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Udal ABH, Stray LL, Pripp AH, Stray T, Egeland J. The Utility of Neuromuscular Assessment to Identify ADHD Among Patients with a Complex Symptom Picture. J Atten Disord 2024; 28:1577-1588. [PMID: 39221625 PMCID: PMC11403920 DOI: 10.1177/10870547241273102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
OBJECTIVE Diagnostic assessment of ADHD is challenging due to comorbid psychopathologies and symptoms overlapping with other psychiatric disorders. In this study, we investigate if a distinct pattern of neuromuscular dysregulation previously reported in ADHD, can help identifying ADHD in psychiatric patients with diverse and complex symptoms. METHOD We explored the impact of neuromuscular dysregulation, as measured by The Motor Function Neurologic Assessment (MFNU), on the likelihood of being diagnosed with ADHD, affective disorder, anxiety disorder, or personality disorder among adults (n = 115) referred to a psychiatric outpatient clinic. RESULTS Logistic regression revealed that neuromuscular dysregulation was significantly associated with ADHD diagnosis only (OR 1.15, p < .01), and not with affective-, anxiety-, or personality disorders. Sensitivity and specificity for ADHD at different MFNU scores is provided. CONCLUSIONS A test of neuromuscular dysregulation may promote diagnostic accuracy in differentiating ADHD from other psychiatric disorders in patients with an overlapping symptom picture. This may have important implications for clinical practice. More studies are needed.
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Affiliation(s)
| | - Liv Larsen Stray
- Department of Psychiatry, Sørlandet Hospital HF, Kristiansand, Norway
| | - Are Hugo Pripp
- Department of Biostatistics, Oslo University Hospital, Norway
| | - Torstein Stray
- Department of Psychiatry, Sørlandet Hospital HF, Kristiansand, Norway
| | - Jens Egeland
- Department of psychology, University of Oslo, Norway
- Vestfold Hospital Trust, Tønsberg, Norway
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2
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Anning KL, Langley K, Hobson C, van Goozen SHM. Cool and hot executive function problems in young children: linking self-regulation processes to emerging clinical symptoms. Eur Child Adolesc Psychiatry 2024; 33:2705-2718. [PMID: 38183461 PMCID: PMC11272683 DOI: 10.1007/s00787-023-02344-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/28/2023] [Indexed: 01/08/2024]
Abstract
Self-regulation (SR) difficulties are implicated in a wide range of disorders which develop in childhood, including attention deficit hyperactivity disorder (ADHD), oppositional defiance disorder (ODD), anxiety and depression. However, the integration of the existing research evidence is challenging because of varying terminology and the wide range of tasks used, as well as the heterogeneity and comorbidity within and across diagnostic categories. The current study used the Research Domain Criteria (RDoC) framework to guide the examination of different SR processes in young children showing a wide range of symptomatology. Children (aged 4-8) referred by teachers for moderate-to-high conduct, hyperactivity and/or emotional problems at school (assessed using the Strengths and Difficulties Questionnaire (SDQ) subscales; n = 212), and children in SDQ typical ranges (n = 30) completed computerised cognitive control and decision-making tasks. Parents completed questionnaires to assess ADHD, ODD, anxiety and depression symptoms (n = 191). Compared to children with no teacher-reported difficulties, those with moderate-to-high problems showed poorer visuomotor control and decision-making. A factor analysis revealed that task variables adhered to RDoC dimensions and predicted variance in specific disorders: difficulties in cognitive control predicted ADHD symptoms, low reward-seeking was associated with depression and high reward-seeking was associated with ODD. This study highlights how the assessment of cognitive processes positioned within the RDoC framework can inform our understanding of disorder-specific and transdiagnostic difficulties in SR which are associated with diverse clinical symptoms in children.
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Affiliation(s)
- Kate L Anning
- School of Psychology, Cardiff University, Cardiff, UK.
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
| | - Kate Langley
- School of Psychology, Cardiff University, Cardiff, UK
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3
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Anning KL, Langley K, Hobson C, De Sonneville L, Van Goozen SHM. Inattention symptom severity and cognitive processes in children at risk of ADHD: the moderating role of separation anxiety. Child Neuropsychol 2024; 30:264-288. [PMID: 36960813 DOI: 10.1080/09297049.2023.2190964] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/24/2023] [Indexed: 03/25/2023]
Abstract
Impairments in cognitive processes and their associations with dimensional measures of inattention, hyperactivity-impulsivity and anxiety were examined in children at risk of Attention-Deficit Hyperactivity Disorder. Children referred by teachers for exhibiting ADHD-type problems (n = 116; 43 meeting full diagnostic criteria for ADHD; 4-8 years) completed computerized tasks measuring episodic memory, response inhibition, visuomotor control and sustained attention, while parents were interviewed (DAWBA) to assess ADHD and anxiety symptoms. Of the 116 children assessed, 72% exhibited impaired cognitive processes; 47% had impaired visuomotor control, 37% impaired response inhibition, and 35% had impaired episodic memory. Correlational and hierarchical regression analyses using our final analytic sample (i.e., children who completed all cognitive tasks and a vocabulary assessment, n = 114) showed that poorer task performance and greater within-subject variability were significantly associated with more severe inattention symptoms but not with hyperactivity-impulsivity severity. Symptoms of separation anxiety, which were reported in over half of the sample, moderated associations between inattention and episodic memory, and between inattention and inhibition. Only children without separation anxiety showed significant correlations between ADHD symptoms and poor performance. However, separation anxiety had no moderating effect on associations between inattention and visuomotor control or sustaining attention. Children exhibiting signs of ADHD show impairments across a range of cognitive tasks. Further research to improve our understanding of these processes may be useful in the development of early interventions. Our results suggest that separation anxiety should be taken into account when considering interventions to address emerging neuropsychological deficits associated with this disorder.
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Affiliation(s)
- Kate L Anning
- School of Psychology, Cardiff University, Cardiff, UK
| | - Kate Langley
- School of Psychology, Cardiff University, Cardiff, UK
| | | | - Leo De Sonneville
- Department of Clinical Neurodevelopmental Studies, Leiden University, Leiden, The Netherlands
| | - Stephanie H M Van Goozen
- School of Psychology, Cardiff University, Cardiff, UK
- Department of Clinical Neurodevelopmental Studies, Leiden University, Leiden, The Netherlands
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4
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Thorsson M, Galazka MA, Johnson M, Åsberg Johnels J, Hadjikhani N. Visuomotor tracking strategies in children: associations with neurodevelopmental symptoms. Exp Brain Res 2024; 242:337-353. [PMID: 38078961 PMCID: PMC11297076 DOI: 10.1007/s00221-023-06752-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/19/2023] [Indexed: 01/25/2024]
Abstract
Children with neurodevelopmental disorders (NDDs) often display motor problems that may impact their daily lives. Studying specific motor characteristics related to spatiotemporal control may inform us about the mechanisms underlying their challenges. Fifty-eight children with varying neurodevelopmental symptoms load (median age: 5.6 years, range: 2.7-12.5 years) performed an interactive tablet-based tracking task. By investigating digit touch errors relative to the target's movement direction, we found that a load of neurodevelopmental symptoms was associated with reduced performance in the tracking of abrupt alternating directions (zigzag) and overshooting the target. In contrast, reduced performance in children without neurodevelopmental symptoms was associated with lagging behind the target. Neurodevelopmental symptom load was also associated with reduced flexibility in correcting for lateral deviations in smooth tracking (spiral). Our findings suggest that neurodevelopmental symptoms are associated with difficulties in motor regulation related to inhibitory control and reduced flexibility, impacting motor control in NDDs.
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Affiliation(s)
- Max Thorsson
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Martyna A Galazka
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Division of Cognition and Communication, Department of Applied Information Technology, University of Gothenburg, Gothenburg, Sweden
| | - Mats Johnson
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jakob Åsberg Johnels
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Section of Speech and Language Pathology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nouchine Hadjikhani
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
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5
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Enokizono T, Ohto T, Tanaka M, Maruo K, Mizuguchi T, Sano Y, Kandori A, Takada H. Boys with attention-deficit/hyperactivity disorder perform wider and fewer finger tapping than typically developing boys - Peer comparisons and the effects of methylphenidate from an exploratory perspective. Brain Dev 2022; 44:189-195. [PMID: 34865917 DOI: 10.1016/j.braindev.2021.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/17/2021] [Accepted: 11/02/2021] [Indexed: 10/19/2022]
Abstract
AIM This study aimed to investigate the differences in fine motor and coordination skills between boys with attention-deficit/hyperactivity disorder (ADHD) and typically developing (TD) boys and the effect of methylphenidate (MPH) in boys with ADHD. METHODS Fourteen boys aged 7-12 years who were diagnosed with ADHD and previously treated with MPH were instructed to tap their thumbs and index fingers together repetitively for 10 s after attaching magnetic sensors. The participants executed "in-phase" and "anti-phase" tapping. A two-way analysis of variance for comparing boys with ADHD and TD boys and the paired t-test to investigate the effect of MPH between sessions with and without MPH were performed. RESULTS Boys with ADHD showed a significantly lower "number of taps" and a significantly higher "average of local maximum distance" than TD boys. "Energy balance" was significantly lower in ADHD boys than in TD boys. MPH caused a significant difference in the "standard deviation (SD) of phase difference" in "anti-phase tapping." CONCLUSION Our studies indicated that finger-tapping movements in boys with ADHD tended to be significantly wider and fewer than those in TD boys, and MPH may improve the phase difference of bimanual fine motor coordination skills in boys with ADHD who are above 1.0 SD. The results should be interpreted with caution because we conducted statistical tests for many outcomes and groups without considering the multiplicity factor from an exploratory perspective.
