Attention-deficit disorder (attention-deficit/ hyperactivity disorder without hyperactivity): a neurobiologically and behaviorally distinct disorder from attention-deficit/hyperactivity disorder (with hyperactivity)

EFL Special Education Teachers' Perspectives: Evaluating Game-Based Learning for ADHD Behavioral Disorders

OBJECTIVE

The purpose of this study was to examine the perspectives of English as a Foreign Language Special Education teachers (EFLSE) regarding game-based learning approaches for addressing behavioral disorders in ADHD patients.

METHOD

The study involved a sample (n = 131) of EFLSE teachers who completed a questionnaire to determine how feasible, acceptable, and helpful they found game-based learning.

RESULTS

The study revealed that EFLSE teachers perceive game-based learning to be a feasible and acceptable method for engaging ADHD students and helping to maintain their attention during game-based learning activities. Nevertheless, implementation and individualized approaches are cited as challenges. Additionally, EFLSE teachers emphasized the benefits of game-based learning, including improved problem-solving, assessment methods, collaboration, and the acquisition of academic skills.

CONCLUSIONS

The study contributes insights for educators, policymakers, and researchers that can support the development of evidence-based interventions offering game-based learning for students with ADHD.

Cross-Sectional Study on the Effect of Bilingualism, Age, Gender, and Family Income on Executive Function Development in a Sample of Lebanese School-Aged Children

This study investigates executive functions (EFs) and selected developmental factors in 120 children aged 6-11 years. By examining inhibition, working memory, and cognitive flexibility, the research evaluates the potential influences of age, gender, bilingualism, and family income on these EF skills. Tests adapted to Lebanese Arabic were used to assess EFs. Results indicate a linear development of inhibition, working memory, and flexibility with age. Gender differences were observed, affecting verbal and visuospatial working memory as well as flexibility. Bilingualism positively impacts EFs, with early bilinguals outperforming late bilinguals. Family income, however, shows no significant effect on EFs.

Assessing Adult ADHD: An Updated Review of Rating Scales for Adult Attention Deficit Hyperactivity Disorder (ADHD)

METHOD

Scholarly articles on adult ADHD between 1996 and 2022 were reviewed using the PRISMA guidelines. ADHD rating scales with multiple citations were selected and their psychometric properties and symptom coverage were analyzed.

RESULTS

Ten rating scales, with sound psychometric properties, were identified. Out of those reviewed two (BADDS and BAARS-IV) load on the inattentive domain of ADHD, while the rest focus on a comprehensive assessment of ADHD. Only one scale (BARRS-IV) incorporates an assessment of functional impairment. Some scales though widely utilized have not been adequately examined for their sensitivity.

CONCLUSIONS

Rating scales are reliable and valid, in the assessment of adult ADHD. We present a review of recent scales, with an expanded focus, to help clinicians make informed decisions on diagnosis, identifying targets and planning interventions accordingly.

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

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

Attention Deficit Hyperactivity Disorder (ADHD) Causes and Diagnosis in Adults: A Review

This article focuses on attention deficit hyperactivity disorder (ADHD) in males of the adult age group, exploring its causes and diagnosis. ADHD is commonly identified in children and teenagers, often leading to academic difficulties. Diagnosing adult ADHD involves evaluating recent symptoms, assessing childhood history, examining functional impairment, obtaining developmental and mental health backgrounds, and ruling out other psychiatric conditions. The diagnostic assessment primarily relies on patient interviews, though input from family members and other sources can be valuable. Men and women show differences in ADHD symptoms and associated neurological conditions, with males more frequently diagnosed with ADHD. Inattention, hyperactivity, and impulsivity are signs of ADHD. The difficulties in identifying adult ADHD and separating it from behavioural problems are covered in the essay. It also explores the various symptoms of ADHD in children and adults and their impact on daily life. The causes of ADHD involve abnormalities in brain structure and function, as well as genetic factors. Treatment options for adult ADHD encompass medication, education, skill training, and psychological counselling. While medications can help manage symptoms, they do not provide a cure. The article concludes by emphasizing the need for a healthy lifestyle alongside therapy and medication to manage ADHD symptoms effectively.

Working Memory-Related Neurofunctional Correlates Associated with the Frontal Lobe in Children with Familial vs. Non-Familial Attention Deficit/Hyperactivity Disorder

Attention deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder with high prevalence, heritability, and heterogeneity. Children with a positive family history of ADHD have a heightened risk of ADHD emergence, persistence, and executive function deficits, with the neural mechanisms having been under investigated. The objective of this study was to investigate working memory-related functional brain activation patterns in children with ADHD (with vs. without positive family histories (ADHD-F vs. ADHD-NF)) and matched typically developing children (TDC). Voxel-based and region of interest analyses were conducted on two-back task-based fMRI data of 362 subjects, including 186, 96, and 80 children in groups of TDC, ADHD-NF, and ADHD-F, respectively. Relative to TDC, both ADHD groups had significantly reduced activation in the left inferior frontal gyrus (IFG). And the ADHD-F group demonstrated a significant positive association of left IFG activation with task reaction time, a negative association of the right IFG with ADHD symptomatology, and a negative association of the IFG activation laterality index with the inattention symptom score. These results suggest that working memory-related functional alterations in bilateral IFGs may play distinct roles in ADHD-F, with the functional underdevelopment of the left IFG significantly informing the onset of ADHD symptoms. Our findings have the potential to assist in tailored diagnoses and targeted interventions in children with ADHD-F.

Mechanisms of cognitive disinhibition explain individual differences in adult attention deficit hyperactivity disorder traits

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) in adults is strongly associated with psychiatric comorbidity and functional impairment. Here, we aimed to use a newly developed online cognitive battery with strong psychometric properties for measuring individual differences in three cognitive mechanisms proposed to underlie ADHD traits in adults: 1) attentional control - the ability to mobilize cognitive resources to stop a prepotent motor response; 2) information sampling/gathering - adequate sampling of information in a stimulus detection task prior to making a decision; and 3) shifting - the ability to adapt behavior in response to positive and negative contingencies.

METHODS

This cross-sectional and correlational study recruited 650 adults (330 males) aged 18-69 years (M = 33.06; MD = 31.00; SD = 10.50), with previously diagnosed ADHD (n = 329) and those from the general community without a history of ADHD (n = 321). Self-report measures of ADHD traits (i.e., inattention/disorganization, impulsivity, hyperactivity) and the cognitive battery were completed online.

RESULTS

Latent class analysis, exploratory structural equation modeling and factor mixture modeling revealed self-reported ADHD traits formed a unidimensional and approximately normally distributed phenotype. Bayesian structural equation modeling demonstrated that all three mechanisms measured by the cognitive battery, explained unique, incremental variance in ADHD traits, with a total of 15.9% explained in the ADHD trait factor.

CONCLUSIONS

Attentional control and shifting, as well as the less researched cognitive process of information gathering, explain individual difference variance in self-reported ADHD traits with potential to yield genetic and neurobiological insights into adult ADHD.

Is the deficit in attention-deficit/hyperactivity disorder a concentration deficit?

