Components of visual search in childhood-onset schizophrenia and attention-deficit/hyperactivity disorder

The Eyes Have It: A Meta-analysis of Oculomotor Inhibition in Attention-Deficit/Hyperactivity Disorder

BACKGROUND

Diminished inhibitory control is one of the main characteristics of attention-deficit/hyperactivity disorder (ADHD), and impairments in oculomotor inhibition have been proposed as a potential biomarker of the disorder. The present meta-analysis summarizes the effects reported in studies comparing oculomotor inhibition in ADHD patients and healthy control subjects.

METHODS

Inhibitory outcomes were derived from oculomotor experimental paradigms including the antisaccade (AS), memory-guided saccade, and prolonged fixation tasks. Temporal and spatial measures were also extracted from these tasks and from visually guided saccade tasks as secondary outcomes. Data were available from k = 31 studies (N = 1567 participants). Summary effect sizes were computed using random-effects models and a restricted maximum-likelihood estimator.

RESULTS

Among inhibitory outcomes, direction errors in AS, after correcting for publication bias, showed a moderate effect and large between-study heterogeneity (k = 18, n = 739, g = 0.57, 95% confidence interval [CI] [0.27, 0.88], I²= 74%); anticipatory saccades in memory-guided saccade showed a large effect and low heterogeneity (k = 11, n = 487; g = 0.86, 95% CI [0.64, 1.08], I² = 17.7%); and saccades during prolonged fixation evidenced large effect size and heterogeneity (k = 6, n = 325 g = 1.11, 95% CI [0.56, 1.65], I² = 79.1%) partially related to age. Among secondary outcomes, saccadic reaction time in AS (k = 22, n = 932, g = 0.34, 95% CI [0.06, 0.63], I² = 53.12%) and coefficient of variability in visually guided saccade (k = 5, n = 282, g = 0.53, 95% CI [0.28, 0.78], I² = 0.01%) indicated significant effects with small to moderate effects sizes.

CONCLUSIONS

ADHD groups commit more oculomotor inhibition failures than control groups. The substantial effects support the conclusion that oculomotor disinhibition is a relevant ADHD-related mechanism. Moderate effects observed in saccadic reaction time variability suggest that fluctuant performance in oculomotor tasks is another relevant characteristic of ADHD.

Visual search in neurodevelopmental disorders: evidence towards a continuum of impairment

Disorders with neurodevelopmental aetiology such as Attention-Deficit/Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD) and Schizophrenia share commonalities at many levels of investigation despite phenotypic differences. Evidence of genetic overlap has led to the concept of a continuum of neurodevelopmental impairment along which these disorders can be positioned in aetiological, pathophysiological and developmental features. This concept requires their simultaneous comparison at different levels, which has not been accomplished so far. Given that cognitive impairments are core to the pathophysiology of these disorders, we provide for the first time differentiated head-to-head comparisons in a complex cognitive function, visual search, decomposing the task with eye movement-based process analyses. N = 103 late-adolescents with schizophrenia, ADHD, ASD and healthy controls took a serial visual search task, while their eye movements were recorded. Patients with schizophrenia presented the greatest level of impairment across different phases of search, followed by patients with ADHD, who shared with patients with schizophrenia elevated intra-subject variability in the pre-search stage. ASD was the least impaired group, but similar to schizophrenia in post-search processes and to schizophrenia and ADHD in pre-search processes and fixation duration while scanning the items. Importantly, the profiles of deviancy from controls were highly correlated between all three clinical groups, in line with the continuum idea. Findings suggest the existence of one common neurodevelopmental continuum of performance for the three disorders, while quantitative differences appear in the level of impairment. Given the relevance of cognitive impairments in these three disorders, we argue in favour of overlapping pathophysiological mechanisms.

Lower Attentional Skills predict increased exploratory foraging patterns

When engaged in a search task, one needs to arbitrate between exploring and exploiting the environment to optimize the outcome. Many intrinsic, task and environmental factors are known to influence the exploration/exploitation balance. Here, in a non clinical population, we show that the level of inattention (assessed as a trait) is one such factor: children with higher scores on an ADHD (Attention Deficit/Hyperactivity Disorder) questionnaire exhibited longer transitions between consecutively retrieved items, in both a visual and a semantic search task. These more frequent exploration behaviours were associated with differential performance patterns: children with higher levels of ADHD traits performed better in semantic search, while their performance was unaffected in visual search. Our results contribute to the growing literature suggesting that ADHD should not be simply conceived as a pure deficit of attention, but also as a specific cognitive strategy that may prove beneficial in some contexts.

The Impact of Concurrent Noise on Visual Search in Children With ADHD

OBJECTIVE

The purpose of this study was to investigate the impact of a concurrent "white noise" stimulus on selective attention in children with ADHD.