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Affiliation(s)
- Takashi Enokizono
- Department of Pediatrics, University of Tsukuba Hospital, Ibaraki, Japan.
| | - Tatsuyuki Ohto
- Department of Pediatrics, University of Tsukuba Hospital, Ibaraki, Japan; Department of Child Health, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Mai Tanaka
- Department of Pediatrics, University of Tsukuba Hospital, Ibaraki, Japan
| | - Kazushi Maruo
- Department of Biostatics, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | | | - Yuko Sano
- Research & Development Group, Center for Technology Innovation - Healthcare, Hitachi, Ltd., Tokyo, Japan
| | - Akihiko Kandori
- Research & Development Group, Center for Exploratory Research, Hitachi, Ltd., Saitama, Japan
| | - Hidetoshi Takada
- Department of Pediatrics, University of Tsukuba Hospital, Ibaraki, Japan; Department of Child Health, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Takagi S, Hori H, Yamaguchi T, Ochi S, Nishida M, Maruo T, Takahashi H. Motor Functional Characteristics in Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorders: A Systematic Review. Neuropsychiatr Dis Treat 2022; 18:1679-1695. [PMID: 35971415 PMCID: PMC9375548 DOI: 10.2147/ndt.s369845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/26/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The development of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorders (ASDs) has various influences on physical abilities. Identification of specific physical abilities of people with ADHD/ASDs as biomarkers for diagnosing these conditions is necessary. Therefore, in the present review, we aimed firstly to extract the difference in physical abilities of people with ADHD or ASDs compared to those of normal individuals. Secondly, we aimed to extract the specific physical ability characteristics for identifying potential diagnostic biomarkers in people with ADHD/ASDs. METHODS A systematic literature review was performed. The databases were searched for relevant articles on motor function deficits and characteristics of ADHD or ASD. RESULTS Forty-one cross-sectional studies and three randomized controlled trials were identified, comprising 33 studies of ADHD, 10 studies of ASDs, and 1 study of both ADHD and ASDs. The quality of studies varied. Three types of physical activities/exercises were identified, including coordinated movement, resistance-type sports, and aerobic-type sports. People with ADHD/ASDs generally exhibited poorer physical abilities for all types of activities, possibly because of low levels of physical activity. Specifically, we found temporal discoordination of movement in ADHD and integration or synchronization of separate movements in ASDs. CONCLUSION Specific deficits in physical ability may be attributed to ADHD/ASDs. However, there is not enough research on the physical abilities of people with ADHD and ASDs to clarify the specific deficits. Investigation of specific motor functions that characterize ADHD/ASDs should be facilitated.
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Affiliation(s)
- Shunsuke Takagi
- Department of Psychiatry and Behavioral Neurosciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, 113-8510, Japan
| | - Hikaru Hori
- Department of Psychiatry, School of Medicine, Fukuoka University, Fukuoka, 814-0180, Japan
| | - Tatsuya Yamaguchi
- Institute for Integrated Sports Medicine, School of Medicine, Keio University, Shinjuku-ku, Tokyo, 160-8582, Japan.,Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Shinichiro Ochi
- Department of Neuropsychiatry, Molecules and Function, Ehime University Graduate School of Medicine, Shitsukawa, Ehime, 791-0295, Japan
| | - Masaki Nishida
- Faculty of Sport Science, Waseda University Tokorozawa, Saitama, 359-1192, Japan
| | - Takashi Maruo
- Department of Psychiatry and Behavioral Neurosciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, 113-8510, Japan
| | - Hidehiko Takahashi
- Department of Psychiatry and Behavioral Neurosciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, 113-8510, Japan
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Faedda N, Guariglia C, Piccardi L, Natalucci G, Rossetti S, Baglioni V, Alunni Fegatelli D, Romani M, Vigliante M, Guidetti V. Link Between Topographic Memory and the Combined Presentation of ADHD (ADHD-C): A Pilot Study. Front Psychiatry 2021; 12:647243. [PMID: 34220569 PMCID: PMC8245696 DOI: 10.3389/fpsyt.2021.647243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Topographic memory is the ability to reach various places by recognizing spatial layouts and getting oriented in familiar environments. It involves several different cognitive abilities, in particular executive functions (EF), such as attention, working memory, and planning. Children with attention deficit hyperactivity disorder (ADHD) show impairments in inhibitory control, regulation of attention, planning, and working memory. Aim: The aim of this study was to evaluate the topographic memory in children with ADHD-combined subtype (ADHD-C). Method: Fifteen children (8-10 years) with a diagnosis of ADHD-C (DSM-5) (ADHD-C group) were compared to 15 children with typical development (TD group) of the same age. All children performed Raven's colored progressive matrices (CPM) test to obtain a measure related with cognitive functioning. The walking Corsi test (WalCT), a large-scale version of the Corsi block-tapping test, was used to assess topographic memory in experimental environment. Results: A higher impairment was observed in ADHD-C than TD with significant differences in the WalCT, in particular on the topographic short-term memory (TSTM) task, on the topographic learning (TL) task, and on the repetition number (RN) task during the TL task. Perseverative errors were reported in performing the square-sequence in the WalCT. Zero-order correlations showed a positive correlation between TSTM and auditory attention, and memory of design of NEPSY-II and digit span of WISC-IV. No statistically significant differences were found between the ADHD-C group and TD group in the TL task in the WalCT condition. Conclusion: In ADHD-C, initial topographic learning was compromised whereas the long-term retention of learned topographical material seemed to not be impaired. In particular, these impairments seem to be linked with difficulties in sustained attention, in spatial memory for novel visual materials, in a poor working memory, and in perseverative behaviors.
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Affiliation(s)
- Noemi Faedda
- Section of Child and Adolescents Neuropsychiatry, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Cecilia Guariglia
- Department of Psychology, Sapienza University of Rome, Rome, Italy.,Cognitive and Motor Rehabilitation and Neuroimaging Unit, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) Fondazione Santa Lucia, Rome, Italy
| | - Laura Piccardi
- Department of Psychology, Sapienza University of Rome, Rome, Italy.,Cognitive and Motor Rehabilitation and Neuroimaging Unit, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) Fondazione Santa Lucia, Rome, Italy
| | - Giulia Natalucci
- Section of Child and Adolescents Neuropsychiatry, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Serena Rossetti
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | - Valentina Baglioni
- Section of Child and Adolescents Neuropsychiatry, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Danilo Alunni Fegatelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Maria Romani
- Section of Child and Adolescents Neuropsychiatry, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Miriam Vigliante
- Section of Child and Adolescents Neuropsychiatry, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Vincenzo Guidetti
- Section of Child and Adolescents Neuropsychiatry, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
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Boshomane TT, Pillay BJ, Meyer A. Attention-deficit/hyperactivity disorder and behavioural planning deficiencies in South African primary school children. S Afr J Psychiatr 2020; 26:1411. [PMID: 33240545 PMCID: PMC7669961 DOI: 10.4102/sajpsychiatry.v26i0.1411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 08/04/2020] [Indexed: 11/08/2022] Open
Abstract
Background Attention-deficit/hyperactivity disorder (ADHD) is defined as a cognitive or behavioural developmental disorder. Inattentiveness, overactivity and impulsivity are regarded as the main clinical symptoms of ADHD. These symptoms may occur together or separately resulting in three recognised presentations: predominantly inattentive, predominantly hyperactive–impulsive and combined presentations. Aim This study investigated deficiencies in behavioural planning in South African primary school children with and without ADHD. Setting Tzaneen area in Limpopo province, South Africa. Methods A total of 156 children (78 with ADHD and 78 matched controls without ADHD) of both genders, who were medication naïve and aged 6–15 years, participated in the study. The performance of the two groups was compared on a test of planning and problem-solving, the Tower of London (ToL) task. The results were analysed as a function of gender, age and ADHD presentation. Results Children with ADHD especially ADHD-PI and ADHD-C used significantly more moves and took a longer time to complete the task than the controls (p < 0.001). There were no significant differences in the number of moves and time taken by the predominantly hyperactive-impulsive presentations of ADHD when compared to the controls. Gender and age did not influence the performance. Conclusion The results showed that children with ADHD showed significantly more deficits mainly the ADHD-PI and ADHD-C presentations, which indicates that inattention is mainly responsible for deficiencies in behaviour planning. The ADHD-HI presentations and the control group were not affected.
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Affiliation(s)
- Tshikani T Boshomane
- Department of Behavioural Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Basil J Pillay
- Department of Behavioural Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Anneke Meyer
- Department of Behavioural Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Openneer TJC, Forde NJ, Akkermans SEA, Naaijen J, Buitelaar JK, Hoekstra PJ, Dietrich A. Executive function in children with Tourette syndrome and attention-deficit/hyperactivity disorder: Cross-disorder or unique impairments? Cortex 2020; 124:176-187. [PMID: 31901563 DOI: 10.1016/j.cortex.2019.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 09/30/2019] [Accepted: 11/19/2019] [Indexed: 01/19/2023]
Abstract
Findings of executive functioning deficits in Tourette syndrome (TS) have so far been inconsistent, possibly due to methodological challenges of previous studies, such as the use of small sample sizes and not accounting for comorbid attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), or medication use. We aimed to address these issues by examining several areas of executive functioning (response inhibition, attentional flexibility, cognitive control, and working memory) and psychomotor speed in 174 8-to-12-year-old children with TS [n = 34 without (TS-ADHD) and n = 26 with comorbid ADHD (TS+ADHD)], ADHD without tics (ADHD-TS; n = 54), and healthy controls (n = 60). We compared executive functioning measures and psychomotor speed between these groups and related these to ADHD severity across the whole sample, and tic severity across the TS groups. Children with TS+ADHD, but not TS-ADHD, made more errors on the cognitive control task than healthy children, while TS-ADHD had a slower psychomotor speed compared to healthy controls. The ADHD group showed impairment in cognitive control and working memory versus healthy controls. Moreover, higher ADHD severity was associated with poorer cognitive control and working memory across all groups; there was no relation between any of the executive functioning measures and tic severity. OCD severity or medication use did not influence our results. In conclusion, we found little evidence for executive function impairments inherent to TS. Executive function problems appear to manifest predominantly in relation to ADHD symptomatology, with both cross-disorder and unique features of neuropsychological functioning when cross-comparing TS and ADHD.