Attention-deficit/hyperactivity disorder (ADHD) is comprised of two behavioral clusters of symptoms, inattention and hyperactivity/impulsivity. Numerous studies have attempted to address the underlying neuropsychological mechanism of ADHD. However, there is still no uniform mechanism that can fully explain both inattention and hyperactivity/impulsivity symptoms. This review describes the research findings that have shifted the focus from cognitive selective attention to executive function deficits and notes that the prominence of the attention deficit remains unclear. As ADHD is not consistently explained by cognitive selective attention but rather with cognitive sustained attention/vigilance and executive function deficits, this review suggests that concentration deficit is likely the cause of inattention symptoms. Indeed, considering concentration deficit as the cause of inattention symptoms may better describe the underlying difficulties of maintaining and controlling attention in ADHD. In addition, as concentration, impulsivity, and hyperactivity may share a common cognitive deficit, this shift in focus may help in identifying a single mechanism for all ADHD symptoms.

Evaluating High and Low Heart Rate Variability Response and Neurocognitive Performance in Workers: An Exploratory Study

Heart rate variability (HRV) has the potential to be a predicting factor of cognitive performance. The present research aimed to explore the differences in neurocognitive performance of workers with high HRV and low HRV. A total of 48 white-collar workers and 53 blue-collar workers were assessed. An electrocardiogram was used to obtain HRV data, whereby a 10 min baseline and an active (neuropsychological task) recording were taken. Median splits were performed on data to obtain high- and low-HRV groups. The Cambridge Neuropsychological Test Automated Battery, specifically, the spatial working memory, attention-switching task, rapid visual processing, and spatial span were used. Higher HRV (RMSSD and HF) was linked to better neurocognitive performance measures. Interestingly, the blue- and white-collar groups exhibited different correlations and, in some cases, showed an inverse relationship with the same variables. The differences observed in the present study demonstrate the importance of assessing task-dependent HRV parameters.

Do Language-Related Cognitive Capacities Help Predict Adjustment in Children with Attention-Deficit/Hyperactivity Disorder?

The goal of this paper was to examine the role that language-related cognitive capacities (LRCC) might play in explaining adjustment of 7 to 12 year-old children (M_age = 9.24; SD_age = 0.91) with and without ADHD. The sample was comprised of 178 children with ADHD and 86 typically-developing children (77.3% male; 81.4% White; 9.5% Black; 1.9% Hispanic; 0.8% Asian; 5.7% multiracial; 0.8% did not report race/ethnicity). Using simultaneous regression, we examined whether LRCC accounted for unique variance in achievement, attention problems, oppositional problems, conduct problems, and internalizing, over and above what standard covariates and ADHD diagnostic status could explain. Finally, we examined LRCC as a mediator of the relation between ADHD diagnostic status and these adjustment measures. Results indicated that LRCC significantly predicted 6 of 7 and partially mediated 5 of 7 measures, suggesting that language-related constructs warrant greater attention in diagnosis and treatment of ADHD.

An exploratory analysis of the performance of methylphenidate regimens based on a PKPD model of dopamine and norepinephrine transporter occupancy

Methylphenidate (MPH) is a psychostimulant which inhibits the uptake of dopamine and norepinephrine transporters, DAT and NET, and is mostly used to treat Attention Deficit/Hyperactivity Disorder. The current dose optimization is done through titration, a cumbersome approach for patients. To assess the therapeutic performance of MPH regimens, we introduce an in silico framework composed of (i) a population pharmacokinetic model of MPH, (ii) a pharmacodynamic (PD) model of DAT and NET occupancy, (iii) a therapeutic box delimited by time and DAT occupancy, and (iv) a performance score computation. DAT occupancy data was digitized (n = 152) and described with Emax models. NET occupancy was described with a KPD model. We used this integrative framework to simulate the performance of extended-release (18-99 mg) and tid MPH regimens (25-40 mg). Early blood samples of MPH seem to lead to higher DAT occupancy, consistent with an acute tolerance observed in clinical rating scales. An Emax model with a time-dependent tolerance was fitted to available data to assess the observed clockwise hysteresis. Peak performance is observed at 63 mg. While our analysis does not deny the existence of an acute tolerance, data precision in terms of formulation and sampling times does not allow a definite confirmation of this phenomenon. This work justifies the need for a more systematic collection of DAT and NET occupancy data to further investigate the presence of acute tolerance and assess the impact of low MPH doses on its efficacy.

The brain network underlying attentional blink predicts symptoms of attention deficit hyperactivity disorder in children

Attention deficit hyperactivity disorder (ADHD) is a chronic neuropsychiatric disease that can markedly impair educational, social, and occupational function throughout life. Behavioral deficits may provide clues to the underlying neurological impairments. Children with ADHD exhibit a larger attentional blink (AB) deficit in rapid serial visual presentation (RSVP) tasks than typically developing children, so we examined whether brain connectivity in the neural network associated with AB can predict ADHD symptoms and thus serve as potential biomarkers of the underlying neuropathology. We first employed a connectome-based predictive model analysis of adult resting-state functional magnetic resonance imaging data to identify a distributed brain network for AB. The summed functional connectivity (FC) strength within the AB network reliably predicted individual differences in AB magnitude measured by a classical dual-target RSVP task. Furthermore, the summed FC strength within the AB network predicted individual differences in ADHD Rating Scale scores from an independent dataset of pediatric patients. Our findings suggest that the individual AB network could serve as an applicable neuroimaging-based biomarker of AB deficit and ADHD symptoms.

Epilepsy and Attention Deficit Hyperactivity Disorder: Connection, Chance, and Challenges

Comorbidities are common in children with epilepsy, with nearly half of the patients having at least one comorbidity. Attention deficit hyperactivity disorder (ADHD) is a psychiatric disorder characterized by hyperactivity and inattentiveness level disproportional to the child’s developmental stage. The burden of ADHD in children with epilepsy is high and can adversely affect the patients’ clinical outcomes, psychosocial aspects, and quality of life. Several hypotheses were proposed to explain the high burden of ADHD in childhood epilepsy; the well-established bidirectional connection and shared genetic/non-genetic factors between epilepsy and comorbid ADHD largely rule out the possibility of a chance in this association. Stimulants are effective in children with comorbid ADHD, and the current body of evidence supports their safety within the approved dose. Nonetheless, safety data should be further studied in randomized, double-blinded, placebo-controlled trials. Comorbid ADHD is still under-recognized in clinical practice. Early identification and management of comorbid ADHD are crucial to optimize the prognosis and reduce the risk of adverse long-term neurodevelopmental outcomes. The identification of the shared genetic background of epilepsy and ADHD can open the gate for tailoring treatment options for these patients through precision medicine.

A Qualitative Microanalysis of the Immediate Behavioural Effects of Mindfulness Practices on Students’ Self-Regulation and Attention

The study examined the immediate effects of mindfulness practices on students’ attention and self-regulation during mathematical problem-solving tasks. Participants were 15 4th-grade Finnish students and their teacher. Data were collected during six study sessions of mathematical problem-solving, with and without mindfulness practices. The sessions were video-recorded, and children responded to the Freiburg mindfulness inventory and the cognitive and affective mindfulness scale-revised. A qualitative video micro-analysis focused on coding the observable behaviours related to attention and self-regulation. Self-report instruments were scored and tabulated for comparison. The findings indicate microbehavioural changes indicating positive effects of mindfulness practices on students’ self-regulation, with higher signs of engagement and lower signs of disengagement after mindfulness practices. This study enlightens the use of mindfulness practices in school routines and discusses the impacts of these practices while evidencing that future research on the topic is needed.