METHOD

Participants were 33 children aged 7 to 14 years, who had been previously diagnosed with ADHD. All children completed a computer-based conjunction search task under two noise conditions: a classroom noise condition and a classroom noise + white noise condition. The white noise stimulus was sounds of rain, administered using an iPhone application called Sleep Machine.

RESULTS

There were no overall differences between conditions for target detection accuracy, mean reaction time (RT), or reaction time variability ( SD). The impact of white noise on visual search depended on children's medication status.

CONCLUSION

White noise may improve task engagement for non-medicated children. White noise may be beneficial for task performance when used as an adjunct to medication.

Oculomotor Abnormalities in Children with Attention-Deficit/Hyperactivity Disorder Are Improved by Methylphenidate

BACKGROUND

There are relatively few studies of saccadic eye movements in children with attention-deficit/hyperactivity disorder (ADHD). The aim of this study was to examine inhibitory abilities of eye movements in children with ADHD and to explore the effect of methylphenidate (MPH) on eye movement performance.

METHODS

Thirty-one children with ADHD (mean age 9.9 ± 0.4 years) and 31 sex-, age-, and IQ-matched children with normal development were examined. Saccades elicited not only by the gap, step, overlap, and antisaccade paradigms but also a simple fixation paradigm have been recorded using an eye tracker. The latency of each type of saccade, the error rate of antisaccades, and the number of saccades made during fixation have been measured.

RESULTS

Children with ADHD and naive to treatment with respect to controls showed significantly shorter mean latency of voluntary saccades (overlap paradigm), more frequent errors during the antisaccade paradigm, and higher number of saccades made during fixation. After 1 month of MPH treatment, all these parameters changed significantly and reached control values.

CONCLUSION

Taken together, these results suggest that oculomotor abilities are poor in children with ADHD, which may correlate with deficits in inhibitory mechanisms. Treatment with MPH improves oculomotor performances through adaptive strategies, which may involve brain structures related to cognitive inhibition.

Visual search performance in infants associates with later ASD diagnosis

An enhanced ability to detect visual targets amongst distractors, known as visual search (VS), has often been documented in Autism Spectrum Disorders (ASD). Yet, it is unclear when this behaviour emerges in development and if it is specific to ASD. We followed up infants at high and low familial risk for ASD to investigate how early VS abilities links to later ASD diagnosis, the potential underlying mechanisms of this association and the specificity of superior VS to ASD. Clinical diagnosis of ASD as well as dimensional measures of ASD, attention-deficit/hyperactivity disorder (ADHD) and anxiety symptoms were ascertained at 3 years. At 9 and 15 months, but not at age 2 years, high-risk children who later met clinical criteria for ASD (HR-ASD) had better VS performance than those without later diagnosis and low-risk controls. Although HR-ASD children were also more attentive to the task at 9 months, this did not explain search performance. Superior VS specifically predicted 3 year-old ASD but not ADHD or anxiety symptoms. Our results demonstrate that atypical perception and core ASD symptoms of social interaction and communication are closely and selectively associated during early development, and suggest causal links between perceptual and social features of ASD.

A Preliminary Study of Motor Problems in Children with Attention-Deficit/Hyperactivity Disorder

Although many children with Attention-Deficit/Hyperactivity Disorder (ADHD) are described as “clumsy,” there is relatively little research on problems in motor development in this population. We used a survey method to assess retrospectively developmental histories of 25 children with ADHD and 27 control children (ages 8–15 years). Children with ADHD reportedly had more difficulty than control children with both learning and performing a variety of motor skills, e.g., tying shoes, printing letters, playing sports. In contrast, parents reported few problems in their children's language development. Severity of motor problems was related to performance on specific IQ indices and reading and spelling tests. Given previous research on adverse consequences of clumsiness in children with attention deficits, results of this preliminary study indicate that further research on motor development can shed light on the developmental psychopathology of ADHD.

Usefulness of the measurement of saccadic refixation in the diagnosis of attention-deficit hyperactivity disorder/hyperkinetic disorder in adults

Background:

The aim of the research is to evaluate the usefulness of the measurement of saccadic refixation in the diagnosis of attention-deficit hyperactivity disorder (ADHD)/hyperkinetic disorder (HKD) in adults.

Methods:

Seventy-eight individuals were examined: 40 with ADHD/HKD and 38 healthy ones. A noninvasive eye movement examination using the Saccadometer (Advanced Clinical Instrumentation, Cambridge, UK) was applied. Two saccadic tests, prosaccades task (PT) and antisaccades task (AT), were carried out.

Results:

Based on the results, we can assume that selected parameters, such as latency, standard deviation of latency, promptness, and correctness (directional errors), in individuals with ADHD/HKD differ statistically in the relevant parameters from the healthy ones. The latency and the standard deviation of latency in ADHD/HKD participants are greater when compared to healthy ones. ADHD/HKD participants have a greater number of directional errors in comparison to healthy ones.

