Development of Inattention, Impulsivity, and Processing Speed as Measured by the d2 Test: Results of a Large Cross-sectional Study in Children Aged 7–13

Executive functions and their relationship with age: Insights from a novel neuropsychological Assessment Battery in Children-a pilot study

Executive functions (EFs) are a set of cognitive processes that enable individuals to manage and coordinate their thoughts and actions toward achieving specific goals. EFs include planning, organizing, initiating, and monitoring actions, and have been found to improve with age due to the maturation of the brain, especially during childhood. Therefore, our correlational study sought to determine the relationship between the performance in executive functions and age in 79 children (36 girls, 45.6%) throughout development, between the ages of 6 and 12 (mean = 9.25; SD = 2.05), using a battery designed in Chile: BEFE (Batería de Evaluación de las Funciones Ejecutivas: Executive Function Assessment Battery) based on traditional neuropsychological tests to evaluate Working Memory, Inhibitory Control, Cognitive Flexibility, and Planning skills. Our results showed various correlations between the variables age and performance in various behavioral parameters, demonstrating an increase in the number of correct responses (positive correlation) and/or a decrease in errors (negative correlation) with age (6-12) in the subtests that correspond to dimensions of Cognitive Flexibility (Semantic and Phonological Fluency, Card Sorting Game, and Tracing Tasks), Inhibitory Control (ENA-F and Sentence Completion), Working Memory (Audio-verbal WM Forward and Ordering, and Visuospatial WM Forward and Backward), and Planning (La Portada de Antofagasta and FISA Maps). These results are consistent with previous empirical evidence and support the notion of a developmental relationship between EF performance and age. Additionally, this study contributes to understanding EF development in culturally specific contexts, highlighting the importance of contextually relevant assessment tools in evaluating cognitive development.

Adaptations of the Walking Corsi Test (WalCT) for 2- and 3-year-old preterm and term-born toddlers: A preliminary study

Introduction

Topographical memory is crucial for navigation and environmental representation. The Walking Corsi Test (WalCT) has been used to evaluate topographical memory in children from 4 years upward. The present study aims to determine whether adapted versions of the WalCT- by simplifying instructions and increasing motivation- can be adopted to test topographical memory in 2- and 3-year-old toddlers born at term and preterm. Assessing this skill in such young children is important in light of recent studies that have shown how spatial cognition underlies the development of skills in other cognitive domains as well. Methods: For this purpose, 47 toddlers (27.39 ± 4.34 months, 38.3% females), 20 born at term and 27 preterm, performed two aimed-designed versions of WalCT.

Results

The results showed better performance of the term groups with increasing age and for both versions. On the other hand, performance was better in 2-year-old term toddlers vs. preterm. When rising motivation, 2-year-old preterm toddlers improve their performance but differences between both groups were still significant. The preterm group showed lower performance related to lower levels of attention.

Discussion

This study provides preliminary data on the suitability of the adapted versions of WalCT in early ages and prematurity conditions.

UCancellation: A new mobile measure of selective attention and concentration

Measuring selective attention in a speeded task can provide valuable insight into the concentration ability of an individual, and can inform neuropsychological assessment of attention in aging, traumatic brain injury, and in various psychiatric disorders. There are only a few tools to measure selective attention that are freely available, psychometrically validated, and can be used flexibly both for in-person and remote assessment. To address this gap, we developed a self-administrable, mobile-based test called “UCancellation” (University of California Cancellation), which was designed to assess selective attention and concentration and has two stimulus sets: Letters and Pictures. UCancellation takes less than 7 minutes to complete, is automatically scored, has multiple forms to allow repeated testing, and is compatible with a variety of iOS and Android devices. Here we report the results of a study that examined parallel-test reliability and convergent validity of UCancellation in a sample of 104 college students. UCancellation Letters and Pictures showed adequate parallel test reliability (r = .71–.83, p < 0.01) and internal consistency (ɑ = .73–.91). It also showed convergent validity with another widely used cancellation task, d2 Test of Attention (r = .43–.59, p < 0.01), and predicted performance on a cognitive control composite (r = .34–.41, p < 0.05). These results suggest that UCancellation is a valid test of selective attention and inhibitory control, which warrants further data collection to establish norms.

