Verbal learning and memory as measured by the Rey-Auditory Verbal Learning Test: ADHD with and without learning disabilities

The 10-Word Auditory Verbal Learning Test and Vocabulary Performance in 4- and 5-Year-Old Children

BACKGROUND

Understanding the different factors that determine vocabulary development in young children is essential for the diagnosis and rehabilitation of language disorders in children. Language development is closely related to other cognitive processes such as auditory verbal learning and memory. This research focuses on the development of a novel auditory verbal learning test (AVLT) for 4- and 5-year-old children within the Dutch population. This new test is an adaptation of the common AVLT for both older children and adults, usually including a list of 15 words. Considering the lower attention span and limited executive functioning in young children, the word list of this new instrument is reduced to 10 words. Besides, a second recognition form has been developed to improve the ability to distinguish between possible underlying learning and memory deficits.

METHOD

Ninety-five preschool children (ages 4;0-5;12 [years;months]) were tested with this new AVLT 10-word test for kids (10WT-K), yielding different measures of verbal auditory memory. Forty-eight of 95 children received a recognition task with semantically unrelated items, and 47 of 95 received a recognition task with semantically related items. Three additional language skills were assessed to establish test validation: receptive and expressive vocabulary performance and nonword repetition. Outcome of the 10WT-K was related to scores on the language measures.

RESULTS

Positive correlations were found between the total score of the 10WT-K and all three aforementioned language skills. We found no correlations between frequency of error types (intrusions and repetitions) and language measures. Furthermore, children who were administered the recognition list with semantically related items showed fewer correct answers and more false-positive and false-negative responses than children who received a recognition list with semantically unrelated items.

CONCLUSIONS

The 10WT-K for young children can be used to (a) measure different aspects of auditory verbal learning and memory, (b) clarify the nature of possible verbal learning difficulties, and (c) identify a possible nature of language disorders. The word recognition task tested with semantically related items provides a more accurate measurement of individual differences, namely, in distinguishing retrieval and storage abilities. The significant relation found between auditory verbal short-term memory capacity and vocabulary performance in preschool children is a first step toward establishing test validity.

Memory performance on the ChAMP in autism spectrum disorder with and without attention-deficit/hyperactivity disorder

Memory difficulties have been identified in youth with neurodevelopmental conditions including autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). The Child and Adolescent Memory Profile (ChAMP) is a newer memory measure with a burgeoning research base. This study seeks to explore memory performance on the Lists and Objects subtests of the ChAMP in a clinical sample of those with ASD with/without co-occurring ADHD. Participants were 146 youth referred for a neuropsychological evaluation (M age = 11.8 years; 76.03% male) diagnosed with ASD (N = 92 with ADHD, N = 54 without). Logistic regression (p = .393) indicated ChAMP performance is not predictive of whether the ASD group had co-occurring ADHD indicating there is no additive effect on memory. Compared to the ChAMP examiner's manual ASD sample, this study sample performed significantly better (p <.001) on all ChAMP measures. While the ChAMP is sensitive to memory difficulties in neurodevelopmental disorders, as indicated by the performance of the manual sample, the ASD sample of the manual may differ from other ASD samples. There were no differences between verbal and visual memory performance across the present study's sample.

Determining the neurocognitive profile of children with tuberous sclerosis complex within the Western Cape region of South Africa

BACKGROUND

Tuberous sclerosis complex (TSC) is a multisystem genetic disorder associated with a wide spectrum of cognitive impairments that can often result in impaired academic, social and adaptive functioning. However, studies investigating TSC have found it difficult to determine whether TSC is associated with a distinct cognitive phenotype and more specifically which aspects of functioning are impaired. Furthermore, children with TSC living in low-income and middle-income countries, like South Africa, experience additional burdens due to low socio-economic status, high mortality rates and poor access to health care and education. Hence, the clinical population of South Africa may vary considerably from those populations from high-income countries discussed in the literature.

METHODS

A comprehensive neuropsychological battery composed of internationally recognised measures examining attention, working memory, language comprehension, learning and memory, areas of executive function and general intellectual functioning was administered to 17 children clinically diagnosed with TSC.