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Affiliation(s)
- Thaïra J C Openneer
- University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Groningen, the Netherlands.
| | - Natalie J Forde
- University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Groningen, the Netherlands; Department of Cognitive Neuroscience, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands; Center for Cognitive Neuroimaging, Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - Sophie E A Akkermans
- Department of Cognitive Neuroscience, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands; Center for Cognitive Neuroimaging, Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - Jilly Naaijen
- Department of Cognitive Neuroscience, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands; Center for Cognitive Neuroimaging, Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands; Center for Cognitive Neuroimaging, Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands; Karakter Child and Adolescent Psychiatry, University Center, Nijmegen, the Netherlands
| | - Pieter J Hoekstra
- University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Groningen, the Netherlands
| | - Andrea Dietrich
- University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Groningen, the Netherlands
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10
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Pila-Nemutandani RG, Pillay BJ, Meyer A. Gender and hand dominance on fine motor skills among Grade 1–7 learners with attention-deficit hyperactivity disorder. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2019. [DOI: 10.1177/0081246319846076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Children diagnosed with attention-deficit/hyperactivity disorder encounter difficulties in many activities in their daily lives that require motor coordination skills. The aim of this study was to establish whether children with attention-deficit/hyperactivity disorder have deficits in fine motor skills. Eighty male and female learners diagnosed with attention-deficit/hyperactivity disorder matched with 80 non-attention-deficit/hyperactivity disorder from the North West and Limpopo provinces (South Africa), aged 7–13 years, participated in the study. All participants completed the grooved pegboard test, the maze coordination task, and the finger tapping test. These instruments measure various functions of motor speed and eye–hand coordination. The findings reveal that children with attention-deficit/hyperactivity disorder performed significantly poorer than the control group with regard to the grooved pegboard and maze coordination tasks, but not with the finger tapping task. There were no gender differences in all the tests. Performance on the maze coordination task with the non-dominant hand was poorer for the attention-deficit/hyperactivity disorder group with regard to the time taken to complete the task. However, no hand dominance differences were found on the grooved pegboard and finger tapping tests. The study revealed a relationship between attention-deficit/hyperactivity disorder symptomatology and motor problems with regard to complex tasks of accuracy, but not on a simple task of motor speed. It is, therefore, recommended that since children with attention-deficit/hyperactivity disorder show motor deficiencies, motor skill training should be considered as part of the intervention, as these skills are needed for many daily activities and academic competencies.
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Affiliation(s)
| | - Basil Joseph Pillay
- Department of Behavioural Medicine, School of Health Sciences, University of KwaZulu-Natal, South Africa
| | - Anneke Meyer
- Department of Behavioural Medicine, School of Health Sciences, University of KwaZulu-Natal, South Africa
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11
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Slobodin O, Cassuto H, Berger I. Age-Related Changes in Distractibility: Developmental Trajectory of Sustained Attention in ADHD. J Atten Disord 2018; 22:1333-1343. [PMID: 25791438 DOI: 10.1177/1087054715575066] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study investigated age-related changes in sustained attention in children with ADHD and in their typically developed peers. METHOD The study used a Continuous Performance Test (CPT) that includes visual and auditory stimuli serving as distractors. The rate of omission errors was used as a measurement of difficulty in sustained attention. Participants were children and adolescents aged 7 to 18 years (478 with ADHD and 361 without ADHD). RESULTS Both groups of adolescents (with and without ADHD) showed reduced distractibility than younger children from the same group. However, distractibility tended to diminish in non-ADHD adolescents, but not in adolescents with ADHD. CONCLUSION Although part of the difficulties in ADHD could be explained by developmental delay that improves with time, other deficits, such as increased distractibility causing more omission errors, do not show a clear developmental trajectory. The results suggest that deficits in inhibitory control might be the core of ADHD.
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Affiliation(s)
- Ortal Slobodin
- 1 Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Itai Berger
- 1 Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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12
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Guxens M, Vermeulen R, van Eijsden M, Beekhuizen J, Vrijkotte TGM, van Strien RT, Kromhout H, Huss A. Outdoor and indoor sources of residential radiofrequency electromagnetic fields, personal cell phone and cordless phone use, and cognitive function in 5-6 years old children. ENVIRONMENTAL RESEARCH 2016; 150:364-374. [PMID: 27348251 DOI: 10.1016/j.envres.2016.06.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 06/06/2016] [Accepted: 06/12/2016] [Indexed: 05/20/2023]
Abstract
BACKGROUND Little is known about the exposure of young children to radiofrequency electromagnetic fields (RF-EMF) and potentially associated health effects. We assessed the relationship between residential RF-EMF exposure from mobile phone base stations, residential presence of indoor sources, personal cell phone and cordless phone use, and children's cognitive function at 5-6 years of age. METHODS Cross-sectional study on children aged 5-6 years from the Amsterdam Born Children and their Development (ABCD) study, the Netherlands (n=2354). Residential RF-EMF exposure from mobile phone base stations was estimated with a 3D geospatial radio wave propagation model. Residential presence of indoor sources (cordless phone base stations and Wi-Fi) and children's cell phone and cordless phone use was reported by the mother. Speed of information processing, inhibitory control, cognitive flexibility, and visuomotor coordination was assessed using the Amsterdam Neuropsychological Tasks. RESULTS Residential presence of RF-EMF indoor sources was associated with an improved speed of information processing. Higher residential RF-EMF exposure from mobile phone base stations and presence of indoor sources was associated with an improved inhibitory control and cognitive flexibility whereas we observed a reduced inhibitory control and cognitive flexibility with higher personal cordless phone use. Higher residential RF-EMF exposure from mobile phone base stations was associated with a reduced visuomotor coordination whereas we observed an improved visuomotor coordination with residential presence of RF-EMF indoor sources and higher personal cell phone use. CONCLUSIONS We found inconsistent associations between different sources of RF-EMF exposure and cognitive function in children aged 5-6 years.
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Affiliation(s)
- Mònica Guxens
- Institute for Risk Assessment Sciences, Division of Environmental Epidemiology, Utrecht University, PO Box 80178, 3508 TD Utrecht, The Netherlands; Center for Research in Environmental Epidemiology, C/ Doctor Aiguader 88, 08003 Barcelona, Spain; Pompeu Fabra University, C/ Doctor Aiguader 88, 08003 Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Avenue de Monforte de Lemos, 5, 28029 Madrid, Spain; Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre-Sophia Children's Hospital, PO Box 2060, 3000 CB Rotterdam, The Netherlands.
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Division of Environmental Epidemiology, Utrecht University, PO Box 80178, 3508 TD Utrecht, The Netherlands; Julius Centre for Public Health Sciences and Primary Care, University Medical Centre, PO Box 85500, 3508 GA Utrecht, The Netherlands.
| | - Manon van Eijsden
- Department of Epidemiology and Health Promotion, Public Health Service of Amsterdam (GGD), PO Box 2200, 1000 CE Amsterdam, The Netherlands.
| | - Johan Beekhuizen
- Institute for Risk Assessment Sciences, Division of Environmental Epidemiology, Utrecht University, PO Box 80178, 3508 TD Utrecht, The Netherlands.
| | - Tanja G M Vrijkotte
- Department of Public Health, Academic Medical Center, University of Amsterdam, Meidergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Rob T van Strien
- Department of Environmental Health, Public Health Service of Amsterdam (GGD), PO Box 2200, 1000 CE Amsterdam, The Netherlands.
| | - Hans Kromhout
- Institute for Risk Assessment Sciences, Division of Environmental Epidemiology, Utrecht University, PO Box 80178, 3508 TD Utrecht, The Netherlands.
| | - Anke Huss
- Institute for Risk Assessment Sciences, Division of Environmental Epidemiology, Utrecht University, PO Box 80178, 3508 TD Utrecht, The Netherlands; Institute for Social and Preventive Medicine, University of Bern, Finkenhubelweg 9, 3012 Bern, Switzerland.
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13
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Razza RA, Martin A, Brooks-Gunn J. Links between motor control and classroom behaviors: Moderation by low birth weight. JOURNAL OF CHILD AND FAMILY STUDIES 2016; 25:2423-2434. [PMID: 27594776 PMCID: PMC5008452 DOI: 10.1007/s10826-016-0410-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
It is unclear from past research on effortful control whether one of its components, motor control, independently contributes to adaptive classroom behaviors. The goal of this study was to identify associations between early motor control, measured by the walk-a-line task at age 3, and teacher-reported learning-related behaviors (approaches to learning and attention problems) and behavior problems in kindergarten classrooms. Models tested whether children who were vulnerable to poorer learning behaviors and more behavior problems due to having been born low birth weight benefited more, less, or the same as other children from better motor control. Data were drawn from the national Fragile Families and Child-Wellbeing Study (n = 751). Regression models indicated that motor control was significantly associated with better approaches to learning and fewer behavior problems. Children who were low birth weight benefitted more than normal birth weight children from better motor control with respect to their approaches to learning, but equally with respect to behavior problems. Additionally, for low but not normal birth weight children, better motor control predicted fewer attention problems. These findings suggest that motor control follows a compensatory model of development for low birth weight children and classroom behaviors.
