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Son HM, Calub CA, Fan B, Dixon JF, Rezaei S, Borden J, Schweitzer JB, Liu X. A quantitative analysis of fidgeting in ADHD and its relation to performance and sustained attention on a cognitive task. Front Psychiatry 2024; 15:1394096. [PMID: 39011341 PMCID: PMC11246969 DOI: 10.3389/fpsyt.2024.1394096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/31/2024] [Indexed: 07/17/2024] Open
Abstract
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.
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Affiliation(s)
- Ha Min Son
- Department of Computer Science, University of California, Davis, Davis, CA, United States
| | - Catrina Andaya Calub
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, United States
- MIND Institute, University of California, Davis, Sacramento, CA, United States
| | - Boyang Fan
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, United States
- MIND Institute, University of California, Davis, Sacramento, CA, United States
| | - J Faye Dixon
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, United States
- MIND Institute, University of California, Davis, Sacramento, CA, United States
| | - Shahbaz Rezaei
- Department of Computer Science, University of California, Davis, Davis, CA, United States
| | - Jared Borden
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, United States
- MIND Institute, University of California, Davis, Sacramento, CA, United States
| | - Julie B Schweitzer
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, United States
- MIND Institute, University of California, Davis, Sacramento, CA, United States
| | - Xin Liu
- Department of Computer Science, University of California, Davis, Davis, CA, United States
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Johnsen KH, Kvitland LR, Sollie H, Reiestad M, Jonsbu E, Hagen K, Weidle B. Is the Conners' continuous performance test helpful for assessing attention deficit hyperactivity disorder in a clinical setting? Nord J Psychiatry 2024; 78:120-127. [PMID: 37971369 DOI: 10.1080/08039488.2023.2279640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Despite lacking validation for Norwegian populations, the Conners Continuous Performance Test II (CCPT-II) is applied to almost one-third of children receiving an ADHD diagnosis. However, evidence of the CCPT-II's ability to differentiate between children with and without ADHD is contradictory. Thus, this study examines how CCPT-II results correlate with ADHD symptoms reported by mothers and teachers in a sample representing ordinary child and adolescent mental health services and explores the extent to which the CCPT-II influences the diagnostic result. METHODS Correlations between CCPT-II results and ADHD Rating Scale scores and a clinical diagnosis of ADHD were analysed in children aged 6-15 years (N = 69) referred to a child and adolescent psychiatric outpatient clinic. RESULTS Total ADHD symptom scores rated by mothers correlated with hit reaction time (HRT) block change (.260), HRT inter-stimulus interval (ISI) change (.264) and CCPT-II overall index (.263), while hyperactivity subscale scores correlated with omissions (.285), HRT (.414) and variability (.400). In teachers' ratings, total ADHD and both subscale scores correlated with commissions (.280-.382), while hyperactivity scores correlated with variability (.265). A higher number of commissions was the only significant difference in CCPT-II performance between children diagnosed with and children without ADHD. CONCLUSIONS Correlations between CCPT-II results and ADHD symptoms were all small to moderate. As such, CCPT-II results should be interpreted with caution, because they correspond to a limited degree with other sources of information.