RESULTS

The exploration of descriptive data indicated generalised cognitive difficulties in most cognitive domains, aside from memory. With only two participants performing in the average to above-average ranges, the rest of the sample showed poor verbal comprehension, perceptual reasoning, working memory, processing speed, disinhibition, and problems with spatial planning, problem solving, frustration tolerance, set shifting and maintaining a set of rules. Furthermore, correlational findings indicated several associations between socio-demographic and cognitive variables.

CONCLUSIONS

Importantly, this is the first study to comprehensively examine multiple domains of neurocognitive functioning in a low-resource setting sample of children with TSC. Current study findings showed that children with TSC have generalised impairments across several cognitive domains, rather than domain-specific impairments. Therefore, although examining individual aspects of cognition, such as those found in previous literature, is important, this approach is limiting. With a comprehensive assessment, including understanding the associations between domains, appropriate and directed support can be provided to ensure all aspects of development are addressed and considered.

Assessment of learning and memory impairments in adults with predominately inattentive versus combined presentation attention-deficit/hyperactivity disorder

This cross-sectional study compared adults diagnosed with Attention-Deficit/Hyperactivity Disorder-Inattentive (ADHD-I) and ADHD-Combined (ADHD-C) presentations with a non-ADHD group on verbal and visual learning and delayed recall using the Rey Auditory Verbal Learning Test (RAVLT) and Brief Visuospatial Memory Test-Revised (BVMT-R), respectively. Data from 380 predominately college student adult outpatients were used, with 155 who met criteria for ADHD-I, 165 who met criteria for ADHD-C, and 60 who did not meet criteria for ADHD but were diagnosed with a primary depressive or anxiety disorder or received no diagnosis. Each patient was administered the RAVLT and BVMT-R as part of a comprehensive neuropsychological evaluation. Significant main effects of study group were found, such that patients with ADHD-C demonstrated worse learning and delayed recall of both verbal and visual information than patients with ADHD-I and the non-ADHD group. Patients with ADHD-I performed comparably to the non-ADHD group, apart from visual learning and delayed recall. Notably, more patients in the ADHD groups had possible or probable learning and memory impairment compared to the non-ADHD group. Findings were consistent with previous research indicating that those with ADHD exhibit poorer verbal and visual learning and delayed recall than those without ADHD.

Verbal Memory Interference in Attention-Deficit Hyperactivity Disorder: A Meta-Analytic Review

OBJECTIVE

Interference control is used to overcome conflict among competing memory representations and may contribute to memory difficulties in ADHD. This meta-analytic review examined memory interference to evaluate susceptibility to proactive, retroactive, and memory control interference among those with ADHD.

METHOD

Twenty studies (1987-2019) examining verbal memory interference in ADHD met inclusion criteria (age: 8-36 years). Proactive and retroactive interference indices were extracted from list-learning tasks, and memory control indices were extracted from experimental paradigms (e.g., directed-forgetting).

RESULTS

Children with ADHD were less affected by proactive interference (g=-0.53, 95% CI [-0.75, -0.31]), whereas no significant differences were found in adults (g=0.13, 95% CI [-0.02, 0.28]). Adults and children with ADHD exhibited more retroactive interference (g=0.17, 95% CI [0.05, 0.29]) and performed worse on memory control tasks (g=0.35, 95% CI [0.08, 0.62]) relative to controls.

CONCLUSION

Differences in verbal memory interference control in ADHD were observed but effects were different depending upon interference type and participant age.

The neurocognitive profile of adults with Becker muscular dystrophy in the Netherlands

Background:

In Becker muscular dystrophy evidence for neurocognitive and behavioral comorbidity is evolving. More insight into the extend of these problems is of great importance for early detection and remediation in clinical practice.

Objective:

In this study we aimed to describe the neurocognitive and behavioral features of a Dutch adult cohort of BMD patients, and to evaluate correlations to motor function outcomes.

Methods:

28 adult BMD patients were included. Intelligence, executive functioning, verbal memory and reaction times were assessed cross-sectionally. Additionally, patients completed questionnaires on behavioral and emotional symptoms, psychosocial and executive functions. Results were compared to normative data and correlated with disease severity as measured by the 10-meter run/walk test and Performance of the Upper Limb version 1.2.

Results:

15 patients (53.6%) had a high educational level despite frequent grade repeating (48.3%) during primary or secondary school. Neuropsychological testing revealed that intellectual abilities, verbal memory, processing speed and executive functioning were statistically significant below average, but still within normal range. Regarding outcomes of the behavioral questionnaires, no significant differences were reported compared to the norm population. No relevant correlations with disease severity were found.