Temporal Deployment of Attention by Mental Training: an fMRI Study

In this study, we employed a visuo-motor imagery task of alertness as a mental training to examine temporal processing of motor responses within healthy young adults. Participants were divided into two groups (group 1; n = 20 who performed the mental training before the real physical task and a control group who performed the physical task without mental training). We vary the time interval between the imperative stimulus and the preceding one (fore-period) in which temporal preparation and arousal increase briefly. Our behavioural results provide clear evidence that mental training reinforces both temporal preparation and arousal, by shortening reaction time (RT), especially for the shortest fore-periods (FP) within exogenous "FP 250 ms" (p = 0.008) and endogenous alertness "FP 650 ms" (p = 0.001). We investigated how the brain controls such small temporal changes. We focus our neural hypothesis on three brain regions: anterior insula, dorsolateral prefrontal cortex, and anterior cingulate cortex and three putative circuits: one top-down (from dorsolateral prefrontal cortex to anterior cingulate cortex) and two bottom-up (from anterior insula to dorsolateral prefrontal cortex and anterior cingulate cortex). In fMRI, effective connectivity is strengthened during exogenous alertness between anterior insula and dorsolateral prefrontal cortex (p = 0.001), between anterior insula and cingulate cortex (p = 0.01), and during endogenous alertness between dorsolateral prefrontal cortex and anterior cingulate cortex (p = 0.05). We suggest that attentional reinforcement induced by an intensive and short session of mental training induces a temporal deployment of attention and allow optimizing the time pressure by maintaining a high state of arousal and ameliorating temporal preparation.

Convergent validity, academic correlates and age- and SES-based normative data for the d2 Test of attention in children

The d2, test of attention is one of the most used neuropsychological tests to measure attention in clinical and research settings. To date, no studies have examined neither its convergent and divergent validity in children nor its relationship with academic skills at school age. The aims of the present study were: (1) to examine the convergent and divergent validity of the d2 Test in a non-clinical pediatric population, (2) to explore the relationship between d2 task performance and academic skills (i.e., math, reading and writing abilities) and (3) to develop normative data for Spanish-speaking children (n = 360 8- to 12-year-old children) stratified by age and socioeconomic status (SES). Pearson's correlation and Structural Equation Models (SEM) were used to analyze the d2 Test validity and its relationship with academic skills. A between-subjects factorial MANOVA was used to examine differences among SES (Middle, Low), age (8-10, 11-12), and sex (male, female). Findings revealed a significant relationship between d2 task performance and all attention and executive functions (EF) measures under analysis providing evidence of good convergent validity. Furthermore, SEM results showed that attention has direct effects on math and reading and writing skills. Finally, our study confirms the influence of age and SES on d2 task performance and provides normative data for middle- and low-SES children. These results have important implications for the assessment of attention functions in clinical and research settings in children with typical and atypical development.

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.

Physical Fitness and Dynamic Balance in Medication Naïve Turkish Children with ADHD

This study investigated physical fitness levels and dynamic balance in medication-naïve children with Attention-Deficit/Hyperactivity Disorder (ADHD). Participants were 24 medication-naïve Turkish children with ADHD (4 girls, 20 boys) and 19 typically developing (TD) Turkish children (4 girls, 15 boys). We measured physical fitness levels with the Eurofit Test Battery, body composition with the Inbody 720 Body Composition Analyzer, cognitive attention with the Stroop Test, and dynamic balance with the Y-Balance Test. We found significantly poorer dynamic balance and both upper extremity and running fitness problems among the medication-naïve Turkish children with ADHD compared to the TD group (p = 0.002; p = 0.032; p = 0.002). It may be important to adress dynamic balance and physical fitness when treating children with ADHD.