Pilot study to explore poor visual searching capabilities in children with ADHD: a tablet-based computerized test battery study

Aim: The frequent visual attention deficiency reported in children with attention-deficit/hyperactivity disorder (ADHD) could represent a relevant biomarker but robust estimates of such cognitive impairment in clinical populations remained challenging. To assess visual attention impairment in children ADHD using a new design tablet-based computerized test battery which allowed objective recording of visual search performances.Methods: Forty-nine children with ADHD and their IQ- and age-matched typically developmental (TD) children were enrolled in the study. Visual attention abilities were estimated by using the computerized modified barrage test developed by Metrisquare. We analyzed the time spent to achieve the whole battery and, the errors and omissions done by each child during each of the three sub-tasks.Results: We observed a significant association between the load of sustained attention requested to perform a sub-task and the numbers of errors and omissions made by the children whatever the group considered. During the most stringent sub-task in term of visual attention engagement, children with ADHD displayed more significant errors and omissions when compared to IQ- and age-matched controls. This effect was not mediated by the time spent to perform the task since we did not report any significant difference between groups.Conclusion: The different performance of the most stringent sub-task observed in children with ADHD could be due to their deficient neural activity in frontal areas responsible of visual endogenous attention needed for difficult visual searching tasks. This cognitive battery could be a useful instrument to estimate visual attention impairment in children with ADHD.HIGHLIGHTSWe assessed if a new design tablet-based computerized test battery would allow objective recording of visual search performances.We observed that children with ADHD made significantly more errors and omissions with respect to age-, sex- matched controls during the most stringent sub-task in terms of visual attention engagementThe tablet-based computerized test battery could be a promising tool to objectively estimate abnormal attention search impairment in ADHD.

Sleep as a protective factor of children's executive functions: A study during COVID-19 confinement

Confinements due to the COVID-19 outbreak affected sleep and mental health of adults, adolescents and children. Already preschool children experienced acutely worsened sleep, yet the possible resulting effects on executive functions remain unexplored. Longitudinally, sleep quality predicts later behavioral-cognitive outcomes. Accordingly, we propose children's sleep behavior as essential for healthy cognitive development. By using the COVID-19 confinement as an observational-experimental intervention, we tested whether worsened children's sleep affects executive functions outcomes 6 months downstream. We hypothesized that acutely increased night awakenings and sleep latency relate to reduced later executive functions. With an online survey during the acute confinement phase we analyzed sleep behavior in 45 children (36-72 months). A first survey referred to the (retrospective) time before and (acute) situation during confinement, and a follow-up survey assessed executive functions 6 months later (6 months retrospectively). Indeed, acutely increased nighttime awakenings related to reduced inhibition at FOLLOW-UP. Associations were specific to the confinement-induced sleep-change and not the sleep behavior before confinement. These findings highlight that specifically acute changes of children's nighttime sleep during sensitive periods are associated with behavioral outcome consequences. This aligns with observations in animals that inducing poor sleep during developmental periods affects later brain function.

The ventrolateral prefrontal cortex is part of the modular working memory system: A functional neuroanatomical perspective

For many years, the functional role of the ventrolateral Pre-Frontal Cortex (PFC) was associated with executive functions, specifically in the context of non-affective cognitive processes. However, recent research has suggested that the ventrolateral PFC is also involved in the attention system. The Ben Shalom model of the functional organization of the prefrontal cortex (2019) posits that the ventrolateral PFC selects perceptual stimuli after integration by the adjacent ventromedial PFC. This article reviews the state-of-the-art findings to better understand the role of the ventrolateral PFC in the selection of perceptual information as grounded in the Ben Shalom model. Numerous studies have reported converging evidence for the selective role of this area. However, most argue that this perceptual selection takes place through the active updating of information values linked to goal-oriented actions. These studies thus view the ventrolateral PFC as part of a system that actively manipulates and changes processed information such as the working memory function, rather than being part of the attention system. In agreement with this view, this review suggests that this area is part of a complex and modular working memory system and illustrates with reference to Diamond's work on ADD. This working memory system is functionally and anatomically dispersed and includes the dorsolateral PFC, the ACC, the parietal cortex, the basal ganglia, and the cerebellum. Hence, future research should continue to explore the specific neurofunctional roles of these areas in working memory systems, and the connections between the different subareas in this complex array.

Internet and Video Games: Causes of Behavioral Disorders in Children and Teenagers

Even though video games have been present among children for many years, children are using them more continuously and in an abusive and indiscriminate way nowadays because of the "technological boom". It is affecting the behavior of children and adolescents. This is the reason why we are carrying out this systematic review. The main objective of this article is to investigate literature that directly connects the continuous and undifferentiated use of video games with the emergence of behavioral disorders in children and young people. The PRISMA statement was followed in the process of this article. We used SCOPUS, Web of Science and PubMed as databases, moreover, we searched studies with a scoping review. The results indisputably supported six out of seven of our hypotheses. We find that the excessive use of video games causes addiction to technology, aggressive behaviors, sleep disorders, and poor school performance. In addition, it hinders social relationships and the development of emotional intelligence. To conclude, it is necessary to correctly use video games in particular, and technologies in general, adapting their content to children's age, as well as the amount of time that they dedicate to use them.

Factors Influencing the Executive Functions of Male and Female Cadets

Executive functions (EFs) are related to human abilities that allow individuals to achieve planned goals, contribute to creativity and the analysis of new ideas, and allow for adaptation to new situations in daily life. Thorough analyses of the factors affecting EFs can aid in the development of appropriate training programs for various social and professional groups, including the military. The purpose of this study was to determine the factors affecting the EFs of cadets (18 women and 108 men) studying at a military academy in Poland after the first and second terms of military training, and to investigate gender differences in the level of EFs, shooting performance (SP), and components of physical fitness (PF). The Neuropsychological Color Trails Test (CTT-2) was used to determine some of the EFs of the test subjects. Meanwhile, the level of SP was represented by the score achieved during marksmanship training implemented during military training. Assessment of the subjects' PF was guided by the principles of the Health-Related Fitness assessment concept, i.e., health-related fitness. Differences between men and women in specific variables were calculated using the Mann-Whitney U test for independent samples, whilst the relationship between variables was analyzed using the best subset regression method. The results revealed that cadets' EFs were influenced by their SP and their level of strength. However, there were no significant differences between male and female cadets in the levels of EFs or SP.