Conclusions:

This cohort of adult BMD patients exhibits minor cognitive impairments and no significant behavioral problems. The lower outcomes on processing speed and verbal memory, combined with the relatively high prevalence of grade repeating during primary and secondary school, implies that these minor impairments played a role in childhood. However, the on average high educational levels suggests that they grow out of their cognitive impairments with ageing.

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

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

Safety of focused ultrasound neuromodulation in humans with temporal lobe epilepsy

OBJECTIVE

Transcranial Focused Ultrasound (tFUS) is a promising new potential neuromodulation tool. However, the safety of tFUS neuromodulation has not yet been assessed adequately. Patients with refractory temporal lobe epilepsy electing to undergo an anterior temporal lobe resection present a unique opportunity to evaluate the safety and efficacy of tFUS neuromodulation. Histological changes in tissue after tFUS can be examined after surgical resection, while further potential safety concerns can be assessed using neuropsychological testing.

METHODS

Neuropsychological functions were assessed in eight patients before and after focused ultrasound sonication of the temporal lobe at intensities up to 5760 mW/cm². Using the BrainSonix Pulsar 1002, tFUS was delivered under MR guidance, using the Siemens Magnetom 3T Prisma scanner. Neuropsychological changes were assessed using various batteries. Histological changes were assessed using hematoxylin and eosin staining, among others.

RESULTS

With respect to safety, the histological analysis did not reveal any detectable damage to the tissue, except for one subject for whom the histology findings were inconclusive. In addition, neuropsychological testing did not show any statistically significant changes in any test, except for a slight decrease in performance on one of the tests after tFUS.

SIGNIFICANCE

This study supports the hypothesis that low-intensity Transcranial Focused Ultrasound (tFUS) used for neuromodulation of brain circuits at intensities up to 5760 mW/cm² may be safe for use in human research. However, due to methodological limitations in this study and inconclusive findings, more work is warranted to establish the safety. Future directions include greater number of sonications as well as longer exposure at higher intensity levels to further assess the safety of tFUS for modulation of neuronal circuits.

Validation of the SCAT5 and Child SCAT5 Word-List Memory Task

The Sports Concussion Assessment Tool-5th Edition (SCAT5) and the child version (Child SCAT5) are the current editions of the SCAT and have updated the memory testing component from previous editions. This study aimed to validate this new memory component against the Rey Auditory Verbal Learning Test (RAVLT) as the validated standard. This prospective, observational study, carried out within The Royal Children's Hospital Emergency Department, Melbourne, Australia, recruited 198 participants: 91 with concussion and 107 upper limb injury or healthy sibling controls. Partial Pearson correlations showed that memory acquisition and recall on delay aspects of the SCAT5 were significantly correlated with the RAVLT equivalents when controlling for age (p < 0.001, r = 0.565 and p < 0.001, r = 0.341, respectively). Factor analysis showed that all RAVLT and SCAT5 memory components load on to the same factor, accounting for 59.13% of variance. Logistic regression models for both the RAVLT and SCAT5, however, did not predict group membership (p > 0.05). Receiver operating curve analysis found that the area under the curve for all variables and models was below the recommended 0.7 threshold. This study demonstrated that the SCAT5 and Child SCAT5 memory paradigm is a valid measure of memory in concussed children.

Adolescent neurocognitive development and impacts of substance use: Overview of the adolescent brain cognitive development (ABCD) baseline neurocognition battery

Adolescence is characterized by numerous social, hormonal and physical changes, as well as a marked increase in risk-taking behaviors. Dual systems models attribute adolescent risk-taking to tensions between developing capacities for cognitive control and motivational strivings, which may peak at this time. A comprehensive understanding of neurocognitive development during the adolescent period is necessary to permit the distinction between premorbid vulnerabilities and consequences of behaviors such as substance use. Thus, the prospective assessment of cognitive development is fundamental to the aims of the newly launched Adolescent Brain and Cognitive Development (ABCD) Consortium. This paper details the rationale for ABC'lected measures of neurocognition, presents preliminary descriptive data on an initial sample of 2299 participants, and provides a context for how this large-scale project can inform our understanding of adolescent neurodevelopment.