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Affiliation(s)
- Rachel A Razza
- Department of Child and Family Studies, Syracuse University, 144D White Hall, Syracuse, NY 13244,
| | - Anne Martin
- National Center for Children and Families, Teachers College, Columbia University, 525 West 120 Street, Box 39, New York, NY 10027
| | - Jeanne Brooks-Gunn
- National Center for Children and Families, Teachers College, Columbia University, 525 West 120 Street, Box 39, New York, NY 10027
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14
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Lazeron RHC, de Sonneville LMJ, Scheltens P, Polman CH, Barkhof F. Cognitive slowing in multiple sclerosis is strongly associated with brain volume reduction. Mult Scler 2016; 12:760-8. [PMID: 17263004 DOI: 10.1177/1352458506070924] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction In this study, we investigated the influence of in vivo disease pathology (measured as magnetic resonance imaging (MRI) lesion load and brain volume reduction) on cognitive functioning, especially the speed of processing, in multiple sclerosis (MS) patients. Since MS is characterized by cognitive slowing rather than impaired accuracy, we used the Amsterdam Neuropsychological Tasks (ANT) program, a computerized test proven to be very sensitive to cognitive slowing in MS patients. Methods Thirty-two patients performed the ANT and underwent MRI scanning. Using the ANT computerized tests, we investigated focused, divided, sustained attention, executive function and psychomotor function, and examined associations of speed, speed fluctuation and accuracy of performance of these tests with MRI lesion load and brain volume parameters. Results A decrease in the speed of processing and response speed stability, and a decrease in psychomotor accuracy and stability were clearly associated with less brain volume, and with higher lesion loads, in particular at frontal and occipital areas. Correlations with brain volume reduction were found for all domains, except for visuo-spatial processing. In particular, speed and speed fluctuation scores correlated with brain volume reduction, while accuracy of performance, in general, did not correlate. Only some test speed scores and speed fluctuation scores correlated with lesion load measurements. Conclusion This study shows that, in MS patients, accuracy of processing is not compromised unless high working memory demands are involved. Problems in neurocognitive functioning in MS are mainly modulated by speed and stability of speed processing, in particular when attention-demanding controlled information processing is required. Abnormalities in these domains are most strongly associated with brain volume loss, confirming that pathology beyond focal lesions is important in MS.
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Affiliation(s)
- R H C Lazeron
- Department of Neurology, Vrije Universiteit Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
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15
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Casnar CL, Janke KM, van der Fluit F, Brei NG, Klein-Tasman BP. Relations between fine motor skill and parental report of attention in young children with neurofibromatosis type 1. J Clin Exp Neuropsychol 2014; 36:930-43. [PMID: 25284746 DOI: 10.1080/13803395.2014.957166] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Neurofibromatosis type 1 (NF1) is one of the most common genetic disorders presenting in approximately 1 in 3,500 live births. NF1 is a highly variable condition with a large number of complications. A common complication is neuropsychological problems, including developmental delays and learning difficulties that affect as many as 60% of patients. Research has suggested that school-aged children with NF1 often have poorer fine motor skills and are at greater risk for attention difficulties than the general population. Thirty-eight children with NF1 and 23 unaffected children between the ages of 4 and 6 years, who are enrolled in a study of early development in NF1, were included in the present study. Varying levels of fine motor functioning were examined (simple to complex fine motor tasks). For children with NF1, significant difficulties were demonstrated on lab-based mid-level and complex fine motor tasks, even after controlling for nonverbal reasoning abilities, but not on simple fine motor tasks. Parental report also indicated difficulties in everyday adaptive fine motor functioning. No significant correlations were found between complex fine motor ability and attention difficulties. This study provides much needed descriptive data on the early emergence of fine motor difficulties and attention difficulties in young children with NF1.
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Affiliation(s)
- Christy L Casnar
- a Department of Psychology , University of Wisconsin-Milwaukee , Milwaukee , WI , USA
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16
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Mao HY, Kuo LC, Yang AL, Su CT. Balance in children with attention deficit hyperactivity disorder-combined type. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:1252-1258. [PMID: 24685941 DOI: 10.1016/j.ridd.2014.03.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 03/08/2014] [Indexed: 06/03/2023]
Abstract
The balance ability in children with attention deficit hyperactivity disorder-combined type (ADHD-C) has not been fully examined, particularly dynamic sitting balance. Moreover, the findings of some published studies are contradictory. We examined the static and dynamic sitting balance ability in 20 children with ADHD-C (mean age: 9 years 3 months; 18 boys, 2 girls) and 20 age-, sex-, height-, weight-, and IQ-matched healthy and typically developing controls (mean age: 9 years 2 months; 18 boys, 2 girls). The balance subtests of the Movement Assessment Battery for Children (MABC) and the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) were used to compare the two groups, and a mechanical horseback riding test was recorded using a motion-capture system. Compared with the controls, children with ADHD-C had less-consistent patterns of movement, more deviation of movement area, and less-effective balance strategies during mechanical horseback riding. In addition, their performance on the balance subtests of the MABC and BOTMP were not as well as those of the controls. Our findings suggest that balance ability skill levels in children with ADHD-C were generally not as high as those of the controls in various aspects, including static and dynamic balance.
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Affiliation(s)
- Hsun-Ying Mao
- Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Li-Chieh Kuo
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ai-Lun Yang
- Graduate Institute of Exercise Science, University of Taipei, Taipei, Taiwan
| | - Chia-Ting Su
- Department of Occupational Therapy, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
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17
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Scharoun SM, Bryden PJ, Otipkova Z, Musalek M, Lejcarova A. Motor skills in Czech children with attention-deficit/hyperactivity disorder and their neurotypical counterparts. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:4142-4153. [PMID: 24060728 DOI: 10.1016/j.ridd.2013.08.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 08/06/2013] [Accepted: 08/06/2013] [Indexed: 06/02/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is the most commonly diagnosed neurobehavioural disorder. Characterized by recurring problems with impulsiveness and inattention in combination with hyperactivity, motor impairments have also been well documented in the literature. The aim of this study was to compare the fine and gross motor skills of male and female children with ADHD and their neurotypical counterparts within seven skill assessments. This included three fine motor tasks: (1) spiral tracing, (2) dot filling, (3) tweezers and beads; and four gross motor tasks: (1) twistbox, (2) foot tapping, (3) small plate finger tapping, and (4) large plate finger tapping. It was hypothesized that children with ADHD would display poorer motor skills in comparison to neurotypical controls in both fine and gross motor assessments. However, statistically significant differences between the groups only emerged in four of the seven tasks (spiral tracing, dot filling, tweezers and beads and foot tapping). In line with previous findings, the complexity underlying upper limb tasks solidified the divide in performance between children with ADHD and their neurotypical counterparts. In light of similar research, impairments in lower limb motor skill were also observed. Future research is required to further delineate trends in motor difficulties in ADHD, while further investigating the underlying mechanisms of impairment.
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Affiliation(s)
- S M Scharoun
- Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, Canada N2L 3G1.
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Berger I, Slobodin O, Aboud M, Melamed J, Cassuto H. Maturational delay in ADHD: evidence from CPT. Front Hum Neurosci 2013; 7:691. [PMID: 24298243 PMCID: PMC3829464 DOI: 10.3389/fnhum.2013.00691] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 09/30/2013] [Indexed: 11/13/2022] Open
Abstract
While data from behavioral, neuropsychological, and brain studies suggested that Attention-Deficit/Hyperactivity Disorder (ADHD) is related to a developmental lag that reduces with age, other studies have proposed that ADHD represents a deviant brain function. The present study used a cross-sectional approach to examine whether ADHD children show a developmental delay in cognitive performance measured by continuous performance test (CPT). We thus, compared six age groups of ADHD children (N = 559) and their unaffected peers (N = 365), aged 6–11, in four parameters of MOXO-CPT performance: Attention, Timing, Hyperactivity and Impulsivity. Results have shown that despite improvement in CPT performance with age, ADHD children continued to demonstrate impaired performance as compared to controls. In most parameters, CPT performance of ADHD children matched that of 1–3 years younger normal controls, with a delay most prominent in older children. However, in the Hyperactivity parameter, ADHD children's performance resembled that of much younger healthy children, with almost no evidence for a developmental catch up. This study suggests that while some cognitive functions develop slower but normally, other functions (e.g., inhibitory control) show a different trajectory.
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Affiliation(s)
- Itai Berger
- Pediatric Division, The Neuro-Cognitive Center, Hadassah-Hebrew University Medical Center Jerusalem, Israel
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19
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A comparison of phenylketonuria with attention deficit hyperactivity disorder: do markedly different aetiologies deliver common phenotypes? Brain Res Bull 2013; 99:63-83. [PMID: 24140048 DOI: 10.1016/j.brainresbull.2013.10.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 09/04/2013] [Accepted: 10/07/2013] [Indexed: 01/21/2023]
Abstract
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.
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Mingebach T, Roller A, Dalir S, Becker K, Pauli-Pott U. Spezifische und gemeinsame neuropsychologische Basisdefizite bei ADHS- und ODD-Symptomen im Vorschulalter. KINDHEIT UND ENTWICKLUNG 2013. [DOI: 10.1026/0942-5403/a000119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Es ist anzunehmen, dass unterschiedliche neuropsychologische Basisdefizite den Symptomen der ADHS zugrunde liegen. Die Frage ist, ob spezielle Basisdefizite spezifisch mit der ADHS-Symptomatik verbunden sind oder auch mit Symptomen einer Störung des Sozialverhaltens mit oppositionellem, aufsässigem Verhalten (ODD) korrelieren. Deswegen wurden neuropsychologische Aufgaben zur Erfassung von exekutiver Inhibitionskontrolle, Verzögerungsaversion, Intelligenz und Sensomotorik mit 141 Kindern (davon 68 Jungen) zwischen drei und sechs Jahren durchgeführt. Eltern (Pre-PACS Interview, SDQ) und Erzieher/innen (SDQ) aus dem Kindergarten schätzten die ADHS- und ODD-Symptome ein. Die ADHS-Symptome korrelierten bei Berücksichtigung von Kontrollvariablen signifikant mit exekutiver Inhibitionskontrolle, Verzögerungsaversion, Intelligenz und Sensomotorik. Bei zusätzlicher Kontrolle der ODD-Symptome zeigten sich weiterhin signifikante Assoziationen mit Verzögerungsaversion und Intelligenz. Auch in der multiplen Regressionsanalyse klärten diese beiden neuropsychologischen Basisdefizite jeweils unabhängig signifikant Varianz der ADHS-Symptome auf. Die ODD-Symptome zeigten keinen über die ADHS-Symptome hinausgehenden Zusammenhang mit den neuropsychologischen Basisdefiziten. ADHS-Symptome im Vorschulalter gehen mit höherer Verzögerungsaversion und Intelligenzdefiziten einher, während ODD-Symptome nicht unabhängig mit neuropsychologischen Basisdefiziten assoziiert sind.