Implementation of an attention training programme with a sample of children who have sustained traumatic brain injuries in South Africa: A pilot study

This pilot study evaluated the feasibility of implementing an attention-training programme for children who have sustained moderate-to-severe traumatic brain injuries (TBIs) in a South African context. We compared the performance on the programme of children with TBI (TBI Intervention Group) to children who had been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD Intervention Group), a TBI Art group and a TBI No-intervention Group (n=5 in each group) in this preliminary study. Children in the two Intervention Groups participated in the "Pay Attention!" programme for 45 minutes twice a week for 12 weeks. All children were aged 6-8 years and underwent neuropsychological testing pre- and post-intervention. Behavioural data were collected from parents. Children in the ADHD Intervention Group showed individual clinically significant attentional improvements on measures of the Conners' Continuous Performance Test II using the Reliable Change Index (≥ 2.58 SD). Despite mixed results, the pilot study demonstrates that implementing a cognitive rehabilitation programme in South Africa is feasible and necessary, despite limited infrastructure and access to resources.

Selective Attention and Inhibitory Control of Attention Are Correlated With Music Audiation

Executive functions (EFs) are cognitive functions needed for adaptive and targeted behavior. Music aptitude is the potential or capacity for musical achievement. A key element of music aptitude is audiation, defined as the process through which sound becomes music and meaning is attributed to that music. In this paper, we report on the association between audiation skills and executive skills. Not only is this important to consider the validity of the audiation tests, but also to better understand the concept of audiation and its link to cognitive skills. We conducted an empirical study, in which a sample of second grade school students from two elementary schools, one from Ghent, Belgium (N = 36) and the other from Santiago, Chile (N = 25), were administered both a musical aptitude and an attention and inhibitory control test. We hypothesized that a positive correlation exists between sustained attention, inhibitory control and music aptitude.

Exploring correlations between neuropsychological measures and domain-specific consistency in associations with n-3 LCPUFA status in 8-9 year-old boys and girls

Long-chain n-3 polyunsaturated fatty acids (n-3 LCPUFA) have in some studies been associated with cognitive and socioemotional outcomes in children, but results are inconsistent possibly due to the use of different tests and potential gender-specific effects. The objective of this cross-sectional study was to explore overall patterns in neuropsychological scores as well as correlations between scores within specific domains, and to examine potential gender differences and consistency in associations with n-3 LCPUFA status. In 199 Danish 8–9 year-old children, we performed a large battery of tests and questionnaires on attention, processing speed, executive functions, memory, and socioemotional traits, and measured erythrocyte fatty acid composition. Principal component analyses (PCA) showed that most of the variation in both cognitive performance and socioemotional traits was explained by overall performance, followed by speed-accuracy trade off and externalizing vs. internalizing problems, respectively. Boys had higher speed, lower attention and higher externalizing problem scores than girls. Measures of performance within both processing speed and attention domains correlated moderately, whereas no correlations were found for measures of executive functions apart from some weak correlations for impulsivity. Parent-rated scores for both externalizing and internalizing problems correlated strongly, whereas correlations with child-rated scores were weak. Scores within specific domains did not consistently associate with n-3 LCPUFA, except for processing speed measures which all pointed to faster processing with increased n-3 LCPUFA status. Gender differences in the associations were observed for attention and impulsivity. Child- but not parent-rated internalizing and social problems tended to associate directly with n-3 LCPUFA, supported by increased internalizing problems measured by the PCA component. In conclusion, measures of speed and attention seem to represent these domains in general, whereas single measures of more complex cognitive functions should be interpreted with caution. One approach could be to use multiple tests and create multivariate scores to guide interpretations. Furthermore, the results indicate a need to consider both parent- and child-rated socioemotional scores and gender differences in neuropsychological functions e.g. in investigations of n-3 LCPUFA effects.