Day-to-day variation in students' academic success: The role of self-regulation, working memory, and achievement goals

Self-regulation was found to be positively associated with school performance. Interrelations between self-regulation, working memory (WM), and achievement goals, in particular mastery goals, have been established, as well as associations with academic outcomes. It stands to reason that self-regulation, WM, achievement goals, and academic success are related on a daily level. However, previous research rarely considered this level of analysis. Here, we therefore addressed the relations of daily self-regulation, WM, and achievement goals, and their relevance for daily and general academic success. Data were obtained through ambulatory assessments in 90 students before (Study 1; M_age  = 9.83, SD_age  = 0.50) and 108 students after their transition to secondary school (Study 2; M_age  = 10.12, SD_age  = 0.45) across 20 school days. Students reported about daily achievement goals prior to school, self-regulation at school, and perceived academic success after school, as well as report card grades. Daily WM was assessed at school. Study 1 showed positive associations between daily mastery goals and self-regulation, but not with WM. Together, daily performance-approach goals and self-regulation, but not other goals or WM uniquely contributed to daily perceived academic success. Study 2 showed positive associations between daily mastery goals and self-regulation, but not with WM. Average daily mastery goals predicted daily WM. Together, daily mastery goals and self-regulation, but not WM, uniquely contributed to daily perceived academic success. In both studies, average levels of WM, but not achievement goals or self-regulation predicted report card grades. Results thus corroborate theoretical considerations on the importance of distinguishing self-regulation processes at between- and within-person levels. RESEARCH HIGHLIGHTS: Analyses of intensive longitudinal data on daily self-regulation, working memory, and achievement goal orientations in the school context of 9- to 11-year-olds. In primary and secondary school, days with higher mastery goals and self-regulation are days with higher academic success. In primary and secondary school, days with higher mastery goals are days with higher self-regulation. In secondary school, students with higher average mastery goals show better daily WM performance. Average working memory performance predicts report card grades beyond the influence of prior grades and achievement goal orientations.

Therapeutic Approaches for ADHD by Developmental Stage and Clinical Presentation

Attention Deficit Hyperactivity Disorder is a neurodevelopmental disorder with three presentations: inattentive, hyperactive/impulsive and combined. These may represent an independent disease entity. Therefore, the therapeutic approach must be focused on their neurobiological, psychological and social characteristics. To date, there is no comprehensive analysis of the efficacy of different treatments for each presentation of ADHD and each stage of development. This is as narrative overview of scientific papers that summarize the most recent findings and identify the most effective pharmacological and psychosocial treatments by ADHD presentation and age range. Evidence suggests that methylphenidate is the safest and most effective drug for the clinical management of children, adolescents and adults. Atomoxetine is effective in preschoolers and maintains similar efficacy to methylphenidate in adults, whereas guanfacine has proven to be an effective monotherapy for adults and is a worthy adjuvant for the management of cognitive symptoms. The psychosocial treatments with the best results in preschoolers are behavioral interventions that include training of primary caregivers. In adolescents, the combination of cognitive and cognitive-behavioral therapies has shown the best results, whereas cognitive-behavioral interventions are the most effective in adults. Pharmacological and psychosocial treatments must be adjusted to the ADHD presentation and its neurocognitive characteristics through the patient's development.

Immediate and Sustained Effects of Neurofeedback and Working Memory Training on Cognitive Functions in Children and Adolescents with ADHD: A Multi-Arm Pragmatic Randomized Controlled Trial

OBJECTIVE

To evaluate the effects of neurocognitive training methods on targeted cognitive functions in children and adolescent with ADHD.

METHOD

A pragmatic four-arm randomized controlled trial compared two types of neurofeedback (Slow Cortical Potential and Live Z-score) and Working-memory training (WMT) with treatment as usual. N = 202 participants with ADHD aged 9 to 17 years were included. A battery of cognitive function tests was completed pretreatment, posttreatment, and after 6-months.

RESULTS

The effects of WMT on spatial and verbal working-memory were superior to neurofeedback and treatment as usual at posttreatment, but only partially sustained at follow-up. No other consistent effects were observed. We found no clear indications that effects were moderated by ADHD presentation, ongoing medication, age, or sex.

CONCLUSION

The sustained effects of neurocognitive training on cognitive functioning in children and adolescents with ADHD may be limited. Future research should focus on more personalized forms of neurocognitive training.

The role of attention control in complex real-world tasks

Working memory capacity is an important psychological construct, and many real-world phenomena are strongly associated with individual differences in working memory functioning. Although working memory and attention are intertwined, several studies have recently shown that individual differences in the general ability to control attention is more strongly predictive of human behavior than working memory capacity. In this review, we argue that researchers would therefore generally be better suited to studying the role of attention control rather than memory-based abilities in explaining real-world behavior and performance in humans. The review begins with a discussion of relevant literature on the nature and measurement of both working memory capacity and attention control, including recent developments in the study of individual differences of attention control. We then selectively review existing literature on the role of both working memory and attention in various applied settings and explain, in each case, why a switch in emphasis to attention control is warranted. Topics covered include psychological testing, cognitive training, education, sports, police decision-making, human factors, and disorders within clinical psychology. The review concludes with general recommendations and best practices for researchers interested in conducting studies of individual differences in attention control.

The developmental impact of sex chromosome trisomies on emerging executive functions in young children: Evidence from neurocognitive tests and daily life skills

Sex chromosomal trisomies (SCT) are associated with impairments in executive functions in school-aged children, adolescents, and adults. However, knowledge on preschool development of executive functions is limited but greatly needed to guide early intervention. The current study examined emerging executive functions in young children with SCT. Participants were 72 SCT children and 70 population-based controls, aged 3-7 years, who completed a neurocognitive assessment of both global executive function (MEFS) and verbal executive function skills (NEPSY Word Generation). Caregivers completed the Behavior Rating Inventory of Executive Function (BRIEF) questionnaire to capture real-world behavioral manifestations of impairments in executive functions. Results showed that impairments were significantly more prevalent in SCT than in controls and already present from 3 years, specifically verbal executive functions and working memory. Broader more pronounced impairments were found in older children with SCT. Age was significantly related to executive functions, but specific domains showed different relations with age. For example, deficits in planning and organizing remained evident with older age in SCT whereas it declined with age in controls. Impairments in executive functions were present across different levels of intelligence. Already at an early age, impairments across executive functions should be considered part of the neurodevelopmental profile of SCT, which appear more prominent at later age. Future studies should investigate developmental pathways of executive functions in SCT, given its relevance in cognitive, social, and emotional development. Executive functions should be screened and monitored in children with SCT and could be an important target of preventive intervention.

EEG Global Coherence in Scholar ADHD Children during Visual Object Processing

Among neurodevelopmental disorders, attention deficit hyperactivity disorder (ADHD) is the main cause of school failure in children. Notably, visuospatial dysfunction has also been emphasized as a leading cause of low cognitive performance in children with ADHD. Consequently, the present study aimed to identify ADHD-related changes in electroencephalography (EEG) characteristics, associated with visual object processing in school-aged children. We performed Multichannel EEG recordings in 16-year-old children undergoing Navon’s visual object processing paradigm. We mapped global coherence during the processing of local and global visual stimuli that were consistent, inconsistent, or neutral. We found that Children with ADHD showed significant differences in global weighted coherence during the processing of local and global inconsistent visual stimuli and longer response times in comparison to the control group. Delta and theta EEG bands highlighted important features for classification in both groups. Thus, we advocate EEG coherence and low-frequency EEG spectral power as prospective markers of visual processing deficit in ADHD. Our results have implications for the development of diagnostic interventions in ADHD and provide a deeper understanding of the factors leading to low performance in school-aged children.