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Affiliation(s)
| | - Levi Rostad Kvitland
- Regional Centre for Child and Youth Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Child and Adolescent Psychiatry, St. Olav's University Hospital, Trondheim, Norway
| | - Henrik Sollie
- Department of Mental Health, Kristiansund Hospital, Trondheim, Norway
| | - Magnus Reiestad
- Møre and Romsdal Hospital Trust, Department of Neurology, Molde Hospital, Norway
| | - Egil Jonsbu
- Department Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Mental Health, Møre og Romsdal Hospital Trust, Molde Hospital, Norway
| | - Kristen Hagen
- Department Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Mental Health, Møre og Romsdal Hospital Trust, Molde Hospital, Norway
- Bergen Centre for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
| | - Bernhard Weidle
- Regional Centre for Child and Youth Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Child and Adolescent Psychiatry, St. Olav's University Hospital, Trondheim, Norway
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Chitsabesan P, Hall CL, Carter LA, Reeves M, Mohammed V, Beresford B, Young S, Kraam A, Trowse S, Wilkinson-Cunningham L, Lennox C. Using an objective computer task (QbTest) to aid the identification of attention deficit hyperactivity disorder (ADHD) in the Children and Young People Secure Estate (CYPSE): a feasibility randomised controlled trial. BMJ Open 2022; 12:e064951. [PMID: 36526320 PMCID: PMC9764651 DOI: 10.1136/bmjopen-2022-064951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES QbTest has been shown to improve time to decision/diagnosis for young people with attention deficit hyperactivity disorder (ADHD). The aim was to assess the feasibility of QbTest for young people in prison. DESIGN Single-centre feasibility randomised controlled trial (RCT), with 1:1 allocation. Concealed random allocation using an online pseudorandom list with random permuted blocks of varying sizes. SETTING One Young Offenders Institution in England. PARTICIPANTS 355 young people aged 15-18 years displaying possible symptoms of ADHD were assessed for eligibility, 69 were eligible to take part and 60 were randomised. INTERVENTION QbTest-a computer task measuring attention, activity and impulsivity. MAIN OUTCOME MEASURES Eligibility, recruitment and retention rates and acceptability of randomisation and trial participation. RESULTS Of the 355 young people assessed for eligibility, 69 were eligible and 60 were randomised (n=30 QbTest plus usual care; n=30 usual care alone). The study achieved the specified recruitment target. Trial participation and randomisation were deemed acceptable by the majority of participants. 78% of young people were followed up at 3 months, but only 32% at 6 months, although this was also affected by COVID-19 restrictions. Secondary outcomes were mixed. Participants including clinical staff were mostly supportive of the study and QbTest; however, some young people found QbTest hard and there were issues with implementation of the ADHD care pathway. There were no serious adverse events secondary to the study or intervention and no one was withdrawn from the study due to an adverse event. CONCLUSIONS With adaptations, a fully powered RCT may be achievable to evaluate the effectiveness of QbTest in the assessment of ADHD in the Children and Young People Secure Estate, with time to decision (days) as the primary outcome measure. However, further programme developmental work is required to address some of the challenges highlighted prior to a larger trial. TRIAL REGISTRATION NUMBER ISRCTN17402196.
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Affiliation(s)
- Prathiba Chitsabesan
- Children and Young People's Research Unit, Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | - Charlotte Lucy Hall
- Psychiatry, Institute of Mental Health, NIHR CLAHRC-East Midlands, Nottingham, UK
| | - Lesley-Anne Carter
- Centre for Biostatistics, Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
| | - Mindy Reeves
- Medical School, The University of Manchester, Manchester, UK
| | - Vaseem Mohammed
- Medical School, The University of Manchester, Manchester, UK
| | | | - Susan Young
- Department of Clinical and Forensic Psychology, Psychology ServicesLimited, London, UK
- Department of Psychology, University of Reykjavik, Reykjavik, Iceland
| | - Abdullah Kraam
- Children and Adolescent Mental Health, Rotherham Doncaster and South Humber Mental Health NHS Foundation Trust, Doncaster, UK
| | - Sally Trowse
- Child and Adolescent Mental Health Service, Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | | | - Charlotte Lennox
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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Buitelaar J, Bölte S, Brandeis D, Caye A, Christmann N, Cortese S, Coghill D, Faraone SV, Franke B, Gleitz M, Greven CU, Kooij S, Leffa DT, Rommelse N, Newcorn JH, Polanczyk GV, Rohde LA, Simonoff E, Stein M, Vitiello B, Yazgan Y, Roesler M, Doepfner M, Banaschewski T. Toward Precision Medicine in ADHD. Front Behav Neurosci 2022; 16:900981. [PMID: 35874653 PMCID: PMC9299434 DOI: 10.3389/fnbeh.2022.900981] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/16/2022] [Indexed: 11/17/2022] Open
Abstract
Attention-Deficit Hyperactivity Disorder (ADHD) is a complex and heterogeneous neurodevelopmental condition for which curative treatments are lacking. Whilst pharmacological treatments are generally effective and safe, there is considerable inter-individual variability among patients regarding treatment response, required dose, and tolerability. Many of the non-pharmacological treatments, which are preferred to drug-treatment by some patients, either lack efficacy for core symptoms or are associated with small effect sizes. No evidence-based decision tools are currently available to allocate pharmacological or psychosocial treatments based on the patient's clinical, environmental, cognitive, genetic, or biological characteristics. We systematically reviewed potential biomarkers that may help in diagnosing ADHD and/or stratifying ADHD into more homogeneous subgroups and/or predict clinical course, treatment response, and long-term outcome across the lifespan. Most work involved exploratory studies with cognitive, actigraphic and EEG diagnostic markers to predict ADHD, along with relatively few studies exploring markers to subtype ADHD and predict response to treatment. There is a critical need for multisite prospective carefully designed experimentally controlled or observational studies to identify biomarkers that index inter-individual variability and/or predict treatment response.