Test of Everyday Attention for Children (TEA-Ch): Greek Normative Data and Discriminative Validity for Children with Combined Type of Attention Deficit-Hyperactivity Disorder

We examined the utility of the Test of Everyday Attention for Children (TEA-Ch) for Greek children. Discrete and regression-based norms, controlling for demographic characteristics and intelligence, were derived from the performance of 172 children. We also assessed the ability of the TEA-Ch to differentiate children with ADHD-Combined Type (ADHD-C) from healthy matched peers. Children with ADHD-C displayed dysfunction in multiple attentional domains. Discriminant function analysis indicated that two subtests (Sky Search and Walk, Don't Walk) correctly classified 84.2% of children with ADHD-C.

Which Factors Influence Attentional Functions? Attention Assessed by KiTAP in 105 6-to-10-Year-Old Children

This research revealed the children with difficulties in attentional functions among healthy children attending primary school and aimed to identify the possible sociodemographic factors, such as the child’s age, gender, and school grade, that could influence attentive performance. The participants were 105 children aged 6–10 years (M age = 8.6; SD = 1.04), attending primary schools. Family economic condition was mostly at a medium level (63.5%), and parents most frequently had 13 years of schooling. The computerized test KiTAP was administered to children to assess their attentional functions. Results showed a higher frequency of omissions and false alarms and a reduced speed in alertness, go/no-go, and sustained attention tasks compared to Italian norms. Hierarchical regression analyses were run with school grade, gender, and current age as independent variables and mean reaction times (and standard deviation), number of omissions, and false alarms as dependent ones. The results showed that male gender and attending a lower grade impacted on lower attentional performance in several subtests. Girls showed the best performances in tests of distractibility and impulsive reaction tendencies, while higher school grade positively influenced divided and sustained attention. These results could be useful to identify children with major attentional difficulties, and some recommendations for future studies and the implementation of attention empowerment programmes are proposed.

d2-R test for Japanese adolescents: Concurrent validity with the attention deficit-hyperactivity disorder rating scale

BACKGROUND

The d2-R test is a cancellation test developed in Germany to measure concentration and attention. This study examined the validity of the d2-R test for Japanese adolescents in comparison with German standardized data.

METHODS

Japanese junior high school students (n = 121; 61 girls, 60 boys) participated in this study. The students' performance scores in the d2-R test were compared with their daily attentiveness and hyperactivity/impulsiveness assessments conducted by the teachers. The assessments were evaluated using the attention deficit-hyperactivity disorder rating scale, fourth edition (ADHD-RS)-IV. The comparison with German counterparts was also made.

RESULTS

Students who were rated as less attentive and more hyperactive/impulsive performed more slowly and committed more errors in the d2-R test. Although there were no sex differences in any of the d2-R parameters, male students were rated higher than female students in all of the ADHD-RS-IV scores. Japanese adolescents outscored German counterparts on speed, concentration, and carefulness.

CONCLUSION

The concurrent validity of the d2-R test is confirmed. It is an appropriate index to measure the sustained and focused attention of Japanese adolescents. The present research merits attention as the first investigation of the d2-R test conducted for Japanese adolescents.

Effect of alternating postures on cognitive performance for healthy people performing sedentary work

Prolonged sitting is a risk factor for several diseases and the prevalence of worksite-based interventions such as sit-to-stand workstations is increasing. Although their impact on sedentary behaviour has been regularly investigated, the effect of working in alternating body postures on cognitive performance is unclear. To address this uncertainty, 45 students participated in a two-arm, randomised controlled cross-over trial under laboratory conditions. Subjects executed validated cognitive tests (working speed, reaction time, concentration performance) either in sitting or alternating working postures on two separate days (ClinicalTrials.gov Identifier: NCT02863731). MANOVA results showed no significant difference in cognitive performance between trials executed in alternating, standing or sitting postures. Perceived workload did not differ between sitting and alternating days. Repeated measures ANOVA revealed significant learning effects regarding concentration performance and working speed for both days. These results suggest that working posture did not affect cognitive performance in the short term. Practitioner Summary: Prior reports indicated health-related benefits based on alternated (sit/stand) body postures. Nevertheless, their effect on cognitive performance is unknown. This randomised controlled trial showed that working in alternating body postures did not influence reaction time, concentration performance, working speed or workload perception in the short term.