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Affiliation(s)
- Tanja Mingebach
- Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie der Philipps-Universität Marburg
| | - Alisa Roller
- Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie der Philipps-Universität Marburg
| | - Silke Dalir
- Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie der Philipps-Universität Marburg
| | - Katja Becker
- Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie der Philipps-Universität Marburg
| | - Ursula Pauli-Pott
- Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie der Philipps-Universität Marburg
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Lee IC, Chen YJ, Tsai CL. Kinematic performance of fine motor control in attention-deficit/hyperactivity disorder: the effects of comorbid developmental coordination disorder and core symptoms. Pediatr Int 2013; 55:24-9. [PMID: 23163694 DOI: 10.1111/ped.12010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Revised: 01/12/2012] [Accepted: 09/19/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aims of this study were: (i) to determine whether differences exist in the fine motor fluency and flexibility of three groups (children with attention-deficit/hyperactivity disorder [ADHD], children in whom ADHD is comorbid with developmental coordination disorder [DCD] [denoted as ADHD+DCD], and a typically developing control group); and (ii) to clarify whether the degree of severity of core symptoms affects performance. METHODS The Peabody Picture Vocabulary Test-Revised, the Beery-Buktenica Development Test of Visual-Motor Integration and the Movement Assessment Battery for Children were used as prescreening tests. The Integrated Visual and Auditory+Plus test was utilized to assess subjects' attention. The redesigned fine motor tracking and pursuit tasks were administered to evaluate subjects' fine motor performance. RESULTS No significant difference was found when comparing the performance of the Children with ADHD and the typically developing group. Significant differences existed between children in whom ADHD is comorbid with DCD and typically developing children. CONCLUSIONS Children with ADHD demonstrated proper fine motor fluency and flexibility, and deficient performance occurred when ADHD was comorbid with developmental coordination disorder. Children with ADHD had more difficulty implementing closed-loop movements that required higher levels of cognitive processing than those of their typically developing peers. Also, deficits in fine motor control were more pronounced when ADHD was combined with movement coordination problems. The severity of core symptoms had a greater effect on children with ADHD's fine motor flexibility than did fluency performance. In children with pure ADHD, unsmooth movement performance was highly related to the severity of core symptoms.
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Affiliation(s)
- I-Ching Lee
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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22
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Schlee G, Neubert T, Worenz A, Milani TL. Children with ADHD show no deficits in plantar foot sensitivity and static balance compared to healthy controls. RESEARCH IN DEVELOPMENTAL DISABILITIES 2012; 33:1957-1963. [PMID: 22728606 DOI: 10.1016/j.ridd.2012.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Revised: 05/03/2012] [Accepted: 05/04/2012] [Indexed: 06/01/2023]
Abstract
The goal of this study was to investigate plantar foot sensitivity and balance control of ADHD (n=21) impaired children compared to age-matched healthy controls (n=25). Thresholds were measured at 200 Hz at three anatomical locations of the plantar foot area of both feet (hallux, first metatarsal head (METI) and heel). Body balance was quantified using the length, area and velocity described by the center of pressure (COP) during two-legged as well as one-legged stand (right and left legs). The comparison of vibration thresholds showed no differences between ADHD and healthy children at all anatomical locations of both feet. Whereas COP excursion and area were significantly lower in ADHD subjects compared to the healthy controls during two-legged stand, no differences were found in those variables when balancing on one leg. No differences in COP velocity between ADHD and healthy children were found in any analyzed conditions. The results indicate that the unusual and simple test situation may have increased the perception of vibration stimuli by the ADHD children. Furthermore, ADHD subjects seem to be less variable when performing simple tasks than healthy controls.
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Affiliation(s)
- Günther Schlee
- Chemnitz University of Technology, Faculty of Behavioral and Social Sciences, Institute of Sport Science, Department of Human Locomotion, 09107 Chemnitz, Germany.
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23
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Egeland J, Ueland T, Johansen S. Central processing energetic factors mediate impaired motor control in ADHD combined subtype but not in ADHD inattentive subtype. JOURNAL OF LEARNING DISABILITIES 2012; 45:361-370. [PMID: 21685345 DOI: 10.1177/0022219411407922] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Participants with attention-deficit/hyperactivity disorder (ADHD) are often impaired in visuomotor tasks. However, little is known about the contribution of modal impairment in motor function relative to central processing deficits or whether different processes underlie the impairment in ADHD combined (ADHD-C) versus ADHD inattentive (ADHD-I) subtype. The present study analyzes performance on the Visual Motor Integration Test relative to less effortful motor tests as well as on measures of energetics. Both ADHD groups showed evidence of impaired motor function on both visual-motor integration (VMI) and the less effortful motor tests. The ADHD-C group performed below the ADHD-I group on VMI, but their performance correlated highly with the measures of the energetic pools of arousal and effort. Different mechanisms may underlie impaired fine motor skills in ADHD. Central processing deficits contribute significantly to the deficit of ADHD-C but do not explain the motor impairment in ADHD-I.
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Affiliation(s)
- Jens Egeland
- Vestfold Mental Health Care Trust, Tønsberg, Norway.
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24
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de Kloet A, Berger M, Verhoeven I, van Stein Callenfels K, Vlieland TV. Gaming supports youth with acquired brain injury? A pilot study. Brain Inj 2012; 26:1021-9. [DOI: 10.3109/02699052.2012.654592] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Chen YY, Chen CH, Wang CC, Liaw LJ, Guo LY, Wu WL. Comparison of Dynamic Balance under Dual and Simple Task Conditions in Children with Attention Deficit Hyperactivity Disorder. J Phys Ther Sci 2012. [DOI: 10.1589/jpts.24.633] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ying-Yi Chen
- Department of Sports Medicine, Kaohsiung Medical University
| | - Chia-Hsin Chen
- Department of Physical and Rehabilitation Medicine, Kaohsiung Medical University Hospital
| | - Chih-Chung Wang
- Department of Physical and Rehabilitation Medicine, Kaohsiung Medical University Hospital
| | - Lih-Jiun Liaw
- Department of Physical Therapy, Kaohsiung Medical University
| | - Lan-Yuen Guo
- Department of Sports Medicine, Kaohsiung Medical University
- Medical Device Innovation Center, National Cheng Kung University
| | - Wen-Lan Wu
- Department of Sports Medicine, Kaohsiung Medical University
- Medical Device Innovation Center, National Cheng Kung University
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Brossard-Racine M, Majnemer A, Shevell MI. Exploring the neural mechanisms that underlie motor difficulties in children with Attention Deficit Hyperactivity Disorder. Dev Neurorehabil 2011; 14:101-11. [PMID: 21410402 DOI: 10.3109/17518423.2010.547545] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Attention Deficit Hyperactivity Disorder (ADHD) is the most common neurobehavioural disorder of childhood. Motor performance appears to be impaired for an important sub-set of this population. OBJECTIVES This structured review draws attention to the neurological mechanisms that could potentially explain these difficulties. METHODS In August 2010, Medline, PsychINFO and Embase databases were searched with keywords related to ADHD, neuroimaging modalities and motor performance. RESULTS Four studies were retrieved that examined both motor performance and possible neural substrates. Each study explored different hypotheses and no common conclusion is emerging. The cortical activation dysregulation hypothesis, the cerebellar dysfunction hypothesis and the delayed white matter maturation hypothesis were proposed, applying combinations of motor observations and neuroimaging findings. CONCLUSION Published literature to date is insufficient to confirm specific hypotheses. Additional studies coupling discrete motor evaluations to neuroimaging techniques are needed in children with ADHD to better understand the neurobiological mechanisms of their motor difficulties.
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Affiliation(s)
- Marie Brossard-Racine
- School of Physical & Occupational Therapy, McGill University, Montreal Children’s Hospital-McGill University Health Center, Quebec, Canada
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Polderman TJC, van Dongen J, Boomsma DI. The relation between ADHD symptoms and fine motor control: a genetic study. Child Neuropsychol 2010; 17:138-50. [PMID: 21113825 DOI: 10.1080/09297049.2010.518142] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Previous research has shown that fine motor control (MC) performance, measured with a computerized task, was less accurate in children with ADHD and in their unaffected siblings, compared to healthy children. This might indicate a shared genetic etiology between MC and ADHD; it was therefore suggested that MC could serve as endophenotype for ADHD. We examined the association between ADHD symptoms (AS) and MC in a genetically informative design that can distinguish between a genetic and a nongenetic familial etiology for the association. Participants were 12-year-old twins and their siblings (N = 409). AS were rated on a continuous scale with the Strengths and Weaknesses of ADHD and Normal behavior scale (SWAN). MC accuracy and stability was measured with the computerized pursuit task of the Amsterdam Neuropsychological Tasks (ANT). Analyses were performed with Structural Equation Modelling. AS were weakly associated with MC accuracy of the left and right hand (r = -.10/-.10). No association with MC stability was found (r = -.01/-.03). AS were highly heritable (75%), while MC accuracy of the right hand and MC stability showed no genetic influences. For MC accuracy of the left hand, variance was explained by genetic (10%), common environmental (23%), and unique environmental variances. The association between MC accuracy of the left hand and AS was explained by a shared genetic influence but the genetic correlation was low (r = -.14). The phenotypic and genetic associations between AS and computerized MC were weak, suggesting that fine MC is not a proper endophenotype for ADHD.
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Affiliation(s)
- Tinca J C Polderman
- Department of Biological Psychology, VU University Amsterdam, The Netherlands.
