that children with ADHD exhibit a deficit both in automatic and controlled processes.

Sleep and motor sequence learning consolidation in former iron deficient anemic adolescents

BACKGROUND

Iron deficiency is the most prevalent micronutrient deficiency worldwide. There is evidence that iron deficiency produces alterations in the developing brain, eventually leading to long-lasting effects on various cognitive functions.

METHODS

Here, we investigated motor learning and its consolidation after sleep in adolescents who sustained iron deficiency anemia (IDA) in infancy, compared to healthy controls, in the context of a long-term follow-up Chilean research project. Fifty-three adolescents who formerly had iron deficiency anemia as infants and 40 control adolescents practiced a sequential motor finger tapping task, before and after a night of sleep. Performance was measured at the end of learning, 30 min later (boost effect), and the next morning.

RESULTS

Revealed slower learning in subjects with infant iron deficiency anemia than control subjects, followed by a proportionally similar performance boost at 30 min. Performance remained stable overnight in healthy controls but further improved in infant IDA adolescents, suggesting a beneficial effect of post-training sleep on the consolidation of incompletely learned motor skills. In particular, overnight gains in performance were observed in female, but not male infant iron deficiency anemic subjects, suggesting a gender effect.

CONCLUSIONS

Our results indicate long-lasting motor learning deficits in infant IDA adolescents and provide support to the hypothesis that post-training sleep might, to some extent, compensate for hampered motor learning during wakefulness.

Challenges & Issues: Evidence-Based Clinical Skills Teaching and Learning: What Do We Really Know?

The recent programmatic focus on skills development in veterinary medicine means that many programs are devoting increased time to formal clinical skills teaching. This expansion makes it essential that we use the time as effectively as possible. This review examines current practices and veterinary training principles using the broader field of evidence-based motor skills learning as a lens. In many areas, current practices may be hindering learning. Proposed practices include using videos and discussions for pre-laboratory training, focusing on a single complex skill at a time, using more near-peer instructors rather than faculty, including assessments in each teaching or practice session, and encouraging supervised distributed practice by incorporating practice sessions into the formal curriculum. Ensuring mastery of a few core skills rather than exposure to many may be the new goal. Further research is urgently needed on block versus spiral curricula, optimum instructor-to-student ratios, learning and practice schedules, hours required for proficiency, and the benefits of exercise on motor skills learning.

Feedback Timing Modulates Probabilistic Learning in Adults with ADHD

Attention deficit hyperactivity disorder (ADHD) has been associated primarily with executive function deficits. Emerging findings suggest, however, that procedural learning may be compromised as well. To this effect, we recently showed that feedback-based procedural learning is selectively impaired in ADHD, results that coincide with dopaminergic alterations associated with ADHD. Key questions, however, remain unresolved, among which are the learning conditions that may improve procedural learning in ADHD. Here we examined feedback-based probabilistic learning during conditions that engage procedural and declarative learning systems to different degrees, depending on feedback timing. ADHD and control participants carried out a probabilistic learning task in which they were required to learn to associate between cues and outcomes, where outcomes were presented either immediately or with a short/long delays. Whereas performance in probabilistic learning in ADHD participants was comparable to controls in delayed feedback conditions, during both learning and test phases, their performance diminished when feedback was immediate. Furthermore, ADHD symptom severity was negatively correlated with the ability to learn from immediate feedback. These results suggest that feedback-based probabilistic learning can be improved in ADHD, provided appropriate conditions. By shifting the load from midbrain/striatal systems to declarative memory mechanisms, behavioral performance in ADHD populations can be remediated.

Atypical Within-Session Motor Procedural Learning after Traumatic Brain Injury but Well-Preserved Between-Session Procedural Memory Consolidation

Using the finger-to-thumb opposition sequence (FOS) learning task, we characterized motor skill learning in sub-acute patients hospitalized for rehabilitation following traumatic brain injury (TBI). Ten patients (Trained TBI) and 11 healthy participants (Trained Healthy) were trained using a multi-session protocol: a single session was afforded in the first week of the study, and four daily sessions were afforded during the second week. Intensity of practice was adapted to patients. Performance speed and accuracy were tested before and after each session. Retention was tested 1 month later. Ten patients (Control TBI) had no FOS training and were tested only at the beginning and the end of the 6 week period. Although baseline performance on the FOS was very slow, all three phases of skill learning found in healthy adults (acquisition, between-session consolidation gains, and long-term retention) could be identified in patients with TBI. However, their time-course of learning was atypical. The Trained TBI group improved in speed about double the spontaneous improvements observed in the Control TBI group, with no speed-accuracy tradeoff. Normalized to their initial performance on the FOS, the gains accrued by the Trained TBI group after a first training were comparable to those accrued by healthy adults. Only during the second week with daily training, the rate of improvement of the Trained TBI group lagged behind that of the Trained Healthy group, due to increasing within-sessions losses in performance speed; no such losses were found in healthy participants. The Functional Independence Measure scores at the start of the study correlated with the total gains attained at the end of the study; no correlations were found with severity of injury or explicit memory impairments. Despite within-sessions losses in performance, which we propose reflect cognitive fatigue, training resulted in robust overall learning and long-term retention in patients with moderate-severe TBI. Given that the gains in performance evolved mainly between sessions, as delayed, offline, gains, our results suggest that memory consolidation processes can be effectively engaged in patients with TBI. However, practice protocols and schedules may need to be optimized to better engage the potential for long-term plasticity in these patients.