Concentration Endurance Test (d2): Normative data for Spanish-speaking pediatric population

OBJECTIVE

To generate normative data for the Concentration Endurance Test (d2) in Spanish-speaking pediatric populations.

METHOD

The sample consisted of 4,373 healthy children from nine countries in Latin America (Chile, Cuba, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Peru, and Puerto Rico) and Spain. Each participant was administered the d2 test as part of a larger neuropsychological battery. The Total number of items processed (TN), Total number of correct responses (CR), Total performance (TP), and Concentration performance (CP) scores were normed using multiple linear regressions and standard deviations of residual values. Age, age2, sex, and mean level of parental education (MLPE) were included as predictors in the analyses.

RESULTS

The final multiple linear regression models showed main effects for age on all scores, such that scores increased linearly as a function of age. TN scores were affected by age2 for Guatemala and Puerto Rico; CR scores were affected by age2 for Mexico; TP scores were affected by age2 for Chile, Mexico, Puerto Rico, and Spain; and CP scores for Mexico and Spain. Models indicated that children whose parents had a MLPE >12 years obtained higher scores compared to children whose parents had a MLPE≤12 years for Mexico and Spain in all scores, and Puerto Rico for TN, CR, and TP, and Guatemala and Paraguay for CP scores. Sex affect the scores for Ecuador and Honduras (CP scores).

CONCLUSIONS

This is the largest Spanish-speaking pediatric normative study in the world, and it will allow neuropsychologists from these countries to have a more accurate approach to interpret the d2 test in pediatric populations.

Effect of a novel two-desk sit-to-stand workplace (ACTIVE OFFICE) on sitting time, performance and physiological parameters: protocol for a randomized control trial

Background

Prolonged sitting is ubiquitous in modern society and linked to several diseases. Height-adjustable desks are being used to decrease worksite based sitting time (ST). Single-desk sit-to-stand workplaces exhibit small ST reduction potential and short-term loss in performance. The aim of this paper is to report the study design and methodology of an ACTIVE OFFICE trial.

Design

The study was a 1-year three-arm, randomized controlled trial in 18 healthy Austrian office workers. Allocation was done via a regional health insurance, with data collection during Jan 2014 – March 2015. Participants were allocated to either an intervention or control group. Intervention group subjects were provided with traditional or two-desk sit-to-stand workstations in either the first or the second half of the study, while control subjects did not experience any changes during the whole study duration.

Sitting time and physical activity (IPAQ-long), cognitive performance (text editing task, Stroop-test, d2R test of attention), workload perception (NASA-TLX) and physiological parameters (salivary cortisol, heartrate variability and body weight) were measured pre- and post-intervention (23 weeks after baseline) for intervention and control periods. Postural changes and sitting/standing time (software logger) were recorded at the workplace for the whole intervention period.

Discussion

This study evaluates the effects of a novel two-desk sit-to-stand workplace on sitting time, physical parameters and work performance of healthy office based workers. If the intervention proves effective, it has a great potential to be implemented in regular workplaces to reduce diseases related to prolonged sitting.

Trial registration

ClinicalTrials.gov Identifier: NCT02825303, July 2016 (retrospectively registered).

Neuropsychological and behavioral assessment of impulsivity in adolescents: a systematic review

INTRODUCTION:

The aim of neuropsychological assessment is to understand the multifaceted relationship between behavior, cognition and brain organization. The main objective of this study was to conduct a systematic review of the literature on impulsivity and inhibitory control in healthy adolescents and preadolescents.