Conclusions:

The standard deviation of latency prosaccades is a good parameter for distinguishing people from both groups. An important and innovative solution in this study in comparison to the studies of other authors, who reached similar results, is the use of an automatically calibrating system (autonomous) adapted for clinical use as well as a quantitative analysis of the saccadic parameters.

Abnormal early brain responses during visual search are evident in schizophrenia but not bipolar affective disorder

People with schizophrenia show deficits in processing visual stimuli but neural abnormalities underlying the deficits are unclear and it is unknown whether such functional brain abnormalities are present in other severe mental disorders or in individuals who carry genetic liability for schizophrenia. To better characterize brain responses underlying visual search deficits and test their specificity to schizophrenia we gathered behavioral and electrophysiological responses during visual search (i.e., Span of Apprehension [SOA] task) from 38 people with schizophrenia, 31 people with bipolar disorder, 58 biological relatives of people with schizophrenia, 37 biological relatives of people with bipolar disorder, and 65 non-psychiatric control participants. Through subtracting neural responses associated with purely sensory aspects of the stimuli we found that people with schizophrenia exhibited reduced early posterior task-related neural responses (i.e., Span Endogenous Negativity [SEN]) while other groups showed normative responses. People with schizophrenia exhibited longer reaction times than controls during visual search but nearly identical accuracy. Those individuals with schizophrenia who had larger SENs performed more efficiently (i.e., shorter reaction times) on the SOA task suggesting that modulation of early visual cortical responses facilitated their visual search. People with schizophrenia also exhibited a diminished P300 response compared to other groups. Unaffected first-degree relatives of people with bipolar disorder and schizophrenia showed an amplified N1 response over posterior brain regions in comparison to other groups. Diminished early posterior brain responses are associated with impaired visual search in schizophrenia and appear to be specifically associated with the neuropathology of schizophrenia.

The Speed of Visual Attention and Motor-Response Decisions in Adult Attention-Deficit/Hyperactivity Disorder

BACKGROUND

Adults with attention-deficit/hyperactivity disorder (ADHD) exhibit slowed reaction times (RTs) in various attention tasks. The exact origins of this slowing, however, have not been established. Potential candidates are early sensory processes mediating the deployment of focal attention, stimulus response translation processes deciding upon the appropriate motor response, and motor processes generating the response.

METHODS

We combined mental chronometry (RT) measures of adult ADHD (n = 15) and healthy control (n = 15) participants with their lateralized event-related potentials during the performance of a visual search task to differentiate potential sources of slowing at separable levels of processing: the posterior contralateral negativity (PCN) was used to index focal-attentional selection times, while the lateralized readiness potentials synchronized to stimulus and response events were used to index the times taken for response selection and production, respectively. To assess the clinical relevance of event-related potentials, a correlation analysis between neural measures and subjective current and retrospective ADHD symptom ratings was performed.

RESULTS

ADHD patients exhibited slower RTs than control participants, which were accompanied by prolonged PCN and lateralized readiness potentials synchronized to stimulus, but not lateralized readiness potentials synchronized to response events, latencies. Moreover, the PCN timing was positively correlated with ADHD symptom ratings.

CONCLUSIONS

The behavioral RT slowing of adult ADHD patients was based on a summation of internal processing delays arising at perceptual and response selection stages; motor response production, by contrast, was not impaired. The correlation between PCN times and ADHD symptom ratings suggests that this brain signal may serve as a potential candidate for a neurocognitive endophenotype of ADHD.

Attentional blink in children with attention deficit hyperactivity disorder

OBJECTIVE

To explore the temporal mechanism of attention in children with attention deficit hyperactivity disorder (ADHD) and controls using a rapid serial visual presentation (RSVP) task in which two letters (T1 and T2) were presented in close temporal proximity among distractors (attentional blink [AB]).

METHOD

Thirty children aged between 9 and 13 years (12 with ADHD combined type and 18 controls) took part in the study. Both groups performed two kinds of RSVP task. In the single task, participants simply had to identify a target letter (T1), whereas in the dual task, they had to identify a target letter (T1) and a probe letter (T2).

RESULTS

The ADHD and control groups were equivalent in their single-task performance. However, in the dual-task condition, there were significant between-group differences in the rate of detection of the probe letter (T2) at lag + 1 and lag + 4. The ADHD group exhibited a larger overall AB compared with controls.

CONCLUSION

Our findings provide support for a link between ADHD and attentional blink.

Is the impairment in temporal allocation of visual attention in children with ADHD related to a developmental delay or a structural cognitive deficit?