Distributed Training Enhances Implicit Sequence Acquisition in Children With Specific Language Impairment

PURPOSE

This study explored the effects of 2 different training structures on the implicit acquisition of a sequence in a serial reaction time (SRT) task in children with and without specific language impairment (SLI).

METHOD

All of the children underwent 3 training sessions, followed by a retention session 2 weeks after the last session. In the massed-training condition, the 3 training sessions were in immediate succession on 1 day, whereas in the distributed-training condition, the 3 training sessions were spread over a 1-week period in an expanding schedule format.

RESULTS

Statistical analyses showed that the children with normal language were unaffected by the training conditions, performing the SRT task similarly in both training conditions. The children with SLI, however, were affected by the training structure, performing the SRT task better when the training sessions were spaced over time rather than clustered on 1 day.

CONCLUSION

This study demonstrated that although intensive training does not increase learning in children with SLI, distributing training sessions over time does increase learning. The implications of these results on the learning abilities of children with SLI are discussed, as are the mechanisms involved in massed versus distributed learning.

Feedback-based probabilistic category learning is selectively impaired in attention/hyperactivity deficit disorder

Although Attention-Deficit Hyperactivity Disorder (ADHD) is closely linked to executive function deficits, it has recently been attributed to procedural learning impairments that are quite distinct from the former. These observations challenge the ability of the executive function framework solely to account for the diverse range of symptoms observed in ADHD. A recent neurocomputational model emphasizes the role of striatal dopamine (DA) in explaining ADHD's broad range of deficits, but the link between this model and procedural learning impairments remains unclear. Significantly, feedback-based procedural learning is hypothesized to be disrupted in ADHD because of the involvement of striatal DA in this type of learning. In order to test this assumption, we employed two variants of a probabilistic category learning task known from the neuropsychological literature. Feedback-based (FB) and paired associate-based (PA) probabilistic category learning were employed in a non-medicated sample of ADHD participants and neurotypical participants. In the FB task, participants learned associations between cues and outcomes initially by guessing and subsequently through feedback indicating the correctness of the response. In the PA learning task, participants viewed the cue and its associated outcome simultaneously without receiving an overt response or corrective feedback. In both tasks, participants were trained across 150 trials. Learning was assessed in a subsequent test without a presentation of the outcome or corrective feedback. Results revealed an interesting disassociation in which ADHD participants performed as well as control participants in the PA task, but were impaired compared with the controls in the FB task. The learning curve during FB training differed between the two groups. Taken together, these results suggest that the ability to incrementally learn by feedback is selectively disrupted in ADHD participants. These results are discussed in relation to both the ADHD dopaminergic dysfunction model and recent findings implicating procedural learning impairments in those with ADHD.

Procedural Memory Consolidation in Attention-Deficit/Hyperactivity Disorder Is Promoted by Scheduling of Practice to Evening Hours

In young adults without attention-deficit/hyperactivity disorder (ADHD) training on a novel movement sequence results not only in large within-session (online) gains in task performance but also in additional (delayed, off-line) gains in the performance, expressed after an interval of sleep. In contrast, young people with ADHD, given an identical practice, were shown to improve online but expressed much smaller delayed gains overnight. As delayed gains in performance are taken to reflect procedural ("how to") memory consolidation processes, this may explain skill learning deficits in persons with ADHD. However, motor training is usually provided in morning sessions, and, given that persons with ADHD are often evening types, chronobiological constraints may constitute a hidden factor. Here, we tested the hypothesis that evening training, compared to morning training, would result in larger overnight consolidation gains following practice on a novel motor task in young women with ADHD. Participants with (N = 25) and without (N = 24) ADHD were given training on a finger opposition sequence tapping task, either in the morning or at evening. Performance was assessed before and immediately after training, overnight, and at 2 weeks post-training. Individuals with ADHD reported a general preference for evening hours. Evening training was equally effective in participants with and without ADHD, both groups showing robust consolidation gains in task performance overnight. However, the ability to express delayed gains overnight was significantly reduced in participants with ADHD if trained in the morning. Typical peers were as effective in expressing overnight consolidation phase gains irrespective of the time-of-day wherein the training session was afforded. Nevertheless, even after morning training, participants with ADHD fully retained the gains acquired within the first 24 h over an interval of about 2 weeks. Our results suggest that procedural memory consolidation processes are extant and effective in ADHD, but require that specific biobehavioral conditions be met. The affordance of training in the evening hours can relax some of the constraints on these processes in ADHD. The current results are in line with the notion that the control of what is to be retained in procedural memory is atypical or more stringent in ADHD.

Motor memory consolidation processes in young female adults with ADHD may be less susceptible to interference

Young adults with Attention Deficit Hyperactivity Disorder (ADHD) may have an atypical procedural ("how to") memory consolidation phase, after practicing a movement sequence, with smaller gains in speed and some costs in accuracy, compared to typical peers, at 24h post-training. Here we tested the susceptibility of performance gains retained after motor practice by young female adults with (N=16) and without (N=16) ADHD to post-training interference. Participants were trained on the finger-to-thumb opposition sequence learning task with performance speed and accuracy recorded before training, immediately after, and at 24h post-training. Two hour after the initial training, participants practiced a second, similarly constructed but differently ordered sequence of movements. Typical young adults showed a significant interference effect, with only the performance of the second sequence showing robust gains in speed, with no costs in accuracy, in the 24h post-training consolidation phase. Participants with ADHD showed only small additional speed gains in the post-training consolidation phase but for both sequences. Altogether these results suggest that motor memory consolidation processes in young adults with ADHD may be less susceptible to interference compared to typical peers.