METHOD:

Three researchers conducted a systematic review on November 25, 2014. The first step was to conduct searches on the Web of Knowledge and PubMed databases for articles in English using the following keywords: child; adolescents; impulsivity; inhibition; inhibitory control; and neuropsychology. The second step was to analyze all the references cited in the articles selected from the search results in order to identify further literature.

RESULTS:

Just 13 articles met all the inclusion criteria. There was no consistency in the aims of these studies, or in the instruments or procedures employed.

CONCLUSION:

There was no uniformity among the articles that met all the criteria in terms of any of the items analyzed. There was considerable heterogeneity in these studies of impulsivity and inhibitory control, and few of them evaluated healthy samples.

Differences in the effects of school meals on children's cognitive performance according to gender, household education and baseline reading skills

BACKGROUND/OBJECTIVES

We previously found that the OPUS School Meal Study improved reading and increased errors related to inattention and impulsivity. This study explored whether the cognitive effects differed according to gender, household education and reading proficiency at baseline.

SUBJECTS/METHODS

This is a cluster-randomised cross-over trial comparing Nordic school meals with packed lunch from home (control) for 3 months each among 834 children aged 8 to 11 years. At baseline and at the end of each dietary period, we assessed children's performance in reading, mathematics and the d2-test of attention. Interactions were evaluated using mixed models. Analyses included 739 children.

RESULTS

At baseline, boys and children from households without academic education were poorer readers and had a higher d2-error%. Effects on dietary intake were similar in subgroups. However, the effect of the intervention on test outcomes was stronger in boys, in children from households with academic education and in children with normal/good baseline reading proficiency. Overall, this resulted in increased socioeconomic inequality in reading performance and reduced inequality in impulsivity. Contrary to this, the gender difference decreased in reading and increased in impulsivity. Finally, the gap between poor and normal/good readers was increased in reading and decreased for d2-error%.

CONCLUSIONS

The effects of healthy school meals on reading, impulsivity and inattention were modified by gender, household education and baseline reading proficiency. The differential effects might be related to environmental aspects of the intervention and deserves to be investigated further in future school meal trials.

Disease, activity and schoolchildren's health (DASH) in Port Elizabeth, South Africa: a study protocol

BACKGROUND

An in-depth epidemiological investigation on intestinal parasite infections in an impoverished area of Port Elizabeth, South Africa provides a unique opportunity for research on its impact on children's physical fitness, cognitive performance and psychosocial health. Additionally, we will screen risk factors for the development of diabetes and hypertension in adulthood.

METHODS/DESIGN

A 2-year longitudinal cohort study will be conducted, consisting of three cross-sectional surveys (baseline and two follow-ups), in eight historically black and coloured (mixed race) primary schools located in different townships in Port Elizabeth, South Africa. Approximately 1000 Grade 4 primary schoolchildren, aged 8 to 12 years, will be enrolled and followed. At each survey, disease status, anthropometry and levels of physical fitness, cognitive performance and psychosocial health will be assessed. After each survey, individuals diagnosed with parasitic worm infections will be treated with anthelminthic drugs, while children with other infections will be referred to local clinics. Based on baseline results, interventions will be tailored to the local settings, embedded within the study and implemented in half of the schools, while the remaining schools will serve as controls. Implementation of the interventions will take place over two 8-week periods. The effect of interventions will be determined with predefined health parameters.

DISCUSSION

This study will shed new light on the health burden incurred by children in deprived urban settings of South Africa and provide guidance for specific health interventions. Challenges foreseen in the conduct of this study include: (i) difficulty in obtaining written informed consent from parents/guardians; (ii) administration of questionnaires in schools where three languages are spoken (Afrikaans, Xhosa and English); (iii) challenges in grasping concepts of psychosocial health among schoolchildren using a questionnaire; and (iv) loss to follow-up due to the study setting where illiteracy, mobility and violence are common. Finally, designing the health interventions together with local principals and teachers will allow all concerned with the research to bolster a sense of community ownership and sustained use of the interventions after the study has ceased.