We investigated the temporal allocation of visual attention in 11-year-old children with attention-deficit/hyperactivity disorder (ADHD) by comparing their attentional blink (AB) parameters (duration, amplitude and minimum performance) with those observed in three groups of healthy control participants (8-year-olds, 11-year-olds and adults). The AB is a marker of impaired ability to detect a second target following the identification of a first target when both appear randomly within a rapid sequence of distractor items. Our results showed developmental effects; with age, the AB duration decreased and the AB minimum moved to shorter lag times. Importantly, 11-year old children with ADHD presented much the same similar AB patterns (in terms of duration and minimum position) as the healthy 8-year-old controls. Our results support the hypothesis whereby impaired allocation of temporal selective attention in children with ADHD is due to a developmental delay and not a specific cognitive deficit.

Effect of visual attention on postural control in children with attention-deficit/hyperactivity disorder

We compared the effect of oculomotor tasks on postural sway in two groups of ADHD children with and without methylphenidate (MPH) treatment against a group of control age-matched children. Fourteen MPH-untreated ADHD children, fourteen MPH-treated ADHD children and a group of control children participated to the study. Eye movements were recorded using a video-oculography system and postural sway measured with a force platform simultaneously. Children performed fixation, pursuits, pro- and anti-saccades. We analyzed the number of saccades during fixation, the number of catch-up saccades during pursuits, the latency of pro- and anti-saccades; the occurrence of errors in the anti-saccade task and the surface and mean velocity of the center of pressure (CoP). During the postural task, the quality of fixation was significantly worse in both groups of ADHD children with respect to control children; in contrast, the number of catch-up saccades during pursuits, the latency of pro-/anti-saccades and the rate of errors in the anti-saccade task did not differ in the three groups of children. The surface of the CoP in MPH-treated children was similar to that of control children, while MPH-untreated children showed larger postural sway. When performing any saccades, the surface of the CoP improved with respect to fixation or pursuits tasks. This study provides evidence of poor postural control in ADHD children, probably due to cerebellar deficiencies. Our study is also the first to show an improvement on postural sway in ADHD children performing saccadic eye movements.

Attentional guidance during visual search among patients with schizophrenia

The current study investigated visual guidance and saccadic selectivity during visual search among patients with schizophrenia (SCZ). Data from a previous study (Elahipanah, A., Christensen, B.K., & Reingold, E.M., 2008. Visual selective attention among persons with schizophrenia: The distractor ratio effect. Schizophr. Res. 105, 61-67.) suggested that visual guidance for the less frequent distractors in a conjunction search display (i.e., the distractor ratio effect) is intact among SCZ patients. The current study investigated the distractor ratio effect among SCZ patients when: 1) search is more demanding, and 2) search involves motion perception. In addition, eye tracking was employed to directly study saccadic selectivity for the different types of distractors. Twenty-eight SCZ patients receiving a single antipsychotic medication and 26 healthy control participants performed two conjunction search tasks: a within-dimension (i.e., colour × colour) search task; and a cross-dimension (i.e., motion × colour) search task. In each task the relative frequency of distractors was manipulated across 5 levels. Despite slower search times, patients' eye movement data indicated unimpaired visual guidance in both tasks. However, in the motion × colour conjunction search task, patients displayed disproportionate difficulty detecting the moving target when the majority of distractors were also moving. Results demonstrate that bottom-up attentional guidance is unimpaired among patients with SCZ; however, patients' impairment in motion discrimination impedes their ability to detect a moving target against noisy backgrounds.

Oculomotor and pupillometric indices of pro- and antisaccade performance in youth-onset psychosis and attention deficit/hyperactivity disorder

The goals of the study were to examine inhibitory deficits on the antisaccade task in 8- to 20-year olds with youth-onset psychosis or attention deficit/hyperactivity disorder (ADHD) and healthy controls and to examine if age-related changes in performance differed across groups. In addition to the conventional measures of performance, pupillary dilations were used to obtain estimates of phasic and tonic level of arousal. Results showed that the psychosis, but not the ADHD, group had elevated antisaccade error rates; however, variability of error rates was high in all groups. These inhibitory failures were accompanied by a lower level of momentary cognitive effort (as indexed by pupillary dilations). The largest differences between the control and clinical groups were found not in the expected indices of inhibition but in the probability of correcting inhibitory errors and in variability of antisaccade response times, which were correlated with each other. These findings did not appear to be attributable to a deficit in maintaining task instructions in mind in either disorder or lack of motivation in ADHD. Instead, results point to impairments in both clinical groups in sustaining attention on a trial-by-trial basis, resulting in deficits in self-monitoring. Thus, results show inhibitory deficits in the context of more general attentional impairments in both disorders.

Shared and nonshared symptoms in youth-onset psychosis and ADHD

OBJECTIVE

We compared ratings of behavior and attention problems between youth-onset psychosis and ADHD, two disorders in which attentional impairments play a key role, and examined the effect of psychostimulant use on age of onset in psychosis.