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Lavasani NM, Stagnitti K. A study on fine motor skills of Iranian children with attention deficit/hyper activity disorder aged from 6 to 11 years. Occup Ther Int 2010; 18:106-14. [DOI: 10.1002/oti.306] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Revised: 09/03/2010] [Accepted: 09/03/2010] [Indexed: 11/09/2022] Open
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Helps SK, Broyd SJ, James CJ, Karl A, Chen W, Sonuga-Barke EJS. Altered spontaneous low frequency brain activity in attention deficit/hyperactivity disorder. Brain Res 2010; 1322:134-43. [PMID: 20117101 DOI: 10.1016/j.brainres.2010.01.057] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Revised: 01/20/2010] [Accepted: 01/22/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND Resting brain activity appears altered in Attention Deficit/Hyperactivity Disorder (ADHD). The default mode interference hypothesis (Sonuga-Barke and Castellanos, 2007) postulates that patterns of spontaneous very low frequency brain activity, typical of the resting brain, cause attention lapses in ADHD when they remain unattenuated following the transition from rest to active task performance. Here we test this hypothesis using DC-EEG. METHODS DC-EEG recordings of very low frequency brain activity (<1.5Hz) were compared for 16 male children with ADHD and 16 healthy controls during both rest and active task performance (two choice reaction time task). RESULTS A previously identified very low frequency resting network of electrodes was replicated. At rest ADHD children showed less EEG power in very low frequency bands (i.e., .02-.2Hz). They also showed less attenuation of power at these frequency bands during rest-to-task transition. Reduced attenuation was associated with a number of measures of performance. DISCUSSION We confirmed the existence of altered very low frequency brain activity in ADHD. ADHD children may have deficits both in maintaining a resting brain when needed and 'protecting' an active brain from the intrusion of resting state brain activity.
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Affiliation(s)
- Suzannah K Helps
- Institute for Disorders for Impulse and Attention, Developmental Brain-Behaviour Laboratory, School of Psychology, University of Southampton, UK
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Wassenberg R, Hendriksen JGM, Hurks PPM, Feron FJM, Vles JSH, Jolles J. Speed of language comprehension is impaired in ADHD. J Atten Disord 2010; 13:374-85. [PMID: 18974079 DOI: 10.1177/1087054708326111] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Children with ADHD have an increased risk of poor academic performance. It is important to identify cognitive processes that may be related to this academic failure. In Western schooling systems, especially language processing skills may be of relevance. The present study, therefore, compares the ability to comprehend complex sentences of individuals with and without ADHD. METHOD Fifteen children (aged 8-11) and 15 adolescents (aged 12-16) with ADHD combined subtype are matched for age, gender, and parental level of education to 30 control subjects. Language comprehension is measured using the neuropsychological procedure proposed by Luria and an adapted version of the Token Test. RESULTS Compared with the control group, children and adolescents with ADHD perform significantly slower on language comprehension tasks. Differences in accuracy are limited. No interaction between age and ADHD is found. CONCLUSIONS Children and adolescents with ADHD are slower and less efficient than matched control subjects with regard to complex sentence comprehension.
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Affiliation(s)
- Renske Wassenberg
- Department of Psychiatry and Neuropsychology, Maastricht University, the Netherlands
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The Effects of Stimulant Medication on the Online Story Narrations of Children with ADHD. SCHOOL MENTAL HEALTH 2009. [DOI: 10.1007/s12310-009-9017-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Davis AS, Pass LA, Finch WH, Dean RS, Woodcock RW. The Canonical Relationship Between Sensory-Motor Functioning and Cognitive Processing in Children with Attention-Deficit/Hyperactivity Disorder. Arch Clin Neuropsychol 2009; 24:273-86. [DOI: 10.1093/arclin/acp032] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Stray LL, Stray T, Iversen S, Ruud A, Ellertsen B, Tønnessen FE. The Motor Function Neurological Assessment (MFNU) as an indicator of motor function problems in boys with ADHD. Behav Brain Funct 2009; 5:22. [PMID: 19450246 PMCID: PMC2697164 DOI: 10.1186/1744-9081-5-22] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Accepted: 05/18/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The paper presents the Motor Function Neurological Assessment (MFNU), as a tool for identifying typical motor function problems in children with Attention Deficit Hyperactivity Disorder (ADHD). The study investigated motor functions in boys diagnosed with Hyperkinetic Disorder (HKD, F.90.0). HKD corresponds to the ADHD-combined (ADHD-C) diagnosis in the DSM-IV. The paper addresses the ability of the instrument to discriminate between non-medicated boys with HKD and a control group consisting of normal non-referred boys without any clinical significant ADHD symptoms. METHODS 25 drug-naïve boys, aged 8-12 years and recently diagnosed as HKD F90.0, were compared with 27 controls, all boys in the same age range, on 17 MFNU subtests, and with a 'Total score' parameter. RESULTS On the individual subtests 80-96% (median 88%) of the ADHD group showed 'moderate' to 'severe' problems, compared to 0-44% (median 14.8%) within the control group. The percentage of 'severe problems' ranged from 44-84%, (median 64%) in the ADHD group, and 0-44% (median 0%) in the control group. The highly significant differences found between the groups on all subtests, and on the Total score scores, indicated that the MFNU had a high discriminative power when children with ADHD and normal controls were compared. The Total score parameter seemed to be a meaningful discriminator of a common underlying factor of the 17 subtests used in the study. CONCLUSION The study confirms our clinical findings that the MFNU measures a consistent pattern of motor function problems in children with HKD, and that these problems are rarely represented in individuals without ADHD. Further research is needed to investigate to what extent the MFNU taps motor problems that are truly specific to ADHD, in contrast to motor problems common to children with DCD or other clinical problems.
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Affiliation(s)
- Liv Larsen Stray
- Department of Child and Adolescent Health, Sørlandet Hospital, Norway.
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Hahnefeld A, Heuschen U. Versorgungsstudie zum Marburger Konzentrationstraining (MKT) bei Grundschulkindern mit Symptomen einer Aktivitäts- und Aufmerksamkeitsstörung. KINDHEIT UND ENTWICKLUNG 2009. [DOI: 10.1026/0942-5403.18.1.30] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
In der vorliegenden Versorgungsstudie wurden die Effekte des „Marburger Konzentrationstraining“ (MKT, Krowatschek, 2000 ) untersucht. 125 Grundschulkinder im Alter von 6 – 11 Jahren mit unterschiedlich stark ausgeprägten Symptomen einer Aktivitäts- und Aufmerksamkeitsstörung und ihre Eltern nahmen an dem in Kleingruppen durchgeführten kognitiv-behavioralen Training teil. Die ADHS-Symptome der Kinder wurden vor der Intervention, direkt danach und drei Monate nach Abschluss derselben erhoben. Im jeweiligen Vorher-Nachher-Vergleich ergab sich ein Rückgang der Symptomatik im Elternurteil direkt nach dem Training. Bei der Follow-up-Befragung zeigte sich eine weitere signifikante Verringerung der Unaufmerksamkeitssymptome. Zusätzlich wurde erhöhte Selbstständigkeit der Kinder in der Hausaufgabensituation sowohl während des Trainings als auch in den drei Monaten danach berichtet. Es zeigt sich hier also ein positiver Effekt einer relativ niederschwelligen und kurzzeitigen Intervention.
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Wagenaar K, van Weissenbruch M, Knol D, Cohen-Kettenis P, Delemarre-van de Waal H, Huisman J. Information processing, attention and visual-motor function of adolescents born after in vitro fertilization compared with spontaneous conception. Hum Reprod 2008; 24:913-21. [DOI: 10.1093/humrep/den455] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Koekkoek S, de Sonneville LMJ, Wolfs TFW, Licht R, Geelen SPM. Neurocognitive function profile in HIV-infected school-age children. Eur J Paediatr Neurol 2008; 12:290-7. [PMID: 17950012 DOI: 10.1016/j.ejpn.2007.09.002] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2007] [Revised: 08/29/2007] [Accepted: 09/02/2007] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Evaluation of neurocognitive function of school-age children with HIV. DESIGN Cross-sectional observational study. METHODS Twenty-two children (median age 9.46 years) with perinatally acquired HIV infection were administered a global intelligence test and tests from the Amsterdam Neuropsychological Tasks (ANT) program. The relationship between various patient-, disease- and treatment factors and neurocognitive outcome variables was examined. RESULTS Compared with age-appropriate norms, mean IQ of the HIV-infected children was in the average range. However, the HIV-infected children performed poorer on several neuropsychological tests compared with age-appropriate norms. Executive function (attentional flexibility, visuospatial working memory) and processing speed emerged as the most sensitive cognitive measures in relation to HIV disease. The correlational analyses resulted in only two significant outcomes, showing that higher CD4% at initiation of highly active antiretroviral therapy (HAART) and longer treatment duration were associated with better working memory function and attentional control, respectively. CONCLUSIONS These exploratory data suggest that subtle neurocognitive impairments may exist in HIV-infected school-age children, in particular characterized by compromised executive function and slowed information processing. Further research with larger sample sizes is needed to confirm these findings.
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Affiliation(s)
- Sanneke Koekkoek
- Department of Clinical Neuropsychology, Faculty of Psychology and Education, Vrije Universiteit, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands.
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Rommelse NNJ, Altink ME, Oosterlaan J, Beem L, Buschgens CJM, Buitelaar J, Sergeant JA. Speed, variability, and timing of motor output in ADHD: which measures are useful for endophenotypic research? Behav Genet 2008; 38:121-32. [PMID: 18071893 PMCID: PMC2257997 DOI: 10.1007/s10519-007-9186-8] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2006] [Accepted: 11/27/2007] [Indexed: 11/17/2022]
Abstract
Attention-Deficit/Hyperactivity Disorder (ADHD) shares a genetic basis with motor coordination problems and probably motor timing problems. In line with this, comparable problems in motor timing should be observed in first degree relatives and might, therefore, form a suitable endophenotypic candidate. This hypothesis was investigated in 238 ADHD-families (545 children) and 147 control-families (271 children). A motor timing task was administered, in which children had to produce a 1,000 ms interval. In addition to this task, two basic motor tasks were administered to examine speed and variability of motor output, when no timing component was required. Results indicated that variability in motor timing is a useful endophenotypic candidate: It was clearly associated with ADHD, it was also present in non-affected siblings, and it correlated within families. Accuracy (under- versus over-production) in motor timing appeared less useful: Even though accuracy was associated with ADHD (probands and affected siblings had a tendency to under-produce the 1,000 ms interval compared to controls), non-affected siblings did not differ from controls and sibling correlations were only marginally significant. Slow and variable motor output without timing component also appears present in ADHD, but not in non-affected siblings, suggesting these deficits not to be related to a familial vulnerability for ADHD. Deficits in motor timing could not be explained by deficits already present in basic motor output without a timing component. This suggests abnormalities in motor timing were predominantly related to deficient motor timing processes and not to general deficient motor functioning. The finding that deficits in motor timing run in ADHD-families suggests this to be a fruitful domain for further exploration in relation to the genetic underpinnings of ADHD.