Perceived Expressed Emotion and Irritability in Adolescents With Attention-Deficit/Hyperactivity Disorder Inattentive Type: The Moderating Effect of Subtype

The current study aimed to investigate perceived expressed emotion (EE) and irritability among adolescents with inattentive and combined type attention-deficit/hyperactivity disorder (ADHD-I and ADHD-C, respectively), and to assess whether the subtype plays a moderating role in the relationship between perceived EE and irritability. The current cross-sectional, case-control study comprised 37 adolescents with ADHD-I, 62 adolescents with ADHD-C, and 58 age- and sex-matched adolescents without ADHD. After controlling for confounding factors, adolescents with ADHD-C were found to exhibit significantly higher levels of perceived lack of emotional support than adolescents with ADHD-I (p = 0.029). Results of moderation analysis showed ADHD subtype to be a moderating factor in the relationship between perceived EE and irritability. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Structure and trends of externalizing and internalizing psychiatric symptoms and gender differences among adolescents in the US from 1991 to 2018

PURPOSE

We aimed to estimate the structure of internalizing and externalizing symptoms and potential time dynamics in their association. This is understudied among adolescents, despite increasing internalizing and decreasing externalizing symptoms in recent years.

METHODS

We analyzed data from US Monitoring the Future cross-sectional surveys (1991-2018) representative of school-attending adolescents (N = 304,542). Exploratory factor analysis using maximum likelihood estimation method and promax rotation resulted in a two-factor solution (factor correlation r = 0.24) that differentiated eight internalizing and seven conduct-related externalizing symptoms. Time-varying effect modification linear regression models estimated the association between standardized internalizing and externalizing symptoms factor scores over time overall and by gender.

RESULTS

In 2012, trends in average factor scores diverged for internalizing and externalizing factors. The average standardized internalizing factor score increased from - 0.03 in 2012 to 0.06 in 2013 and the average externalizing factor score decreased from - 0.06 in 2011 to - 0.13 in 2012. We found that for every one-unit increase in standardized internalizing factor score, standardized externalizing factor score increased by 0.224 units in 2010 (95% CI: 0.215, 0.233); the magnitude of this increase was 22.3% lower in 2018 (i.e., 0.174 units; 95% CI: 0.160, 0.188). Decoupling of internalizing and externalizing symptoms began earlier among boys (~ 1995) than among girls (~ 2010).

CONCLUSION

The decoupling of internalizing and externalizing symptoms among adolescents suggests that changes in the prevalence of shared risk factors for adolescent psychiatric symptoms affect these dimensions in opposing directions, raising the importance of considering symptoms and their risk factors together in prevention and intervention efforts.

Attention Control in Children With ADHD: An Investigation Using Functional Near Infrared Spectroscopy (fNIRS)

Attention problems are a predominant contributor to near- and far-term functional outcomes in attention-deficit/hyperactivity disorder (ADHD); however, most interventions focus on improving the alerting attentional network, which has failed to translate into improved learning for a majority of children with ADHD. Comparatively less is known regarding the executive attentional network and its overarching attention control process, which governs the ability to maintain relevant information in a highly active, interference-free state, and is intrinsic to a broad range of cognitive functions. This is the first study to compare attention control abilities in children with ADHD and typically developing (TD) children using the Visual Array Task (VAT) and to simultaneously measure hemodynamic functioning (oxyHb) using functional Near-Infrared Spectroscopy (fNIRS). Nineteen children with ADHD Combined type and 18 typically developing (TD) children aged 8 to 12 years were administered the VAT task while prefrontal activity was monitored using fNIRS. Results revealed that children with ADHD evinced large magnitude deficits in attention control and that oxyHb levels in the left dorsal lateral prefrontal cortex (dlPFC) were significantly greater in children with ADHD relative to TD children. These findings suggest that poor attention control abilities in children with ADHD may be related to increased left dlPFC activation in response to an underdeveloped and/or inefficient right dlPFC. The need to design interventions that target and strengthen attention control and its corresponding neural network is discussed based on the likelihood that attention control serves as the potential quaesitum for understanding a wide array of ADHD-related deficits.

Unique and overlapping contributions of sustained attention and working memory to parent and teacher ratings of inattentive behavior

Sustained attention and working memory are two closely intertwined executive functions that may underlie inattentive behavior. However, little research has teased apart their precise contributions in a single study. This study examines the extent to which ratings of children's inattentive behavior are associated with these executive functions. Specifically, we investigated the unique and overlapping statistical contributions of sustained attention capacity and working memory capacity to parent and teacher ratings of inattentive behavior (operationalized as scores on both the Inattentive and Hyperactive/Impulsive scales of the Conners' Rating Scale), while controlling for IQ. Children aged 8-11 years completed measures of sustained attention capacity, working memory capacity and IQ. Parents and teachers completed Conners-3 Parent and Teacher Short Forms, as a measure of inattentive behavior. We found that the unique statistical contribution of sustained attention capacity emerged as the most important factor in both parent and teacher ratings of inattentive behavior, with effects of moderate magnitude. In contrast, working memory capacity accounted for a small amount of variance. The overlap between sustained attention and working memory explained a small but substantive amount of variance in inattentive behavior. These findings support the idea that sustained attention and working memory are distinct executive functions that may contribute to goal-directed behavior both uniquely and through their interactions.

Bidirectional relationship of problematic Internet use with hyperactivity/inattention and depressive symptoms in adolescents: a population-based cohort study

Problematic Internet use (PIU), hyperactivity/inattention, and depressive symptoms are comorbid problems in adolescence, but the causal relationships among these issues are unclear. To assess the relationships among PIU, hyperactivity/inattention, and depressive symptoms in adolescents in the general population. This longitudinal cohort study used data from the Tokyo Teen Cohort study in Tokyo, Japan, for two years between October 2012 and January 2015. Of the 3171 pairs of children and parents, 3007 pairs continued to participate in the second wave of the Tokyo Teen Cohort study. A total of 3007 children were included in the analysis (mean [standard deviation] age, 9.7 [0.4] years; 1418 women [47.2%]. Cross-lagged panel analysis revealed that PIU at timepoint 1 was significantly associated with hyperactivity/inattention at timepoint 2 (β = 0.03; 95% confidence interval (CI) 0.01-0.06), and hyperactivity/inattention at timepoint 1 was also significantly associated with PIU at timepoint 2 (β = 0.07; 95% CI 0.04-0.10), even after adjustments were made for depressive symptoms. Furthermore, PIU at timepoint 1 was significantly associated with depressive symptoms at timepoint 2 (β = 0.05; 95% CI 0.01-0.12), and depressive symptoms at timepoint 1 were also significantly associated with PIU at timepoint 2 (β = 0.05; 95% CI 0.02-0.07), even after adjustments were made for hyperactivity/inattention. These results support the bidirectional relationships among PIU, hyperactivity/inattention, and depressive symptoms. PIU may be a target to improve hyperactivity/inattention and depressive symptoms in adolescents.