METHOD

Parent and teacher ratings of behavioral problems and ADHD symptoms were collected using the Achenbach CBCL, TRF, and SNAP-IV Teacher Rating Scales on 42 participants with psychosis, 36 with ADHD and 57 controls (ages 8-19).

RESULTS AND CONCLUSIONS

Results suggested that academic, externalizing, and attention problems reflect symptoms shared between the disorders, whereas internalizing, social and thought problems reflect factors that differ between disorders. Furthermore, participants with psychosis who had been prescribed psychostimulants had a younger age of onset of psychotic symptoms than those who had not. This difference could reflect dissimilarities in symptom severity symptom between subgroups or potentially harmful effects of psychostimulants in individuals predisposed to develop psychosis.

The impact of instruction and response cost on the modulation of response-style in children with ADHD

Background

The present study investigated the impact of divergent instructions and response cost on strategic cognitive control in children with ADHD.

Methods

Children with ADHD (N = 34), combined subtype, and control children (N = 34) performed a series of self-paced computerized visual search tasks. The tasks varied by verbal instructions: after a baseline task, children were either instructed to work as fast as possible (speed instruction) or as accurately as possible (accuracy instruction). In addition, tasks were performed with and without response cost.

Results

Both groups modulated latencies and errors according to instructions in a comparable way, except for latency in the accuracy - instruction without response cost, where control children showed a larger increase of response time. Response cost did not affect the modulation of response style in children with ADHD to a larger extent than in controls. However, with instructions group differences related to target criteria became clearly more accentuated compared to baseline but disappeared when response cost was added.

Conclusions

Delay aversion theory and motivational or state regulation models may account for different aspects of the results. Modifications related to task presentation, such as the emphasis put on different details in the verbal instruction, may lead to divergent results when comparing performances of children with ADHD and control children on a self-paced task.

From bench to bedside: translating new research from genetics and neuroimaging into treatment development for early-onset schizophrenia

OBJECTIVE

Children and adolescents with schizophrenia share a similar pattern of phenomenological, genetic and cognitive abnormalities to adults with schizophrenia. However, an early-onset of schizophrenia (EOS) (prior to 18 years of age) is associated with a higher frequency of risk indicators associated with schizophrenia (e.g. developmental delays and familial spectrum disorders) and a worse long-term outcome. This overview examines recent research on the neurobiological alterations, possible causes, developmental trajectory and treatment of EOS and attempts to identify gaps in the field.

METHOD

The authors provide a selective review of major findings from genetics, neuroimaging and treatment studies of pediatric schizophrenia that were presented at a workshop sponsored by the National Institute of Mental Health. These data are synthesized in conjunction with preclinical studies into a model of the pathophysiology of EOS.

RESULTS

EOS is associated with a high frequency of cytogenetic abnormalities (e.g. velocardiofacial syndrome, sex chromosome anomalies) and other rare denovo chromosomal aberrations. Brain imaging research in adolescents with EOS has revealed a progressive loss of cortical grey matter post-onset of psychosis and subtle abnormalities in white matter microstructure. Although EOS patients are more likely to be treatment-refractory than their adult counterparts, there are substantial data that this subgroup is particularly responsive to clozapine.

CONCLUSIONS

Genetic or environmental factors operating during adolescence that reduce frontal capacity might contribute to an EOS in susceptible individuals. Additional longitudinal studies of adolescents with schizophrenia are needed to better understand the relationship between structural changes in fronto-limbic regions, stress responsivity, and cognitive and neurochemical development.

ERP correlates of selective attention and working memory capacities in children with ADHD and/or PDD-NOS

OBJECTIVE

We examined whether children (8-11 years) diagnosed with Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) or Attention-Deficit/Hyperactivity Disorder (ADHD) showing primarily hyperactive behavior, differed in selective attention and working memory (WM) abilities.

METHODS

Healthy controls and children with ADHD, PDD-NOS or symptoms of both disorders (PDD/HD) (n=15 in each group) carried out a visual selective memory search task while their EEG was recorded from which event-related potentials were derived.

RESULTS

Compared to the control group, all patient groups made more omissions while hyperactive children also exhibited more false alarms. Regarding the process of WM-controlled search, significant group differences in ERP data were found between the control group and each of the clinical groups.

CONCLUSIONS

The results point to less efficient WM-functioning in all patient groups. Whereas the clinical groups differed from each other at the behavioral level as measured by questionnaires, no distinction between the clinical groups could be made with respect to performance or ERP measures of WM capacity and selective attention.

SIGNIFICANCE

The results suggest that a possible differentiation in selectivity and working memory capacities between PDD-NOS and ADHD is hard to find. This may agree with clinical practice, where differential diagnosis is a subject of discussion.