TRIAL REGISTRATION

Controlled-trials.com; identifier: ISRCTN68411960 (date assigned: 14 February 2014).

The DiViSA's Predictive Validity by Age: An Objective Online Test of Attention

The purpose of this study was to analyze the DiViSA's predictive validity in school-age children. To do so, two groups of school-age children were compared: one with low school achievement (N = 1,174), and one with typical development (N = 1,426). The obtained results show that: (1) in all grades, children with poor school performance exhibited lower levels of attention and task organization, greater hastiness, and made more commission errors; (2) the combination of variables that best differentiated between groups was not the same in all grades; (3) level of organization improved with age in the low-school-achievement group, and did not in the typical-development group; (4) the data regarding sensitivity (81% to 93%) and specificity (79% to 90%), for the first time computed for each grade separately, support the test's predictive validity in the grades we evaluated. The discussion focuses on the DiViSA test's usefulness in diagnosing attention problems. It is the first computerized test to include separate scores for: (a) how children complete the task (organization) and (2) the source of their errors (distraction or hastiness).

Diet-induced changes in iron and n-3 fatty acid status and associations with cognitive performance in 8-11-year-old Danish children: secondary analyses of the Optimal Well-Being, Development and Health for Danish Children through a Healthy New Nordic Diet School Meal Study

Fe and n-3 long-chain PUFA (n-3 LCPUFA) have both been associated with cognition, but evidence remains inconclusive in well-nourished school-aged children. In the Optimal Well-Being, Development and Health for Danish Children through a Healthy New Nordic Diet (OPUS) School Meal Study, the 3-month intervention increased reading performance, inattention, impulsivity and dietary intake of fish and Fe. This study investigated whether the intervention influenced n-3 LCPUFA and Fe status and, if so, explored how these changes correlated with the changes in cognitive performance. The study was a cluster-randomised cross-over trial comparing school meals with packed lunch (control). At baseline and after each treatment, we measured serum ferritin, whole-blood n-3 LCPUFA and Hb, and performance in reading, mathematics and d2-test of attention. Data were analysed using mixed models (n 726) and principal component analysis of test performances (n 644), which showed two main patterns: 'school performance' and 'reading comprehension'. The latter indicated that children with good reading comprehension were also more inattentive and impulsive (i.e. higher d2-test error%). The intervention improved 'school performance' (P=0·015), 'reading comprehension' (P=0·043) and EPA+DHA status 0·21 (95% CI 0·15, 0·27) w/w % (P<0·001), but it did not affect serum ferritin or Hb. At baseline, having small Fe stores was associated with poorer 'school performance' in girls, but with better 'reading comprehension' in both boys and girls. Both baseline EPA+DHA status and the intervention-induced increase in EPA+DHA status was positively associated with 'school performance', suggesting that n-3 LCPUFA could potentially explain approximately 20 % of the intervention effect. These exploratory associations indicate that increased fish intake might explain some of the increase in reading performance and inattention in the study.

Inspection time and attention-deficit/hyperactivity disorder symptoms in children with cerebral palsy

OBJECTIVE

To examine between-groups differences in the associations between aspects of processing speed assessed with an inspection time task and attention-deficit/hyperactivity disorder (ADHD) symptoms.

RESEARCH DESIGN

Two groups comprising 34 children with cerebral palsy (CP) and 70 nonaffected peers (control), ages 8-16 years, participated in a prospective correlational study. Measures included a visual inspection time task and the Conners' Parent Rating Scale-Revised: Long Version.

RESULTS

Children with CP exhibited significantly slower processing speed and more symptoms of inattention and hyperactivity than controls. Significant associations between inspection time and ADHD symptoms were found only in the control group.

CONCLUSIONS

Findings have implications for clinical assessment and understanding of attentional risks associated with CP.