Differential structure-function network coupling in the inattentive and combined types of attention deficit hyperactivity disorder

The heterogeneous presentation of inattentive and hyperactive-impulsive core symptoms in attention deficit hyperactivity disorder (ADHD) warrants further investigation into brain network connectivity as a basis for subtype divisions in this prevalent disorder. With diffusion and resting-state functional magnetic resonance imaging data from the Healthy Brain Network database, we analyzed both structural and functional network efficiency and structure-functional network (SC-FC) coupling at the default mode (DMN), executive control (ECN), and salience (SAN) intrinsic networks in 201 children diagnosed with the inattentive subtype (ADHD-I), the combined subtype (ADHD-C), and typically developing children (TDC) to characterize ADHD symptoms relative to TDC and to test differences between ADHD subtypes. Relative to TDC, children with ADHD had lower structural connectivity and network efficiency in the DMN, without significant group differences in functional networks. Children with ADHD-C had higher SC-FC coupling, a finding consistent with diminished cognitive flexibility, for all subnetworks compared to TDC. The ADHD-C group also demonstrated increased SC-FC coupling in the DMN compared to the ADHD-I group. The correlation between SC-FC coupling and hyperactivity scores was negative in the ADHD-I, but not in the ADHD-C group. The current study suggests that ADHD-C and ADHD-I may differ with respect to their underlying neuronal connectivity and that the added dimensionality of hyperactivity may not explain this distinction.

Examining Distinctive Working Memory Profiles in Chinese Children With Predominantly Inattentive Subtype of Attention-Deficit/Hyperactivity Disorder and/or Reading Difficulties

Although evidence has shown that both RD and ADHD-I children suffer from working memory problems, inconsistencies in impaired modalities have been reported. This study aimed to (1) compare the three WM domains (i.e., verbal WM, visual-spatial WM, and behavioral WM) among pure ADHD-I, pure RD, comorbid ADHD-I+RD, and typical control groups and (2) examine the impact of comorbidity on the three WM domains. A Chinese sample of participants from Hong Kong included 29 children in the ADHD-I group, 78 children in the RD group, 31 children in the comorbid group (ADHD-I+RD), and 64 children in the TD control group. All participants completed the assessments individually. The findings showed that the children with ADHD-I and/or RD exhibited diverse cognitive profiles. In particular, RD was associated with verbal and visual-spatial working memory deficits, while ADHD-I was associated with behavioral working memory deficits. Interestingly, the comorbid condition demonstrated additive deficits of the two disorders but with greater deficits in behavioral working memory. These findings support the cognitive subtype hypothesis and provide a clearer picture of the distinctive working memory profiles of different groups, allowing for the development of intervention programs in the future.

Impact of attention-deficit/hyperactivity disorder comorbidity on longitudinal course in Internet gaming disorder: a 3-year clinical cohort study

BACKGROUND

Although attention-deficit/hyperactivity disorder (ADHD) symptoms were identified as a key risk factor for Internet gaming disorder (IGD), the effect of ADHD comorbidity on longitudinal course of IGD in the clinical population remains to be further examined. This study aimed to investigate whether ADHD comorbidity in IGD patients affects the recovery, recurrence rates, and trajectories of IGD symptoms, and examine the relationship between the changes in IGD and ADHD symptoms.

METHODS

The study included 128 IGD patients without any psychiatric comorbidities (pure-IGD group) and 127 IGD patients with comorbid ADHD (ADHD-IGD group) aged 11 to 42 years. IGD and ADHD were diagnosed according to DSM-5 criteria at enrollment. Participants were offered 8-week treatment with additional care provided as needed and followed up over a 3-year period. IGD diagnosis was reassessed annually and used as a dichotomous outcome. The severity of IGD and ADHD symptoms was measured using the Young Internet Addiction Scale and the Korean ADHD rating scale, respectively, at baseline and each annual follow-up.

RESULTS

The recovery rates of IGD by Year 3 were 60% and 93% in ADHD-IGD and in pure-IGD groups, respectively. The ADHD-IGD group showed lower rates of recovery, higher odds of recurrence within 1 year, and higher severity of IGD symptoms over time than the pure-IGD group. Family environment was also associated with the trajectories of IGD symptoms. The changes in ADHD symptoms were significantly associated with the changes in IGD symptoms.

CONCLUSIONS

This study found that ADHD comorbidity in IGD patients was associated with poor clinical course of IGD and that the changes in ADHD symptoms were associated with the changes in IGD symptoms over time. Our findings suggest that evaluation and treatment of ADHD symptoms and family environment in IGD patients may be important in improving the prognosis of IGD.

Structural Brain Changes and Associated Symptoms of ADHD Subtypes in Children

Attention-deficit/hyperactivity disorder (ADHD) is presumed to be heterogeneous, but the best way to characterize this heterogeneity remains unclear. Although considerable evidence suggests that the 2 different types of ADHD, inattention and combined, have different cognitive and behavioral profiles, and underlying neurobiologies, we currently lack information on whether these subtypes reflect separated brain structure changes. Structural magnetic resonance imaging scans (N = 234), diagnostic, and demographic information were obtained from the ADHD-200 database. Of this sample, 138 were Typically Developing people, 37 were ADHD-Combined, and 59 were ADHD-Inattentive patients. Freesurfer segmentation methods were used to measure cortical thickness, area, and volume, subcortical volume and hipposubfield volume. ADHD-Inattentive patients showed milder clinical symptoms but more serious cognitive injury than ADHD-Combined patients. In addition, dissociable structural brain changes were found in different subtypes of ADHD, particularly in terms of decreased subcortical volume in ADHD-Combined patients compared with Typically Developing people. Clinical symptoms were predominantly related to smaller rh_caudalanteriorcingulate thickness and left-Pallidum volume, whereas verbal IQ injury was correlated strongly with smaller rh_insula area. These findings indicate that there are significant differences in clinical symptoms and gray matter damage between ADHD-Combined and -Inattentive patients. This supports the growing evidence of heterogeneity in the ADHD-Inattentive subtype and the evidence of brain structure differences.

Verbal working memory and processing speed: Correlations with the severity of attention deficit and emotional dysregulation in adult ADHD

Objectives

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐5), emphasizes symptoms severity with regard to the diagnosis of attention deficit hyperactivity disorder (ADHD). Many clinicians use neuropsychological test results as objective measures of cognitive functions as part of the diagnostic work‐up. The aim of this study was to investigate whether the psychometric test results regarding verbal working memory and processing speed are useful as indicators of the severity of attention deficits and emotional dysregulation in adults with ADHD.

Methods

This observational cross‐sectional clinical study included 418 adults diagnosed with ADHD according to the DSM‐5. Attention deficit severity was defined based on the inattentive subscale of the Adult ADHD Self‐Report Scale. Emotional dysregulation was assessed with the Deficient Emotional Self‐Regulation scale. Verbal working memory was measured with the Working Memory Index (WMI), and processing speed was measured with the Processing Speed Index (PSI) from the Wechsler Adult Intelligence Scale, third edition.

Results

The full‐scale intelligence quotients of the participants were in the normal range, with expected reductions in verbal working memory and processing speed. Only processing speed was associated with attention deficits (β = −.056, p = .003). The association between the psychometric test result for verbal working memory and processing speed and that between the severity of attention deficits and emotional dysregulation were weak (R² < .1) and mostly non‐significant.

Conclusion

The psychometric index scores for verbal working memory (WMI) and processing speed (PSI) seem to have limited utility as indicators of the severity of attention deficits and emotional dysregulation in adult ADHD patients.