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Affiliation(s)
- Nanda N J Rommelse
- Department of Clinical Neuropsychology, VU University Amsterdam, Van der Boechorststraat 1, Amsterdam 1081 BT, The Netherlands.
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Bond C, Cole M, Crook H, Fletcher J, Lucanz J, Noble J. The Development of the Manchester Motor Skills Assessment (MMSA): An initial evaluation. EDUCATIONAL PSYCHOLOGY IN PRACTICE 2007. [DOI: 10.1080/02667360701661132] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- C. Bond
- a Manchester Educational Psychology Service , UK
| | - M. Cole
- a Manchester Educational Psychology Service , UK
| | - H. Crook
- b Manchester Diversity and Inclusion Team , UK
| | - J. Fletcher
- a Manchester Educational Psychology Service , UK
| | - J. Lucanz
- b Manchester Diversity and Inclusion Team , UK
| | - J. Noble
- a Manchester Educational Psychology Service , UK
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Rommelse NNJ, Altink ME, Oosterlaan J, Buschgens CJM, Buitelaar J, De Sonneville LMJ, Sergeant JA. Motor control in children with ADHD and non-affected siblings: deficits most pronounced using the left hand. J Child Psychol Psychiatry 2007; 48:1071-9. [PMID: 17995482 DOI: 10.1111/j.1469-7610.2007.01781.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is strongly influenced by heritability. Identifying heritable vulnerability traits (endophenotypes) that mark a relatively high risk of developing the disorder can contribute to the identification of risk genes. A fruitful area for the search for such endophenotypes may be motor control in children with ADHD, since the disorder is frequently accompanied by motor problems. METHOD The current study used a large sample of 350 children with ADHD, 195 non-affected siblings and 271 normal controls aged 5-19 years. Children were administered two computerised motor control tasks in which they had to trace a path between two circles (Tracking task) and follow a randomly moving target (Pursuit task). Both tasks were performed with both the right and the left hand. RESULTS Children with ADHD were less precise and stable than controls. Non-affected siblings also deviated from controls, but only on the Tracking task. Group differences were modulated by the use of the right versus the left hand: no group differences emerged when the right hand was used, yet group differences did emerge when the left hand was used. Performance on both tasks was significantly familial. CONCLUSIONS Imprecision and instability of movements in children with ADHD and in their non-affected siblings as measured by the Tracking task might be suitable endophenotypic candidates: these deficits are familially present in children having ADHD as well as in their non-affected siblings. Motor performance might be best assessed in children using their left hand, because motor control deficits are most pronounced using the left hand. This might relate to right hemispheric brain pathology in children with ADHD (and possibly in their non-affected siblings) that is related to the control of the left hand and/or relate to differential effects of daily life practice on both hands, which may be smaller on the left hand.
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Affiliation(s)
- Nanda N J Rommelse
- Department of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
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Buchmann J, Gierow W, Weber S, Hoeppner J, Klauer T, Benecke R, Haessler F, Wolters A. Restoration of disturbed intracortical motor inhibition and facilitation in attention deficit hyperactivity disorder children by methylphenidate. Biol Psychiatry 2007; 62:963-9. [PMID: 17719015 DOI: 10.1016/j.biopsych.2007.05.010] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2007] [Revised: 05/10/2007] [Accepted: 05/11/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Previous investigations using transcranial magnetic stimulation (TMS) have shown that neural inhibitory motor circuits are disturbed in ADHD children. We sought to investigate the influence of methylphenidate (MPH) on inhibitory and facilitatory motor circuits of ADHD children with TMS paired pulse protocols using surplus long interval inter-stimulus intervals (ISI) not investigated so far. METHODS Motorcortical modulation was tested with TMS paired pulse protocols employing ISI of 3, 13, 50, 100, 200, and 300 msec in 18 ADHD children before and on treatment with MPH. Clinical improvement by MPH was measured by the Conners score. RESULTS Analysis of variance (ANOVA) revealed a significant three-way interaction "Group x Amplitude x ISI," p = .001. Subsequent two-factorial ANOVAs and t-tests showed group specific differences of motor evoked potential (MEP) amplitudes for inhibitory ISIs of 3 and 100 msec, and for facilitatory ISIs of 13 and 50 msec. Compared to controls, an adjustment of these parameters by MPH could be shown. On MPH, a significant bivariate correlation was found between the Conners score reduction and averaged MEP amplitude changes only for inhibitory ISIs (3 and 100 msec). CONCLUSIONS In ADHD children, MPH modulates disturbed facilitatory and inhibitory motor circuits, which for the latter is associated with clinical improvement.
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Affiliation(s)
- Johannes Buchmann
- Department of Child and Adolescence Psychiatry and Neurology, Center of Nerve Diseases, University of Rostock, Rostock, Germany.
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Jakobson A, Kikas E. Cognitive functioning in children with and without Attention-deficit/Hyperactivity Disorder with and without comorbid learning disabilities. JOURNAL OF LEARNING DISABILITIES 2007; 40:194-202. [PMID: 17518212 DOI: 10.1177/00222194070400030101] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
This study attempted to determine whether children with the combined subtype of attention-deficit/hyperactivity disorder (ADHD) have impairments in cognitive functioning and motor skills. The specific effect of the comorbidity of learning disabilities (LD) was also investigated. A battery of cognitive tests was administered to 26 children with a clinical diagnosis of ADHD-combined subtype (ADHD/C), to 24 children with ADHD/C with a comorbid diagnosis of LD (ADHD/C+LD), and to 102 participants without disabilities, all between ages 7 and 10. The testing battery consisted of tasks assessing memory, visuospatial and verbal abilities, and fine motor skills. In general, the test results of children with ADHD/C were poorer than those of the control group but better than the results of children with a combined ADHD/C+LD diagnosis (with the exception of motor skills). The predictive accuracy of the testing battery tasks in children with ADHD/C and ADHD/C+LD was examined. The results of a standard procedure of discriminant function analyses revealed that the measures correctly classified 73.6% of the children.
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Addamo PK, Farrow M, Hoy KE, Bradshaw JL, Georgiou-Karistianis N. The effects of age and attention on motor overflow production—A review. ACTA ACUST UNITED AC 2007; 54:189-204. [PMID: 17300842 DOI: 10.1016/j.brainresrev.2007.01.004] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Revised: 01/11/2007] [Accepted: 01/15/2007] [Indexed: 12/29/2022]
Abstract
Motor overflow refers to overt involuntary movement, or covert muscle activity, that sometimes co-occurs with voluntary movement. Various clinical populations exhibit overflow. Motor overflow is also present in healthy children and the elderly, although in young adults, overt overflow is considered abnormal unless elicited under conditions of extreme force or muscle fatigue. Current theories of overflow imply that the corpus callosum may mediate production of this phenomenon. However, given that the corpus callosum is a conduit enabling the transfer of cortical information, surprisingly few studies have considered the cortical or subcortical structures underlying overflow. This review considers the developmental trend of motor overflow production, specifically in the upper-limbs, and the mechanisms thought to underlie this age-related phenomenon. Potential neurological correlates of motor overflow will be discussed in conjunction with higher order attentional processes which also regulate motor overflow production. Future research investigating the impact of attentional processes on overflow production may be particularly valuable for designing rehabilitation strategies for patients experiencing induced pathological overflow or conversely, to develop techniques to encourage the recovery of movement function in individuals with paretic limbs.
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Affiliation(s)
- Patricia K Addamo
- Experimental Neuropsychology Research Unit, School of Psychology, Psychiatry and Psychological Medicine, Monash University, Clayton, 3800, Victoria, Australia.
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Motor coordination difficulties in 5–6‐year‐old children with severe behavioural and emotional problems. EMOTIONAL AND BEHAVIOURAL DIFFICULTIES 2007. [DOI: 10.1080/13632750600833817] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Koekkoek S, Eggermont L, De Sonneville L, Jupimai T, Wicharuk S, Apateerapong W, Chuenyam T, Lange J, Wit F, Pancharoen C, Phanuphak P, Ananworanich J. Effects of highly active antiretroviral therapy (HAART) on psychomotor performance in children with HIV disease. J Neurol 2006; 253:1615-24. [PMID: 17093898 DOI: 10.1007/s00415-006-0277-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2005] [Accepted: 03/07/2006] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study assesses the effects of HAART on psychomotor performance of symptomatic HIV-infected children. It is one of the first studies to look at neurobehavioral functioning in children infected with HIV in resource-limited countries. DESIGN A longitudinal pilot study of vertically HIV-infected children at the HIV Netherlands Australia Thailand Research Collaboration Center in Bangkok, Thailand. METHODS A total of 34 children participated in the study of whom 16 had never received antiretroviral (ARV) therapy and were about to start HAART (Newly treated children), 7 did not receive antiretroviral therapy (Untreated children) and 11 had been treated with HAART for more than one year (HAART experienced children). All children were administered 4 psychomotor tasks at baseline and after 4 months. The Newly treated and the Untreated children were also evaluated after 12 months. RESULTS In general, the children performed similarly on all psychomotor tasks at baseline. After 12 months of HAART, there was a significant increase in CD4% in the Newly treated group. Overall, psychomotor performance did not change at the 4-month evaluation in all groups. At the 12-month evaluation psychomotor performance had deteriorated substantially on all tasks in both the Newly treated and the Untreated children. CONCLUSIONS There was no significant difference in psychomotor functioning between children newly treated, previously treated and untreated with HAART over the course of one year. Psychomotor performance deteriorated after 12 months of HAART, which provides important indications concerning the lack of benefits of HAART on psychomotor functions in children despite immunologic reconstitution. Further research with larger sample sizes is needed to confirm these findings.