Maternal Behavior and Children's Early Emotion Regulation Skills Differentially Predict Development of Children's Reactive Control and Later Effortful Control

The role of maternal behavior and children's early emotion regulation skills in the development of children's reactive control, specifically behavioral impulsivity, and later effortful control was examined in a sample of 435 children. HLM analyses indicated significant growth in reactive control across the toddlerhood to early childhood period. Emotion regulation at age-2 positively predicted initial levels of children's reactive control abilities while maternal overcontrol/intrusiveness predicted lower levels of reactive control growth. Maternal behaviors at age-2 predicted children's effortful control abilities at age-5.5. Emotion regulation did not predict effortful control abilities. Maternal behavior and children's early emotion regulation skills may differentially facilitate the development of reactive and effortful control abilities.

Developmental changes in semantic verbal fluency: analyses of word productivity as a function of time, clustering, and switching

We investigated age-related improvement in semantic category verbal fluency (VF) in 309 Dutch schoolchildren attending first to ninth grade. Quantitative analyses of number of correct responses as a function of time as well as qualitative analyses of clustering and switching were conducted. Overall, Dutch VF task performance, i.e., number of correct responses over 60 seconds, was not established before mid-adolescence. This is in line with previously published studies, using VF number of correct responses over 60 seconds as the main outcome measure and examining VF task performance across other cultures and languages (e.g., Italian, French, Hebrew). Next, mean cluster size, a measure of lexico-semantic knowledge, was not established until at least grade 3. In contrast, performance on the VF outcome measures "number of switches/clusters" was established at least 4 years later. Qualitative and quantitative Design Fluency (DF) outcome measures support the notion that the numbers of switches/clusters are valid measures of higher order cognitive functions, such as strategy use and cognitive flexibility. In line of this, VF number of correct responses during 16-60 seconds, a measure of controlled information processing, is established at least 2 years later (i.e., grades 7-8) than number of correct responses during the first 15 seconds time slide, a measure of automatic processing. Finally, environment, i.e., the level of parental education, primarily affected automatic and lexico-semantic knowledge. No effects of sex on VF performance were found. These data suggest that the alternative scoring methods of VF tasks can be used to acquire knowledge on development of lower and higher order cognitive functions in healthy children and the influence of the environment on it.

Clinical and cognitive response to extended-release methylphenidate (Medikinet) in attention deficit/hyperactivity disorder: efficacy evaluation

INTRODUCTION

The objective of the study was to assess the efficacy of extended-release methylphenidate (Mph-ER) (Medikinet; MEDICE Arzneimittel Pütter GmbH & Co KG, Iserlohn, Germany) in the pediatric population with attention deficit/hyperactivity disorder (ADHD); a parallel analysis of the validity of various tools for monitoring short-term clinical response to treatment was made.

METHODS

This was a retrospective analysis of 94 children with ADHD who received treatment with Mph-ER. The ADHD Rating Scale-IV (ADHD-RS) was used to assess clinical efficacy. The following neuropsychological tests were used to assess cognitive-attentional efficacy: the faces test, the D2 test, the Magallanes visual attention scale (EMAV; Escalas Magallanes de Attencion Visual), and the Conners' Continuous Performance Test II (CPT-II). The ADHD-RS scale was completed by the parents at the time of diagnosis and after 3 months of treatment. The tests were taken by patients both without treatment and under the effects of treatment. The results of these variables were transformed into Z values for subsequent analysis.

RESULTS

In all, 84% of the patients lowered their ADHD-RS score with Mph-ER. Regarding the neuropsychological tests, a significant change was seen when the results of patients without treatment were compared with their later results with treatment. When the order of test conditions was reversed (with and then without treatment), the CPT-II was the only test for which there was still a significant difference.

CONCLUSION

Mph-ER improved attention and self-control from a clinical and cognitive point of view. Of those studied, the CPT-II was the most effective neuropsychological test for monitoring efficacy of Mph in the short-term.