Why Are Children So Distractible? Development of Attention and Motor Control From Childhood to Adulthood

Assessing brain iron and its relationship to cognition and comorbidity in children with ADHD with quantitative susceptibility mapping (QSM)

BACKGROUND

Quantitative susceptibility mapping (QSM) is a neuroimaging technique that detects local changes in magnetic susceptibility induced by brain iron. Brain iron and the dopaminergic system are linked since iron is an important cofactor for dopamine synthesis. ADHD is associated with dysregulation of dopaminergic transmission. Therefore, we applied QSM on subcortical structures, to study potential alterations in brain iron and its impact on cognition and mental health in children with ADHD.

METHODS

3 Tesla QSM-data of 111 participants (nADHD= 58, mean age: 13.2 (0.63); nControls=53, mean age: 13.2 (0.51)) were analyzed. Subcortical regional brain iron values were extracted. ANOVAs examined group differences for each region of interest. For dimensional approaches, Pearson correlation analysis was performed across the cohort examining the association with symptoms, mental health, and cognition.

RESULTS

No significant differences were found in iron susceptibility between ADHD and control, between persistent and remitted ADHD, or between medication use. An unexpected finding was that children with internalising disorder had significantly higher iron susceptibility, but the result did not survive multiple comparison corrections. Higher brain iron was associated with sustained attention, but not on inhibition, IQ, and working memory.

CONCLUSION

This is the first study addressing brain iron susceptibility and its association with comorbidities and cognition in ADHD. Alterations in brain iron may not account for the full diagnosis of ADHD but may be an indicator of internalising problems in children. Alterations in brain iron content in children were linked to detrimental sustained attention and may represent developmental variation in cognition.

Synchrony perception across senses: A systematic review of temporal binding window changes from infancy to adolescence in typical and atypical development

Sensory integration is increasingly acknowledged as being crucial for the development of cognitive and social abilities. However, its developmental trajectory is still little understood. This systematic review delves into the topic by investigating the literature about the developmental changes from infancy through adolescence of the Temporal Binding Window (TBW) - the epoch of time within which sensory inputs are perceived as simultaneous and therefore integrated. Following comprehensive searches across PubMed, Elsevier, and PsycInfo databases, only experimental, behavioral, English-language, peer-reviewed studies on multisensory temporal processing in 0-17-year-olds have been included. Non-behavioral, non-multisensory, and non-human studies have been excluded as those that did not directly focus on the TBW. The selection process was independently performed by two Authors. The 39 selected studies involved 2859 participants in total. Findings indicate a predisposition towards cross-modal asynchrony sensitivity and a composite, still unclear, developmental trajectory, with atypical development associated to increased asynchrony tolerance. These results highlight the need for consistent and thorough research into TBW development to inform potential interventions.

Factor structure and measurement invariance of the 8-item CES-D: a national longitudinal sample of Chinese adolescents

BACKGROUND

The 8-item Center for Epidemiologic Studies Depression Scale (CES-D 8) has been widely used to measure depressive symptoms in many large-scale surveys. Due to its brevity, it can lower costs, relieve respondent burdens, and ensure data quality. However, its factor structure and measurement invariance across gender and time among adolescents have not been adequately evaluated. This study investigated its factor structure and measurement invariance across gender and time among adolescents.

METHODS

The data was drawn from the China Family Panel Studies (CFPS) conducted in 2018 and 2020, with 3099 participants (46.82% girls) aged 11 to 18 in 2018. First, exploratory and confirmatory factor analyses were used to examine the factor structure of the CES-D 8. Next, multi-group confirmatory factor analysis was conducted to test its measurement invariance across gender and time. Finally, a longitudinal cross-gender test was conducted to further confirm the stability of the scale.

RESULTS

A two-factor structure was identified among the adolescents, including Negative Symptoms and Diminished Happiness Feeling. Measurement invariance across gender and time, as well as the longitudinal cross-gender invariance, was supported, with configural, factor loadings, thresholds and residual invariance.