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Affiliation(s)
- Jan Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands.,Karakter Child and Adolescent Psychiatry University Center, Nijmegen, Netherlands
| | - Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden.,Child and Adolescent Psychiatry, Stockholm Health Care Services, Stockholm, Sweden.,Curtin Autism Research Group, School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, WA, Australia
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.,Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Arthur Caye
- Department of Psychiatry, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
| | - Nina Christmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Samuele Cortese
- Centre for Innovation in Mental Health, Academic Unit of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom.,Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,Solent National Health System Trust, Southampton, United Kingdom.,Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, United States.,Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - David Coghill
- Departments of Paediatrics and Psychiatry, Royal Children's Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Stephen V Faraone
- Departments of Psychiatry, Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, New York, NY, United States
| | - Barbara Franke
- Departments of Human Genetics and Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Markus Gleitz
- Medice Arzneimittel Pütter GmbH & Co. KG, Iserlohn, Germany
| | - Corina U Greven
- Karakter Child and Adolescent Psychiatry University Center, Nijmegen, Netherlands.,Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands.,King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Sandra Kooij
- Amsterdam University Medical Center, Location VUMc, Amsterdam, Netherlands.,PsyQ, Expertise Center Adult ADHD, The Hague, Netherlands
| | - Douglas Teixeira Leffa
- Department of Psychiatry, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
| | - Nanda Rommelse
- Karakter Child and Adolescent Psychiatry University Center, Nijmegen, Netherlands.,Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jeffrey H Newcorn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Guilherme V Polanczyk
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Luis Augusto Rohde
- National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil.,ADHD Outpatient Program and Developmental Psychiatry Program, Hospital de Clinica de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Emily Simonoff
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Mark Stein
- Department of Psychiatry and Behavioral Sciences, Seattle, WA, United States
| | - Benedetto Vitiello
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Turin, Italy.,Department of Public Health, Johns Hopkins University, Baltimore, MA, United States
| | - Yanki Yazgan
- GuzelGunler Clinic, Istanbul, Turkey.,Yale Child Study Center, New Haven, CT, United States
| | - Michael Roesler
- Institute for Forensic Psychology and Psychiatry, Neurocenter, Saarland, Germany
| | - Manfred Doepfner
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty of the University of Cologne, Cologne, Germany.,School for Child and Adolescent Cognitive Behavioural Therapy, University Hospital of Cologne, Cologne, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
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Wang FH, Sun LY, Cui XM, Zhao HD, Yang LF, Wang Z, Shi TK. Comparative efficacy of targeted structural patterns of electroencephalography neurofeedback in children with inattentive or combined attention deficit hyperactivity disorder. Brain Behav 2022; 12:e2572. [PMID: 35462456 PMCID: PMC9226819 DOI: 10.1002/brb3.2572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/08/2022] [Accepted: 03/20/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate and compare the effects of three courses of different structural patterns of electroencephalography neurofeedback on predominantly inattentive attention deficit hyperactivity disorder (ADHD-PI) and combined ADHD (ADHD-CT). METHODS Thirty-eight ADHD-PI and ADHD-CT children were selected and completed three courses of different structural patterns of electroencephalography neurofeedback according to their ADHD type. Before and after each course, relative power value of electroencephalography, including θ, β, α, SMR and their ratios (θ/β, θ/α), and eighteen integrated visual and auditory continuous performance test (IVA/CPT) quotients were obtained and compared. Data were analyzed by SPSS software, and p < .05 was considered statistically significant. RESULTS After one course, θ, three IVA/CPT quotients in both types and two comprehensive quotients in ADHD-CT changed significantly (all p < .05). After two courses, θ/α, θ/β and five IVA/CPT quotients in both types, θ and α in ADHD-PI, four comprehensive quotients, and four respond control quotients in ADHD-CT varied significantly compared to before treatment and after one course (all p < .05). After three courses, α, β, θ, θ/α, θ/β and ten IVA/CPT quotients in both types changed significantly compared to before treatment and after one course (all p < .05). In addition, six IVA/CPT quotients in both types after three courses were significantly higher than those after two courses (all p < .05). CONCLUSION Different structural patterns of electroencephalography neurofeedback targeted for ADHD-CT and ADHD-PI were both effective and feasible. Three courses of EEG neurofeedback were most effective.