Can the Error-Monitoring System Differentiate ADHD From ADHD With Reading Disability? Reading and Executive Dysfunction as Reflected in Error Monitoring

OBJECTIVES

ADHD and reading disability (RD) are distinct disorders that often appear together. Individuals with both disorders are currently diagnosed based on questionnaires/behavioral performance. The present study aimed to determine whether ADHD alone differs from ADHD with RD in error monitoring, which is part of the executive system, as measured while reading.

METHOD

Event-related potentials were recorded during a lexical decision task performed by children with comorbid ADHD and RD and children with ADHD.

RESULTS

Lower executive function and reading abilities were accompanied by decreased event-related potential components in participants with ADHD and RD, compared with participants with ADHD.

CONCLUSION

Results suggest that the error monitoring activation can be used as a possible biomarker to objectively differentiate ADHD with RD from ADHD alone.

Differential effect of cognitive training on executive functions and reading abilities in children with ADHD and in children with ADHD comorbid with reading difficulties

The comorbidity of ADHD and reading difficulties (ADHD + RD) is believed to be a disability distinct from ADHD alone, with unique challenges faced by individuals suffering from one disability versus the other. We aimed to examine the differential effect of 8 weeks of cognitive training on reading abilities and on executive functions, through use of the Wisconsin task, in children with ADHD and in children with ADHD + RD. Greater impairments in reading and executive functions, especially in speed of processing, were found in the comorbid group at baseline. The comorbid group showed greater improvements in most measures after training as well. We propose that the cognitive training used in the present study affected not only the immediate abilities of executive functioning but also the secondary ability of reading, especially in the comorbid group, by improving in particular, speed of processing. We suggest that a differential approach should be taken when treating children with ADHD + RD versus treating ADHD children.

Cognitive and typing outcomes measured simultaneously with slow treadmill walking or sitting: implications for treadmill desks

Purpose

This study compared cognitive (attention, learning, and memory) and typing outcomes during slow treadmill walking or sitting. Seventy-five healthy individuals were randomly assigned to a treadmill walking group (n=37; 23 female) or sitting group (n=38; 17 female).

Methods

The treadmill walking group completed a series of tests while walking at 1.5 mph. The sitting group performed the same tests while sitting at a standard desk. Tests performed by both groups included: the Rey Auditory Verbal Learning Test and a modified version of the Paced Auditory Serial Attention Test. In addition, typing performance was evaluated.

Results

Participants in the treadmill walking group performed worse on the Rey Auditory Verbal Learning Test for total learning than the sitting group; the main effect was significant (F(1,73)=4.75, p=0.03, η_p²=0.06); however, short- and long-delay recall performance did not differ between groups (p>0.05). For the Paced Auditory Serial Attention Test, total number of correct responses was lower in the treadmill walking group relative to the sitting group; the main effect was significant (F(1,73)=4.97, p=0.03, η_p²=0.06). The performance of both groups followed the same learning slope (Group x Trial interactions were not significant) for the Rey Auditory Verbal Learning Test and Paced Auditory Serial Attention Test. Individuals in the treadmill walking group performed significantly worse for all measures of typing (p<0.05).

Conclusion

Walking on a treadmill desk may result in a modest difference in total learning and typing outcomes relative to sitting, but those declines may not outweigh the benefit of the physical activity gains from walking on a treadmill.

Slow cortical potential neurofeedback and self-management training in outpatient care for children with ADHD: study protocol and first preliminary results of a randomized controlled trial

Background: Treatment for children with attention deficit/hyperactivity disorder (ADHD) today is predominantly pharmacological. While it is the most common treatment, it might not always be the most appropriate one. Moreover, long term effects remain unclear. Behavior therapy (BT) and non-pharmacological treatments such as neurofeedback (NF) are promising alternatives, though there are no routine outpatient care/effectiveness studies yet that have included children with medication or changes in medication.

Methods/design: This paper presents the protocol of a randomized controlled trial to compare the effectiveness of a Slow Cortical Potential (SCP) NF protocol with self-management (SM) in a high frequent outpatient care setting. Both groups (NF/SM) receive a total of 30 high frequent therapy sessions. Additionally, 6 sessions are reserved for comorbid problems. The primary outcome measure is the reduction of ADHD core symptoms according to parent and teacher ratings.