A review on eye movement studies in childhood and adolescent psychiatry

The neural substrates of eye movement measures are largely known. Therefore, measurement of eye movements in psychiatric disorders may provide insight into the underlying neuropathology of these disorders. Visually guided saccades, antisaccades, memory guided saccades, and smooth pursuit eye movements will be reviewed in various childhood psychiatric disorders. The four aims of this review are (1) to give a thorough overview of eye movement studies in a wide array of psychiatric disorders occurring during childhood and adolescence (attention-deficit/hyperactivity disorder, oppositional deviant disorder and conduct disorder, autism spectrum disorders, reading disorder, childhood-onset schizophrenia, Tourette's syndrome, obsessive compulsive disorder, and anxiety and depression), (2) to discuss the specificity and overlap of eye movement findings across disorders and paradigms, (3) to discuss the developmental aspects of eye movement abnormalities in childhood and adolescence psychiatric disorders, and (4) to present suggestions for future research. In order to make this review of interest to a broad audience, attention will be given to the clinical manifestation of the disorders and the theoretical background of the eye movement paradigms.

Literature review: visual search by children with and without ADHD

OBJECTIVE

To summarize the literature that has employed visual search tasks to assess automatic and effortful selective visual attention in children with and without ADHD.

METHOD

Seven studies with a combined sample of 180 children with ADHD (M age = 10.9) and 193 normally developing children (M age = 10.8) are located.

RESULTS

Using a qualitative approach, the authors find no group difference in automatic search, but results are variable for effortful serial search. Using a novel, graphical approach, the authors find that the ADHD group demonstrated less efficient serial search. This overall effect is explored as a function of search display complexity. Children with ADHD search less efficiently at the lowest and highest levels of display complexity.

CONCLUSION

Children with ADHD show impairments in aspects of their effortful visual selective attention, as measured by visual search.

Improving antisaccade performance in adolescents with attention-deficit/hyperactivity disorder (ADHD)

The goal of the study was to examine the effects of task manipulations on antisaccade accuracy and response times (RTs) of adolescents with attention-deficit/hyperactivity disorder (ADHD), age-matched controls, 10-year-olds and young adults. Order effects were tested by administering the task at the beginning and end of the session. Other manipulations involved a visual landmark to reduce demands on working memory and internal generation of saccades; spatially specific and non-specific cues at three intervals; and central engagement of attention through perceptual and cognitive means at three intervals. As expected, adolescents with ADHD were impaired relative to age-matched controls in terms of accuracy and saccadic RT on the first administration of the task. Although their accuracy improved with most of the manipulations, it did not improve disproportionately compared to age-matched controls. Nevertheless, with most of the manipulations, they could achieve the same level of accuracy as unaided controls on the first administration of the task. In contrast, the saccadic RTs of the ADHD group came close to normal under several conditions, indicating that elevated antisaccade RTs in this disorder may be related to attentional factors. The ADHD group made more premature saccades and fewer corrective saccades than both the age-matched and younger groups, suggesting difficulties with impulsivity and goal neglect. The findings suggest that cognitive scaffolds can ameliorate at least some of the inhibition deficits in adolescents with ADHD.

ADHD and schizophrenia phenomenology: visual scanpaths to emotional faces as a potential psychophysiological marker?

Commonalities in the clinical phenomenology and psychopharmacology of ADHD and schizophrenia are reviewed. The potential of psychostimulants to produce psychotic symptoms emphasizes the need for objective psychophysiological distinctions between these disorders. Impaired emotion perception in both disorders is discussed. It is proposed that visual scanpaths to facial expressions of emotion might prove a potentially useful psychophysiological distinction between ADHD and schizophrenia. There is consistent evidence that both facial affect recognition and scanpaths to facial expressions are impaired in schizophrenia, with emerging empirical evidence showing that facial affect recognition is impaired in ADHD also. Brain imaging studies show reduced activity in the medial prefrontal and limbic (amygdala) brain regions required to process emotional faces in schizophrenia, but suggest more localized loss of activity in these regions in ADHD. As amygdala activity in particular has been linked to effective visual scanning of face stimuli, it is postulated that condition-specific breakdowns in these brain regions that subserve emotional behavior might manifest as distinct scanpath aberrations to facial expressions of emotion in schizophrenia and ADHD.

Insights into the control of attentional set in ADHD using the attentional blink paradigm

BACKGROUND

Previous work on visual selective attention in Attention Deficit Hyperactivity Disorder (ADHD) has utilised spatial search paradigms. This study compared ADHD to control children on a temporal search task using Rapid Serial Visual Presentation (RSVP). In addition, the effects of irrelevant singleton distractors on search performance were examined.

METHOD

In each condition, subjects reported the identity of a red letter 'probe' in a sequence of white letters which appeared one after the other at a central fixation point. The temporal position of the probe varied from an initial target, which was distinguished by surrounding asterisks. The target was reported in addition to the probe in condition 2, but not in the baseline condition 1. In a third condition, the initial target was not reported, but one of the asterisks appeared as a colour singleton on some trials.