Psychological and neuropsychological underpinnings of attention-deficit/hyperactivity disorder assessment

The identification and diagnosis of attention-deficit/hyperactivity disorder (ADHD) is extremely important in order to help change the trajectory of an individual's life outcomes. A review of the current state of evidence-based assessment of ADHD is dominated by the DSM-5's conceptualization of behaviorally-oriented diagnostic criteria. This assumption that the DSM-5's method for identifying ADHD is the gold standard underlies the research base that evaluates the incremental validity of measures and methods for diagnosing it. That is, when evaluating whether a measure is useful in the identification of ADHD, the 'right answer' is based on the DSM-5's behaviorally-oriented definition. An alternative model for considering the fact that ADHD is a neurodevelopmental disorder, with its roots in executive dysfunction, is proposed. Using neuropsychological and cognitive tests to identify executive functioning problems can be combined with rating scales and interviews to diagnose ADHD in a way that does not ascribe entirely to a behavioral definition of the disorder.

Association of Symptoms of Attention Deficit and Hyperactivity with Problematic Internet Use among University Students in Wuhan, China During the COVID-19 Pandemic

BACKGROUND

COVID-19 is still spreading worldwide and posing a threat to individuals' physical and mental health including problematic internet use (PIU). A potentially high-risk group for PIU are those with symptoms of attention deficit and hyperactivity (ADHD symptoms), because of restrictions in their physical activity levels and engagement in computer diversions requiring only short attention spans.

METHODS

We used convenience sampling in a cross-sectional survey of university students from 30 universities in Wuhan, Hubei Province, China. We assessed PIU using the Internet Addiction Test and ADHD symptoms using the WHO Adult ADHD Self-Report Screening Scale. Using logistic regression and linear regression analyses we adjusted for demographic, epidemic-related and psychological covariates in models of the association between ADHD symptoms and PIU.

RESULTS

Among 11,254 participants, we found a 28.4% (95% CI, 27.5%-29.2%) prevalence of PIU, relatively higher than before the pandemic. In our final logistic regression model, participants with ADHD symptoms had approximately two times the risk for PIU (OR: 2.31, 95% CI: 1.89-2.83). Similarly, individuals with depression, anxiety, insomnia, PTSD symptoms and feeling stress during the pandemic had a higher risk of PIU, while those exercising regularly during the pandemic had a lower risk.

LIMITATIONS

The cross-sectional design and reliance on internet based self-reports for ADHD symptoms and PIU assessments, without direct structured interviews for validation, are limitations.

CONCLUSIONS

The prevalence of PIU was high during COVID-19, and those people with ADHD symptoms and other mental illness symptoms appear to be at higher risk of PIU. Regular exercise may reduce that PIU risk and hence should be recommended during the COVID-19 pandemic.

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

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

Attention-Deficit/Hyperactivity Disorder Symptom Dimensions Differentially Predict Adolescent Peer Problems: Findings From Two Longitudinal Studies

Introduction: Previous findings that inattention (IA) and hyperactive/impulsive (HI) symptoms predict later peer problems have been mixed. Utilizing two culturally diverse samples with shared methodologies, we assessed the predictive power of dimensionally measured childhood IA and HI symptoms regarding adolescent peer relationships.

Methods: A US-based, clinical sample of 228 girls with and without childhood diagnosed attention-deficit/hyperactivity disorder (ADHD; M age = 9.5) was assessed and followed 5 years later. A Norwegian, population-based sample of 3,467 children (53% girls; M age = 8.3) was assessed and followed approximately 4 years later. Both investigations used parent and teacher reports of ADHD symptoms and peer relations. Multivariate regression analyses examined the independent contributions of IA and HI symptoms to later peer problems, adjusting for baseline childhood peer problems. We also examined childhood sex as a potential moderator within the Norwegian sample.

Results: Higher levels of childhood HI symptoms, but not IA symptoms, independently predicted adolescent peer problems in the all-female clinical sample. Conversely, higher levels of IA symptoms, but not HI symptoms, independently predicted preadolescent peer problems in the mixed-sex population sample. Results did not differ between informants (parent vs. teacher). Associations between ADHD symptom dimensions and peer problems within the Norwegian sample were not moderated by child sex.

Discussion: Differential associations between childhood hyperactive/impulsive and inattention symptoms and adolescent peer problems were found across two diverse samples using a shared methodology. Potential explanations for different findings in the clinical vs. population samples include symptom severity as well as age, sex, and cultural factors. We discuss implications for future research, including the importance of dimensional measures of ADHD-related symptoms and the need for shared methodologies across clinical and normative samples.

Sex differences in prevalence, risk factors and clinical correlates of internet addiction among chinese college students

BACKGROUND

Internet addiction(IA) is now very common. However, few studies have explored the sex differences in risk factors for IA, especially among Chinese college students. This study aimed to investigate the sex differences in prevalence, risk factors and clinical correlates of IA among Chinese college students.

METHODS

A total of 8098 college students from Hunan province were recruited using a cross-sectional design and a convenience sampling method. Each student filled out the survey online anonymously, which collected their information on their socio-demographics, internet addiction(Revised Chinese internet addiction scale;CIAS-R), ADHD(Wender Utah Rating Scale and World Health Organization (WHO) Adult ADHD Self-Report Scale v 1.1 Symptom Checklist), depression(Self-reporting Depression Scale;SDS), insomnia(Athens Insomnia Scale;AIS), anxiety(Self-Rating Anxiety Scale;SAS) and suicidal behaviors through WeChat.

RESULTS

Overall, the prevalence of IA in males and females was 7.21%(259/3592) and 8.17%(368/4506), respectively. Multivariate logistic regression analysis revealed that suicidal ideation[odds ratio (OR),1.557;95% confidence interval (CI),1.083-2.240], suicide attempts(OR,2.081;95%CI:1.271-3.409), ADHD(OR,6.487;95%CI,4.697-8.959) and insomnia(OR,2.596;95%CI,1.910-3.529) were independent risk factors for male IA after controlling for confounding variables. Nationality(OR,1.507;95%CI,1.058-2.145), suicidal ideation(OR,2.012;95%CI,1.532-2.641), depression(OR,1.771;95%CI:1.071-2.930), ADHD(OR,4.497; 95%CI,3.285-6.158) and insomnia(OR,2.356;95%CI,1.813-3.061) were independent risk factors for female IA.

LIMITATION

No causal relationships could be drawn due to the cross-sectional design.

CONCLUSIONS

This study shows IA is common among both sexes. IA is significantly associated with ADHD, insomnia and suicidal behaviors in both male and female students, indicating the importance of screening IA and addressing ADHD, insomnia and suicidal behaviors to improve the mental health of college students and better prevent suicide in both sexes.

Management of anxiety disorders in children with attention-deficit hyperactivity disorder: a narrative review

Anxiety disorders are common comorbidities of attention deficit/hyperactivity disorder (ADHD) and conversely, ADHD is prevalent among anxious youths. A variety of treatments, both psychopharmacological and nonpsychopharmacological, are used to manage combined ADHD/anxiety disorder. This article aims to review the literature on the treatment of ADHD with comorbid anxiety disorders, and make evidence-based recommendations for clinical practice. In most cases, when ADHD is the primary condition, stimulants are the first-line of treatment, frequently resulting not only in improvement in ADHD symptoms but also alleviating the symptoms of the comorbid anxiety disorder. Stimulant treatment is relatively safe and well-tolerated in ADHD with comorbid anxiety disorder. When the stimulant administration does not attenuate the severity of the comorbid anxiety disorder, a treatment that targets specifically the anxiety disorder should be added. This recommendation, however, might be challenged by the impressive efficacy of atomoxetine for both the ADHD and anxiety disorder symptoms. Adjunctive cognitive-behavior therapy for anxiety disorder symptoms is strongly recommended and is considered superior to medication alone. Other options include adding pharmacological treatment for the anxiety symptoms. In moderate and severe cases of comorbid Ads, selective serotonin reuptake inhibitors can be added to the stimulants, with the required caution.