Preliminary Results: Untill now 58 children were included in the study (48 males), with a mean age of 8.42 (1.34) years, and a mean IQ of 110 (13.37). Conners-3 parent and teacher ratings were used to estimate core symptom change. Since the study is still ongoing, and children are in different study stages, pre-post and follow-up results are not yet available for all children included. Preliminary results suggest overall good pre-post effects, though. For parent and teacher ratings an ANOVA with repeated measures yielded overall satisfying pre-post effects (η² 0.175–0.513). Differences between groups (NF vs. SM) could not yet be established (p = 0.81).

Discussion: This is the first randomized controlled trial to test the effectiveness of a NF protocol in a high frequent outpatient care setting that does not exclude children on or with changes in medication. First preliminary results show positive effects. The rationale for the trial, the design, and the strengths and limitations of the study are discussed.

Trial registration: This trial is registered in www.clinicaltrials.gov as NCT01879644.

Association between phthalates and attention deficit disorder and learning disability in U.S. children, 6-15 years

OBJECTIVE

This study investigates the association between urinary phthalate metabolite levels and attention deficit disorder (ADD), learning disability (LD), and co-occurrence of ADD and LD in 6-15-year-old children.

METHODS

We used cross-sectional data from the National Health and Nutrition Examination Survey (NHANES, 2001-2004). Phthalate metabolites with ≥75% detection in urine samples were examined. The study population comprised 1493 children with parent-reported information on ADD or LD diagnosis and phthalate concentrations in urine. Phthalate concentrations were creatinine-adjusted and log10-transformed for analysis. All models controlled for child sex, age, race, household income, blood lead, and maternal smoking during pregnancy.

RESULTS

There were 112 ADD cases, 173 LD cases, and 56 ADD and LD cases in the sample. After adjusting for potential confounders, we found increased odds of ADD with increasing urinary concentration of di-2-ethylhexyl phthalates (OR: 2.1; 95% CI: 1.1, 3.9) and high molecular weight phthalates (OR: 2.7; 95% CI: 1.2, 6.1). In addition, dibutyl phthalates (OR: 3.3; 95% CI: 0.9, 12.7) and high molecular weight phthalates (OR: 3.7; 95% CI: 0.9, 14.8) were marginally associated with increased odds of co-occurring ADD and LD. We did not find associations for any phthalate and LD alone. We observed stronger associations between phthalates and ADD and both ADD and LD in girls than boys in some models.

CONCLUSIONS

We found cross-sectional evidence that certain phthalates are associated with increased odds of ADD and both ADD and LD. Further investigations with longitudinal data are needed to confirm these results.

A comparison of phenylketonuria with attention deficit hyperactivity disorder: do markedly different aetiologies deliver common phenotypes?

Phenylketonuria (PKU) is a well-defined metabolic disorder arising from a mutation that disrupts phenylalanine metabolism and so produces a variety of neural changes indirectly. Severe cognitive impairment can be prevented by dietary treatment; however, residual symptoms may be reported. These residual symptoms appear to overlap a more prevalent childhood disorder: Attention Deficit/Hyperactivity Disorder (ADHD). However, the aetiology of ADHD is a vast contrast to PKU: it seems to arise from a complex combination of genes; and it has a substantial environmental component. We ask whether these two disorders result from two vastly different genotypes that converge on a specific core phenotype that includes similar dysfunctions of Gray's (Gray, 1982) Behavioural Inhibition System (BIS), coupled with other disorder-specific dysfunctions. If so, we believe comparison of the commonalities will allow greater understanding of the neuropsychology of both disorders. We review in detail the aetiology, treatment, neural pathology, cognitive deficits and electrophysiological abnormalities of PKU; and compare this with selected directly matching aspects of ADHD. The biochemical and neural pathologies of PKU and ADHD are quite distinct in their causes and detail; but they result in the disorder in the brain of large amino acid levels, dopamine and white matter that are very similar and could explain the overlap of symptoms within and between the PKU and ADHD spectra. The common deficits affect visual function, motor function, attention, working memory, planning, and inhibition. For each of PKU and ADHD separately, a subset of deficits has been attributed to a primary dysfunction of behavioural inhibition. In the case of ADHD (excluding the inattentive subtype) this has been proposed to involve a specific failure of the BIS; and we suggest that this is also true of PKU. This accounts for a substantial proportion of the parallels in the superficial symptoms of both disorders and we see this as linked to prefrontal, rather than more general, dysfunction of the BIS.