RESULTS

All children displayed an 'attentional blink' with probe detection reduced when it appeared at close temporal relations relative to the target. This 'blink' reduced over time, and there were no group differences in the recovery of performance, although ADHD children made more errors overall. The ADHD group were also more vulnerable than controls to distraction from irrelevant singletons in condition 3.

CONCLUSION

Although the basic mechanisms of selective attention were not impaired in children with ADHD, these children appeared to require more resources to execute the task and were more vulnerable to distraction by irrelevant singletons, indicating deficits in the maintenance of attentional control.

Larger deficits in brain networks for response inhibition than for visual selective attention in attention deficit hyperactivity disorder (ADHD)

BACKGROUND

Brain activation differences between 12 control and 12 attention deficit hyperactivity disorder (ADHD) children (9- to 12-year-olds) were examined on two cognitive tasks during functional magnetic resonance imaging (fMRI).

METHOD

Visual selective attention was measured with the visual search of a conjunction target (red triangle) in a field of distracters and response inhibition was measured with a go/no-go task.

RESULTS

There were limited group differences in the selective attention task, with control children showing significantly greater intensity of activation in a small area of the superior parietal lobule region of interest. There were large group differences in the response inhibition task, with control children showing significantly greater intensity of activation in fronto-striatal regions of interest including the inferior, middle, superior and medial frontal gyri as well as the caudate nucleus and globus pallidus.

CONCLUSION

The widespread hypoactivity for the ADHD children on the go/no-go task is consistent with the hypothesis that response inhibition is a specific deficit in attention deficit hyperactivity disorder.

Exploring selective attention in ADHD: visual search through space and time

BACKGROUND

In order to examine the mechanisms mediating selective attention in Attention Deficit Hyperactivity Disorder (ADHD), this study compared the performance of children diagnosed with ADHD to non-clinical controls on a visual search task in three conditions.

METHOD

In the single feature condition, the target differed from distractors in terms of shape only, whilst in the conjunction baseline, the target was defined by shape and colour relative to distractors. In the preview condition, the conjunction stimuli were segmented over time, so that one set of distractors appeared first, followed 1000 ms later by the second set with the target.

RESULTS

Although children with ADHD were slower overall than controls, RTs revealed no difference in search mechanisms between groups; for all children, search was more efficient in the single feature and preview conditions than in the conjunction baseline. However, children with ADHD made more errors, especially in the conjunction and preview conditions.

CONCLUSIONS

Children with ADHD were not impaired in their mechanisms of visual search relative to controls, but their error patterns implied the adoption of a premature response deadline in the conjunction search condition, and an occasional failure to inhibit old items in the preview condition.

Psychosis proneness and ADHD in young relatives of schizophrenia patients

Symptoms resembling the attentional deficit hyperactivity disorder (ADHD) are frequently observed in young relatives at risk for schizophrenia (HR). We examined the frequency of the ADHD syndrome and its relationship to psychosis related psychopathology and neurobehavioral abnormalities in young HR subjects (n=29) and healthy comparison subjects (HC; n=30). Thirty-one percent of HR subjects (n=9) had ADHD as a lifetime Axis-I diagnosis (HR-A). Compared to healthy comparison subjects, the HR-A group had impaired neurological function. The HR-A group but not the HR subjects without ADHD had higher scores on the Chapman's magical ideation and perceptual aberration scales. Thus, ADHD-like features are more prevalent in the HR population than the one described in the general population and are associated with more frequent psychosis-like clinical features. Longitudinal studies can clarify whether an "ADHD subgroup" within HR subjects predict an increased risk for future emergence of schizophrenia.

Schizophrenia and attention deficit disorder. Two complex disorders of attention

Attentional dysfunction can be found in nearly every form of psychopathology, not just in attention deficit disorder (ADD). Being able to distinguish ADD from other psychiatric conditions is crucial for clinicians working with adolescents and young adults, particularly in the case of psychoses where making the correct diagnosis and beginning treatment promptly is extremely important. In this paper we review the literature on the attentional dysfunction found in schizophrenia and compare it to that found in ADD in an effort to increase our knowledge of etiology and underlying mechanisms. Investigators studying ADD may learn from the study of schizophrenia by realizing that ADD is also a complex disorder of attention that occurs across the developmental spectrum and is characterized by various predispositional, environmental, and maturational factors.