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Affiliation(s)
- Sanneke Koekkoek
- Department of Clinical Neuropsychology, Faculty of Social Sciences, VU University, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands.
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Meyer A, Sagvolden T. Fine motor skills in South African children with symptoms of ADHD: influence of subtype, gender, age, and hand dominance. Behav Brain Funct 2006; 2:33. [PMID: 17029638 PMCID: PMC1626473 DOI: 10.1186/1744-9081-2-33] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2005] [Accepted: 10/09/2006] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Motor problems, often characterised as clumsiness or poor motor coordination, have been associated with ADHD in addition to the main symptom groups of inattention, impulsiveness, and overactivity. The problems addressed in this study were: (1) Are motor problems associated with ADHD symptoms, also in African cultures? (2) Are there differences in motor skills among the subtypes with ADHD symptoms? (3) Are there gender differences? (4) Is there an effect of age? (5) Are there differences in performance between the dominant and non-dominant hand? METHOD A total of 528 children (264 classified as having symptoms of ADHD and 264 matched comparisons) of both genders and from seven different South African ethnic groups participated in the study. They were assessed with three simple, easy to administer instruments which measure various functions of motor speed and eye-hand coordination: The Grooved Pegboard, the Maze Coordination Task, and the Finger Tapping Test. The results were analysed as a function of subtype, gender, age, and hand dominance. RESULTS The findings indicate that children with symptoms of ADHD performed significantly poorer on the Grooved Pegboard and Motor Coordination Task, but not on the Finger Tapping Test than their comparisons without ADHD symptoms. The impairment was most severe for the subtype with symptoms of ADHD-C (combined) and less severe for the subtypes with symptoms of ADHD-PI (predominantly inattentive) and ADHD-HI (predominantly hyperactive/impulsive). With few exceptions, both genders were equally affected while there were only slight differences in performance between the dominant and non-dominant hand. The deficiencies in motor control were mainly confined to the younger age group (6-9 yr). CONCLUSION An association between the symptoms of ADHD and motor problems was demonstrated in terms of accuracy and speed in fairly complex tasks, but not in simple motor tests of speed. This deficiency is found mainly in the children with ADHD-C symptoms, but also to a lesser degree in the children with symptoms of ADHD-PI and ADHD-HI.
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Affiliation(s)
- Anneke Meyer
- School of Health Sciences, University of Limpopo, Private Bag X1106, 0727 Sovenga, South Africa.
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Buizer AI, De Sonneville LMJ, van den Heuvel-Eibrink MM, Njiokiktjien C, Veerman AJP. Visuomotor control in survivors of childhood acute lymphoblastic leukemia treated with chemotherapy only. J Int Neuropsychol Soc 2005; 11:554-65. [PMID: 16212682 DOI: 10.1017/s1355617705050666] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2004] [Revised: 04/12/2005] [Accepted: 04/14/2005] [Indexed: 11/06/2022]
Abstract
Treatment for childhood acute lymphoblastic leukemia (ALL), which includes CNS prophylaxis, is associated with central and peripheral neurotoxicity. The purpose of the present study was to analyze the effects of chemotherapy on various levels of visuomotor control in survivors of childhood ALL treated without cranial irradiation, and to identify risk factors for possible deficits. Visuomotor function was compared between children after treatment for ALL (n = 34), children after treatment for Wilms tumor, which consists of non-CNS directed chemotherapy (n = 38), and healthy controls (n = 151). Three tasks were administered: a simple visual reaction time task and two tasks measuring visuomotor control with one requiring a higher level of cognitive control than the other. Visuomotor deficits were detected only in the ALL group, with poorer performance restricted to the condition requiring the highest level of control. Significant risk factors for poorer performance were female gender and a short time since end of treatment, and a trend was found for a young age at diagnosis. A high cumulative methotrexate dose was an adverse predictive factor in girls. The results indicate that chemotherapy-induced central neurotoxicity in childhood ALL treatment is associated with higher order visuomotor control deficits. Girls appear to be particularly vulnerable.
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Affiliation(s)
- Annemieke I Buizer
- Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands.
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Slaats-Willemse D, de Sonneville L, Swaab-Barneveld H, Buitelaar J. Motor flexibility problems as a marker for genetic susceptibility to attention-deficit/hyperactivity disorder. Biol Psychiatry 2005; 58:233-8. [PMID: 15978548 DOI: 10.1016/j.biopsych.2005.03.046] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2004] [Revised: 03/07/2005] [Accepted: 03/24/2005] [Indexed: 11/25/2022]
Abstract
BACKGROUND Since many children with attention-deficit/hyperactivity disorder (ADHD) have fine visuomotor problems that are already evident at a young age, motor dysfunctioning is investigated in family-genetic perspective. We hypothesized that if fine motor problems may be a marker for genetic susceptibility to ADHD, nonaffected siblings of ADHD probands would experience motor problems similar to those of their ADHD siblings. METHODS Twenty-five carefully phenotyped ADHD probands with a family history of ADHD, their nonaffected siblings (n = 25), and 48 normal control subjects (aged 6 to 17) completed a motor fluency task and a motor flexibility task. The motor fluency task involved completion of a familiar, automatized trajectory, whereas the motor flexibility task required continuous adjustment of movement to complete an unpredictable random trajectory. RESULTS On the motor fluency task, the performance of the nonaffected children was significantly better than that of the ADHD probands; strikingly, on the motor flexibility task, they performed as well as their ADHD siblings. CONCLUSIONS Nonaffected siblings experience complex motor problems similar to their ADHD siblings but only in nonautomatized movements that require controlled processing. The results suggest that higher-order controlled motor deficits in ADHD may be associated with genetic susceptibility for ADHD.
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Affiliation(s)
- Dorine Slaats-Willemse
- Academic Center for Child and Adolescent Psychiatry Oost-Nederland, University Medical Center St. Radboud, Reinier Postlaan 12, 6525 GC Nijmegen, The Netherlands.
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Aase H, Sagvolden T. Moment-to-moment dynamics of ADHD behaviour. Behav Brain Funct 2005; 1:12. [PMID: 16060963 PMCID: PMC1208851 DOI: 10.1186/1744-9081-1-12] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2005] [Accepted: 08/01/2005] [Indexed: 11/24/2022] Open
Abstract
Background The behaviour of children with Attention-Deficit / Hyperactivity Disorder is often described as highly variable, in addition to being hyperactive, impulsive and inattentive. One reason might be that they do not acquire complete and functional sequences of behaviour. The dynamic developmental theory of ADHD proposes that reinforcement and extinction processes are inefficient because of hypofunctioning dopamine systems, resulting in a narrower time window for associating antecedent stimuli and behaviour with its consequences. One effect of this may be that the learning of behavioural sequences is delayed, and that only short behavioural sequences are acquired in ADHD. The present study investigated acquisition of response sequences in the behaviour of children with ADHD. Methods Fifteen boys with ADHD and thirteen boys without, all aged between 6–9 yr, completed a computerized task presented as a game with two squares on the screen. One square was associated with reinforcement. The task required responses by the computer mouse under reinforcement contingencies of variable interval schedules. Reinforcers were cartoon pictures and small trinkets. Measures related to response location (spatial dimension) and to response timing (temporal dimension) were analyzed by autocorrelations of consecutive responses across five lags. Acquired response sequences were defined as predictable responding shown by high explained variance. Results Children with ADHD acquired shorter response sequences than comparison children on the measures related to response location. None of the groups showed any predictability in response timing. Response sequencing on the measure related to the discriminative stimulus was highly related to parent scores on a rating scale for ADHD symptoms. Conclusion The findings suggest that children with ADHD have problems with learning long sequences of behaviour, particularly related to response location. Problems with learning long behavioural sequences may ultimately lead to deficient development of verbally governed behaviour and self control. The study represents a new approach to analyzing the moment-to-moment dynamics of behaviour, and provides support for the theory that reinforcement processes are altered in ADHD.
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Affiliation(s)
- Heidi Aase
- Norwegian Centre for the Studies of Conduct Problems and Innovative Practice, UNIRAND, University of Oslo, P.O.Box 1565 Vika, 0118 Oslo, Norway
- Centre for Advanced Studies (CAS) at the Norwegian Academy for Science and Letters, Oslo, Norway
| | - Terje Sagvolden
- Department of Physiology, University of Oslo, Norway
- Centre for Advanced Studies (CAS) at the Norwegian Academy for Science and Letters, Oslo, Norway
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Slaats-Willemse D, Swaab-Barneveld H, De Sonneville L, Buitelaar J. Familial clustering of executive functioning in affected sibling pair families with ADHD. J Am Acad Child Adolesc Psychiatry 2005; 44:385-91. [PMID: 15782086 DOI: 10.1097/01.chi.0000153227.34473.c7] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate familial clustering of executive functioning (i.e., response inhibition, fine visuomotor functioning, and attentional control) in attention-deficit/hyperactivity disorder (ADHD)-affected sibling pairs. METHOD Fifty-two affected sibling pairs aged 6 to 18 years and diagnosed with ADHD according to DSM-IV performed the Stroop test, go/no-go task, two different fine visuomotor tracking tasks, and a sustained-, divided-, and focused attention task. RESULTS Significant correlations (r = 0.4) were found between siblings for response inhibition and attentional control and for fine visuomotor skills that made high demands on executive functioning. CONCLUSIONS Response inhibition, higher order controlled fine visuomotor functioning, and attentional control seem to cluster in ADHD-affected siblings. This suggests that these aspects of executive dysfunctioning may reflect an endophenotype of ADHD. Measurement of these executive functions may facilitate the identification of genes involved in ADHD by forming more homogeneous subgroups.
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Affiliation(s)
- Dorine Slaats-Willemse
- Department of Psychiatry, Radboud University Medical Center, and The Academic Center for Child and Adolescent Psychiatry Oost-Nederland, Nijmegen, the Netherlands.
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