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Affiliation(s)
- Feng-Hua Wang
- School of Medicine, Jiaxing University, Jiaxing, China
| | - Li-Yan Sun
- School of Medicine, Jiaxing University, Jiaxing, China
| | - Xiao-Mei Cui
- Women's and Children's Hospital Affiliated to Jiaxing University, Jiaxing, China
| | | | - Ling-Fei Yang
- School of Medicine, Jiaxing University, Jiaxing, China
| | - Zheng Wang
- School of Medicine, Jiaxing University, Jiaxing, China
| | - Tong-Kun Shi
- School of Medicine, Jiaxing University, Jiaxing, China
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Montaleão Brum Alves R, Ferreira da Silva M, Assis Schmitz É, Juarez Alencar A. Trends, Limits, and Challenges of Computer Technologies in Attention Deficit Hyperactivity Disorder Diagnosis and Treatment. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2021; 25:14-26. [PMID: 34569852 DOI: 10.1089/cyber.2020.0867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) is a neurobiological condition that appears during an individual's childhood and may follow her/him for life. The research objective was to understand better how and which computer technologies have been applied to support ADHD diagnosis and treatment. The research used the systematic literature review method: a rigorous, verifiable, and repeatable approach that follows well-defined steps. Six well-known academic data sources have been consulted, including search engines and bibliographic databases, from technology and health care areas. After a rigorous research protocol, 1,239 articles were analyzed. For the diagnosis, the use of machine learning techniques was verified in 61 percent of the articles. Neurofeedback was ranked second with 9.3 percent participation, followed by serious games and eye tracking with 5.6 percent each. For the treatment, neurofeedback was present in 50 percent of the articles, whereas some studies combined both approaches, accounting for 31 percent of the total. Nine percent of the articles reported remote assistance technology, whereas another 9 percent have used virtual reality. By highlighting the leading computer technologies used, their applications, results, and challenges, this literature review breaks ground for further investigations. Moreover, the study highlighted the lack of consensus on ADHD biomarkers. The approaches using machine learning call attention to the probable occurrence of overfitting in several studies, thus demonstrating limitations of this technology on small-sized bases. This research also presented the convergence of evidence from different studies on the persistence of long-term effects of using neurofeedback in treating ADHD.
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Evaluating Therapeutic Effects of ADHD Medication Objectively by Movement Quantification with a Video-Based Skeleton Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179363. [PMID: 34501952 PMCID: PMC8431492 DOI: 10.3390/ijerph18179363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 01/14/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is the most common neuropsychiatric disorder in children. Several scales are available to evaluate ADHD therapeutic effects, including the Swanson, Nolan, and Pelham (SNAP) questionnaire, the Vanderbilt ADHD Diagnostic Rating Scale, and the visual analog scale. However, these scales are subjective. In the present study, we proposed an objective and automatic approach for evaluating the therapeutic effects of medication in patients with (ADHD). The approach involved using movement quantification of patients’ skeletons detected automatically with OpenPose in outpatient videos. Eleven skeleton parameter series were calculated from the detected skeleton sequence, and the corresponding 33 features were extracted using autocorrelation and variance analysis. This study enrolled 25 patients with ADHD. The outpatient videos were recorded before and after medication treatment. Statistical analysis indicated that four features corresponding to the first autocorrelation coefficients of the original series of four skeleton parameters and 11 features each corresponding to the first autocorrelation coefficients of the differenced series and the averaged variances of the original series of 11 skeleton parameters significantly decreased after the use of methylphenidate, an ADHD medication. The results revealed that the proposed approach can support physicians as an objective and automatic tool for evaluating the therapeutic effects of medication on patients with ADHD.