Continuous performance tests are sensitive to ADHD in adults but lack specificity. A review and critique for differential diagnosis

Historically, the focus for Attention Deficit Hyperactivity Disorder (ADHD) has been on children, with considerable research and many opinions available in this area. More recently, the focus has been expanded to include ADHD in adults. Assessment of ADHD in adults is complicated by the high rate of co-occurring disorders as well as symptom overlap with a number of disorders. One popular family of measures for the assessment of attention and executive control is the continuous performance test (CPT). A review of the available research on CPTs reveals that they are quite sensitive to CNS dysfunction. This is both a strength and a limitation of CPTs in that multiple disorders can result in impaired performance on a CPT. The high sensitivity of CPTs is further complicated by the multiple variations of CPTs available, some of which may be more sensitive or demonstrate better specificity to ADHD in adults than others. If CPTs are to be used clinically, further research will be needed to answer the questions raised by this review.

Eye movement task measures inhibition and spatial working memory in adults with schizophrenia, ADHD, and a normal comparison group

Schizophrenia and attention deficit/hyperactivity disorder (ADHD) are both associated with deficits in inhibition and working memory, although in ADHD the working memory deficit is hypothesized to be secondary to the inhibitory deficit. This similarity in cognitive processes has been paralleled by similarities across the two groups in the performance of working memory and inhibition tasks. The delayed oculomotor response task is an alternative task, which may allow greater separation of working memory from inhibitory components, and thus its use may provide additional information on primary vs. secondary deficits in these disorders. Ten young adult ADHD sufferers, 10 schizophrenic subjects, and 10 normal subjects were matched on age, gender, and education. Eye movements were recorded during delayed oculomotor response tasks with 1- and 3-s delays. Both the ADHD and the schizophrenic subjects demonstrated dis-inhibition (an increased percentage of premature saccades); however only schizophrenic subjects demonstrated an impaired working memory (decreased spatial accuracy of the remembered saccade). The results are consistent with the hypothesis that working memory is a primary deficit in schizophrenia, but secondary to the inhibitory deficit in ADHD.

Parallel and serial search in two teenagers with lesions of the mesial parietal cortex

Visual-spatial attention was examined in two 14-year-olds who had undergone occipital-parietal craniotomies for removal of mesial parietal tumors, one in the right and one in the left hemisphere. Neither patient showed clinically significant visual neglect. They were administered two visual search tasks from Treisman and Souther [43] that make significantly different demands on visual spatial attention. In feature-present (parallel) search, they searched for the presence of a feature. In feature-absent (serial) search, they searched for its absence. Search rate was estimated from the slope of the function relating display size to response time. Both patients had flat slopes in feature-present search to target-present (TP) displays, indicating that they could conduct parallel search at the same rate as controls. Although the patient with the right-hemisphere lesion also had a flat slope to target-absent (TA) displays, the patient with the left-hemisphere lesion had a steep slope (30 ms/item) in this condition. In feature-absent search, the patients had equally slow search rates compared to controls, suggesting that the mesial parietal cortex is part of the network that mediates serial shifts of attention. Results support the distinction between detection of the target in parallel vs serial search and suggest that processes involved in TP and TA trials in parallel search are also dissociable.

Exploratory eye movements to pictures in childhood-onset schizophrenia and attention-deficit/hyperactivity disorder (ADHD)

We investigated exploratory eye movements to thematic pictures in schizophrenic, attention-deficit/hyperactivity disorder (ADHD), and normal children. For each picture, children were asked three questions varying in amount of structure. We tested if schizophrenic children would stare or scan extensively and if their scan patterns were differentially affected by the question. Time spent viewing relevant and irrelevant regions, fixation duration (an estimate of processing rate), and distance between fixations (an estimate of breadth of attention) were measured. ADHD children showed a trend toward shorter fixations than normals on the question requiring the most detailed analysis. Schizophrenic children looked at fewer relevant, but not more irrelevant, regions than normals. They showed a tendency to stare more when asked to decide what was happening but not when asked to attend to specific regions. Thus, lower levels of visual attention (e.g., basic control of eye movements) were intact in schizophrenic children. In contrast, they had difficulty with top-down control of selective attention in the service of self-guided behavior.

Exploratory eye movements to pictures in childhood-onset schizophrenia and attention-deficit/hyperactivity disorder (ADHD)

We investigated exploratory eye movements to thematic pictures in schizophrenic, attention-deficit/hyperactivity disorder (ADHD), and normal children. For each picture, children were asked three questions varying in amount of structure. We tested if schizophrenic children would stare or scan extensively and if their scan patterns were differentially affected by the question. Time spent viewing relevant and irrelevant regions, fixation duration (an estimate of processing rate), and distance between fixations (an estimate of breadth of attention) were measured. ADHD children showed a trend toward shorter fixations than normals on the question requiring the most detailed analysis. Schizophrenic children looked at fewer relevant, but not more irrelevant, regions than normals. They showed a tendency to stare more when asked to decide what was happening but not when asked to attend to specific regions. Thus, lower levels of visual attention (e.g., basic control of eye movements) were intact in schizophrenic children. In contrast, they had difficulty with top-down control of selective attention in the service of self-guided behavior.