Redefining ADHD Using an Adult Population: Should Inattention be Viewed as a Separate Dimension From Cognitive and Physiological Activity Level?

Objective: The purpose of this study was to reexamine the latent structure of ADHD and sluggish cognitive tempo (SCT) due to issues with construct validity. Two proposed changes to the construct include viewing hyperactivity and sluggishness (hypoactivity) as a single continuum of activity level, and viewing inattention as a separate dimension from activity level. Method: Data were collected from 1,398 adults using Amazon's MTurk. A new scale measuring activity level was developed, and scores of Inattention were regressed onto scores of Activity Level using curvilinear regression. Results: The Activity Level scale showed acceptable levels of internal consistency, normality, and unimodality. Curvilinear regression indicates that a quadratic (curvilinear) model accurately explains a small but significant portion of the variance in levels of inattention. Conclusion: Hyperactivity and hypoactivity may be viewed as a continuum, rather than separate disorders. Inattention may have a U-shaped relationship with activity level. Linear analyses may be insufficient and inaccurate for studying ADHD.

Test-Retest Reliability and Measurement Invariance of Executive Function Tasks in Young Children With and Without ADHD

Objective: Measurement reliability is assumed when executive function (EF) tasks are used to compare groups or to examine relationships between cognition and etiologic and maintaining factors of psychiatric disorders. However, the test-retest reliabilities of many commonly used EF tasks have rarely been examined in young children. Furthermore, measurement invariance between typically developing and psychiatric populations has not been examined. Method: Test-retest reliability of a battery of commonly used EF tasks was assessed in a group of children between the ages of 5 and 6 years old with (n = 63) and without (n = 44) ADHD. Results: Few individual tasks achieved adequate reliability. However, confirmatory factor analysis (CFA) models identified two factors, working memory and inhibition, with test-retest correlations approaching 1.0. Multiple indicators multiple causes (MIMIC) models confirmed configural measurement invariance between the groups. Conclusion: Problems created by poor reliability, including reduced power to detect group differences, index change over time, or to identify relationships with other measures, may be mitigated using latent variable approaches.

Predictors and Moderators of Treatment Outcome in Cognitive Training for Children With ADHD

Objective: To explore whether clinical variables and initial cognitive abilities predict or moderate (far) transfer treatment outcomes of cognitive training. Method: A total of 98 children (aged 8-12 years) with ADHD were randomly assigned to Cogmed Working Memory Training or a new cognitive training called "Paying Attention in Class." Outcome measures included neurocognitive assessment, parent and teacher rated questionnaires of executive functioning behavior and academic performance. Predictor/moderator variables included use of medication, comorbidity, subtype of ADHD, and initial verbal and visual working memory skills. Results: Parent and teacher ratings of executive functioning behavior were predicted and moderated by subtype of ADHD. Word reading accuracy was predicted by subtype of ADHD and comorbidity. Use of medication and initial verbal and visual spatial working memory skills only predicted and moderated near transfer measures. Conclusion: Cognitive training can be beneficial for certain subgroups of children with ADHD; individual differences should be taken into account in future trials.

Time perception in children with attention deficit-hyperactivity disorder (ADHD): Does task matter? A meta-analysis study

We aimed to assess the effects of the nature of the task on time perception deficit (TPD) in children with attention deficit-hyperactivity disorder (ADHD). The inconsistent results from 12 studies in children with ADHD revealed that the problem of time estimation was more obvious in prospective tasks in long-duration intervals. The modality is not a decisive factor. Only two studies reported the subtypes of ADHD that showed TPD in all subtypes. Children with ADHD have difficulties in time perception (TP). The problem is obvious in different types of modality including visual and auditory, in different types of task time estimation, time reproduction, and especially in longer duration.

The Comparison of Perfectionism and Commitment between Professional and Amateur Golfers and the Association between Perfectionism and Commitment in the Two Groups

This study investigated differences in perfectionist traits and commitment between professional and amateur golfers, as well as correlations among perfectionist traits, commitment, and golf handicap. Using simple random sampling, 486 professional golfers (mean age = 22.1 ± 3.0, 52.1% female) and 233 amateur golfers (mean age = 44.8 ± 10.2, 55.8% female) were recruited and assessed using the Multidimensional Perfectionism Scale (MPS) and Expansion of Sports Commitment Model (ESCM). An ANCOVA, controlling for age, golf career length, and training time, revealed lower MPS self-oriented scores (10.3%; F = 8.9, p < 0.01; effect size [ES] = 0.498) and higher ESCM-Cognition (12.6%; F = 9.4, p < 0.01; ES = 0.691) and ESCM-Behavior (9.4%; F = 4.6, p = 0.03; ES = 0.479) scores in professional golfers than in amateur golfers. In partial correlations controlling for age, golf career length, and training time, professional golfers' MPS scores were negatively associated with ESCM-Cognition scores (r = -0.30, p < 0.001). Professional golfers' mean golf handicap was positively correlated with MPS total (r = 0.33, p < 0.01). Altogether, golfers seeking to attain high levels of performance must consider the mental aspect of golfing and find ways to maximize commitment levels while minimizing perfectionist traits.

The Role of Executive and General Cognitive Functioning in the Attention Problems of Very and Extremely Preterm Adults

OBJECTIVE

To determine whether the attention problems in adults born very preterm/very low birth weight (VP/VLBW; <32 weeks' gestation/<1500 g) or extremely preterm (EP; <26 weeks' gestation) are associated with specific executive or general cognitive deficits.

METHOD

Cohorts of VP/VLBW (the Bavarian Longitudinal Study [BLS]) and EP (the EPICure Study) participants were followed from birth to early adulthood, each also following a respective control group. Adult attention deficit hyperactivity disorder (ADHD) symptoms were assessed via self-report in both cohorts and additionally by parent report in the BLS. Participants in both cohorts also had their attention span rated by trained observers. Performed separately in each cohort, hierarchical regression analyses were used to assess whether the association between preterm birth status and attention problems remained after accounting for executive functioning (inhibitory control and working memory) in adulthood, childhood intelligence score (IQ), or sex.

RESULTS

In the discovery cohort of the BLS, significant differences were found between VP/VLBW adults and controls for parent-rated inattention (p < 0.001). However, for self-reported measures of ADHD, no significant differences were found in the BLS or in the EPICure replication cohort. In both cohorts, observer-rated attention spans were lower for VP/VLBW and EP participants in comparison to their respective control groups (p < 0.001). In final models for the BLS, inhibitory control and childhood IQ were significantly associated with parent-rated inattention symptoms (p < 0.006), whereas working memory and childhood IQ were significantly associated with observer-rated attention span (p < 0.001). The effect of childhood IQ on observer-rated attention span was replicated in EPICure.

CONCLUSION

VP/VLBW and EP adults are at increased risk of observer-rated attention problems. These problems were predominantly associated with poorer general cognitive ability in early childhood and somewhat with adult executive functioning.