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Brandt V, Patalay P, Kerner Auch Koerner J. Predicting ADHD symptoms and diagnosis at age 14 from objective activity levels at age 7 in a large UK cohort. Eur Child Adolesc Psychiatry 2021; 30:877-884. [PMID: 32506264 PMCID: PMC8140967 DOI: 10.1007/s00787-020-01566-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 05/01/2020] [Indexed: 12/16/2022]
Abstract
Hyperactivity is one of the three core symptoms in children with attention deficit hyperactivity disorder (ADHD). Diagnosing ADHD typically involves self-report, third party report and observations. Objective activity data can make a valuable contribution to the diagnostic process. Small actigraphy studies in clinical samples have shown that children with ADHD move more than children without ADHD. However, differences in physical activity between children with and without ADHD have not been assessed in large community samples or longitudinally. This study used data from the Millennium Cohort Study to test whether symptoms of ADHD (parent-rating Strengths and Difficulties Questionnaire) and ADHD diagnosis at age 14 (reported by parents) could be predicted from objective activity data (measured with actigraphs) at age 7 in N = 6675 children (final N = 5251). Regressions showed that less sedentary behavior at age 7 predicted more ADHD symptoms at age 14 (β = - 0.002, CI - 0.004 to - 0.001). The result remained significant when controlled for ADHD symptoms at age 7, sex, BMI, month of birth, SES and ethnicity (β = - 0.001, CI - 0.003 to - 0.0003). ADHD diagnosis at age 14 was also significantly predicted by less sedentary behavior at age 7 (β = - 0.008). Our findings show that symptoms of ADHD can be predicted by objective activity data 5 years in advance and suggest that actigraphy could be a useful instrument aiding an ADHD diagnosis. Interestingly, the results indicate that the key difference between children with and without ADHD lies in reduced sedentary activity, i.e., times of rest.
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Affiliation(s)
- Valerie Brandt
- Department of Psychology, Center for Innovation in Mental Health, University of Southampton, Southampton, Hampshire, UK
| | - Praveetha Patalay
- Centre for Longitudinal Studies, Institute of Social Research, UCL, London, UK
- Faculty of Population Health Sciences, MRC Unit of Lifelong Health and Ageing, UCL, London, UK
| | - Julia Kerner Auch Koerner
- Educational Psychology, Helmut-Schmidt-University Hamburg, Holstenhofweg 85, 22043, Hamburg, Germany.
- Center for Individual Development and Adaptive Education of Children at Risk (IDeA), Frankfurt, Germany.
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Hollis C, Hall CL, Guo B, James M, Boadu J, Groom MJ, Brown N, Kaylor-Hughes C, Moldavsky M, Valentine AZ, Walker GM, Daley D, Sayal K, Morriss R. The impact of a computerised test of attention and activity (QbTest) on diagnostic decision-making in children and young people with suspected attention deficit hyperactivity disorder: single-blind randomised controlled trial. J Child Psychol Psychiatry 2018; 59:1298-1308. [PMID: 29700813 PMCID: PMC6124643 DOI: 10.1111/jcpp.12921] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Diagnosis of attention deficit hyperactivity disorder (ADHD) relies on subjective methods which can lead to diagnostic uncertainty and delay. This trial evaluated the impact of providing a computerised test of attention and activity (QbTest) report on the speed and accuracy of diagnostic decision-making in children with suspected ADHD. METHODS Randomised, parallel, single-blind controlled trial in mental health and community paediatric clinics in England. Participants were 6-17 years-old and referred for ADHD diagnostic assessment; all underwent assessment-as-usual, plus QbTest. Participants and their clinician were randomised to either receive the QbTest report immediately (QbOpen group) or the report was withheld (QbBlind group). The primary outcome was number of consultations until a diagnostic decision confirming/excluding ADHD within 6-months from baseline. Health economic cost-effectiveness and cost utility analysis was conducted. Assessing QbTest Utility in ADHD: A Randomised Controlled Trial was registered at ClinicalTrials.gov (https://clinicaltrials.gov/ct2/show/NCT02209116). RESULTS One hundred and thirty-two participants were randomised to QbOpen group (123 analysed) and 135 to QbBlind group (127 analysed). Clinicians with access to the QbTest report (QbOpen) were more likely to reach a diagnostic decision about ADHD (hazard ratio 1.44, 95% CI 1.04-2.01). At 6-months, 76% of those with a QbTest report had received a diagnostic decision, compared with 50% without. QbTest reduced appointment length by 15% (time ratio 0.85, 95% CI 0.77-0.93), increased clinicians' confidence in their diagnostic decisions (odds ratio 1.77, 95% CI 1.09-2.89) and doubled the likelihood of excluding ADHD. There was no difference in diagnostic accuracy. Health economic analysis showed a position of strict dominance; however, cost savings were small suggesting that the impact of providing the QbTest report within this trial can best be viewed as 'cost neutral'. CONCLUSIONS QbTest may increase the efficiency of ADHD assessment pathway allowing greater patient throughput with clinicians reaching diagnostic decisions faster without compromising diagnostic accuracy.
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Affiliation(s)
- Chris Hollis
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Charlotte L Hall
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Boliang Guo
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Marilyn James
- Division of Rehabilitation and Ageing, School of Medicine, B132 Queens Medical Centre, University Of Nottingham, Nottingham, UK
| | - Janet Boadu
- Division of Rehabilitation and Ageing, School of Medicine, B132 Queens Medical Centre, University Of Nottingham, Nottingham, UK
| | - Madeleine J Groom
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Nikki Brown
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Catherine Kaylor-Hughes
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Maria Moldavsky
- Nottinghamshire Healthcare NHS Foundation Trust, West Nottinghamshire Community Team, Mansfield, UK
| | - Althea Z Valentine
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Gemma M Walker
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - David Daley
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Kapil Sayal
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Richard Morriss
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
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10
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Time Effects on Resting EEG in Children With/Without AD/HD. Brain Topogr 2018; 32:286-294. [DOI: 10.1007/s10548-018-0690-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 11/27/2018] [Indexed: 11/26/2022]
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11
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Delgado-Gomez D, Peñuelas-Calvo I, Masó-Besga AE, Vallejo-Oñate S, Baltasar Tello I, Arrua Duarte E, Vera Varela MC, Carballo J, Baca-García E. Microsoft Kinect-based Continuous Performance Test: An Objective Attention Deficit Hyperactivity Disorder Assessment. J Med Internet Res 2017; 19:e79. [PMID: 28320691 PMCID: PMC5379015 DOI: 10.2196/jmir.6985] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 01/27/2017] [Accepted: 02/06/2017] [Indexed: 11/25/2022] Open
Abstract
Background One of the major challenges in mental medical care is finding out new instruments for an accurate and objective evaluation of the attention deficit hyperactivity disorder (ADHD). Early ADHD identification, severity assessment, and prompt treatment are essential to avoid the negative effects associated with this mental condition. Objective The aim of our study was to develop a novel ADHD assessment instrument based on Microsoft Kinect, which identifies ADHD cardinal symptoms in order to provide a more accurate evaluation. Methods A group of 30 children, aged 8-12 years (10.3 [SD 1.4]; male 70% [21/30]), who were referred to the Child and Adolescent Psychiatry Unit of the Department of Psychiatry at Fundación Jiménez Díaz Hospital (Madrid, Spain), were included in this study. Children were required to meet the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria of ADHD diagnosis. One of the parents or guardians of the children filled the Spanish version of the Strengths and Weaknesses of ADHD Symptoms and Normal Behavior (SWAN) rating scale used in clinical practice. Each child conducted a Kinect-based continuous performance test (CPT) in which the reaction time (RT), the commission errors, and the time required to complete the reaction (CT) were calculated. The correlations of the 3 predictors, obtained using Kinect methodology, with respect to the scores of the SWAN scale were calculated. Results The RT achieved a correlation of -.11, -.29, and -.37 with respect to the inattention, hyperactivity, and impulsivity factors of the SWAN scale. The correlations of the commission error with respect to these 3 factors were -.03, .01, and .24, respectively. Conclusions Our findings show a relation between the Microsoft Kinect-based version of the CPT and ADHD symptomatology assessed through parental report. Results point out the importance of future research on the development of objective measures for the diagnosis of ADHD among children and adolescents.
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Affiliation(s)
| | | | | | - Silvia Vallejo-Oñate
- Hospital Universitario Fundación Jiménez Díaz, Child and Adolescents Service, Madrid, Spain
| | - Itziar Baltasar Tello
- Hospital Universitario Fundación Jiménez Díaz, Child and Adolescents Service, Madrid, Spain
| | - Elsa Arrua Duarte
- Hospital Universitario Fundación Jiménez Díaz, Child and Adolescents Service, Madrid, Spain
| | | | - Juan Carballo
- Hospital Universitario Gregorio Marañón, Child and Adolescents Service, Madrid, Spain
| | - Enrique Baca-García
- Hospital Universitario Fundación Jiménez Díaz, Child and Adolescents Service, Madrid, Spain.,Columbia University, New York, NY, United States.,IIS-Jimenez Diaz Foundation, Department of Psychiatry, Madrid, Spain.,Universidad Autónoma, Madrid, Spain.,Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain.,Hospital Universitario Infanta Elena, Valdemoro, Madrid, Spain.,Hospital General de Villalba, Villalba, Madrid, Spain.,CIBERSAM, Madrid, Spain
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