CONCLUSIONS

The factor structure of the CES-D 8 remains stable across gender and time among adolescents, indicating that it is a promising instrument for measuring depressive symptoms, especially in large-scale and longitudinal surveys.

EEG correlates of anticipatory attention and target processing in children and adults during visual spatial attention

The ability of attentional orienting has been suggested to keep developing throughout childhood. Electroencephalography (EEG) studies have shown that 6-10 year old children exhibit lateralized alpha-band (8-13 Hz) activity and event-related potentials (ERPs) that are classic markers of spatial attentional orienting in adults. However, the lack of a direct comparison of these EEG correlates between children and adults in the same experiment made it difficult to evaluate developmental effects on neural activity throughout attentional stages. This study aimed to directly compare cue-related alpha activity and ERPs for the anticipatory attention stage and target-related ERPs for the target processing stage between healthy children and adults. Participants, including 19 children (6-10 years) and 23 adults (18-34 years), successfully completed a visual spatial attention task, although children responded more slowly and less consistently than adults. Both age groups exhibited significant cue-related alpha lateralization and ERPs (EDAN, ADAN, and LDAP) during anticipatory attention and significant attentional modulation of target-related N1 during target processing. However, no significant difference was found in the magnitude of attentional modulation of these EEG correlates between children and adults. These findings suggest that the neural underpinnings of anticipatory attention and target processing during visual spatial attention could have been largely developed in 6-10 year old children.

MDMA-assisted psychotherapy for PTSD in adolescents: rationale, potential, risks, and considerations

3,4-Methylenedioxymetamphetamine(MDMA)-assisted psychotherapy (MDMA-AP) is a proposed treatment for posttraumatic stress disorder (PTSD) that may be approved for adults soon. PTSD is also common among trauma-exposed adolescents, and current treatments leave much room for improvement. We present a rationale for considering MDMA-AP for treating PTSD among adolescents. Evidence suggests that as an adjunct to therapy, MDMA may reduce avoidance and enable trauma processing, strengthen therapeutic alliance, enhance extinction learning and trauma-related reappraisal, and hold potential beyond PTSD symptoms. Drawing on existing trauma-focused treatments, we suggest possible adaptations to MDMA-AP for use with adolescents, focusing on (1) reinforcing motivation, (2) the development of a strong therapeutic alliance, (3) additional emotion and behavior management techniques, (4) more directive exposure-based methods during MDMA sessions, (5) more support for concomitant challenges and integrating treatment benefits, and (6) involving family in treatment. We then discuss potential risks particular to adolescents, including physical and psychological side effects, toxicity, misuse potential, and ethical issues. We argue that MDMA-AP holds potential for adolescents suffering from PTSD. Instead of off-label use or extrapolating from adult studies, clinical trials should be carried out to determine whether MDMA-AP is safe and effective for PTSD among adolescents.

Investigating the contributions of active, playful learning to student interest and educational outcomes

A growing body of evidence from the science of learning demonstrates the educational effectiveness of active, playful learning. Connections are emerging between this pedagogy and the broad set of skills that it promotes in learners, but potential mechanisms behind these relations remain unexplored. This paper offers a commentary based on the science of learning and interest development literature, suggesting that interest may mediate the relation between active, playful learning and student outcomes. This theory is established by identifying principles of active, playful learning that predict interest development and associations between learner interest and key skills for success in the classroom and beyond. Future research should investigate the dynamic relation between active, playful learning, interest, and student achievement over time and across phases of interest while taking a broader set of student outcomes into account.

An Evaluation of the Structure of Attention in Adolescence

This study evaluated the factor structure of attention, considering internal and external attention, and juxtaposed alongside processing speed (PS) and working memory (WM). We expected the hypothesized model to fit better than unitary or method factors. We included 27 measures with 212 Hispanic middle schoolers from Spanish-speaking backgrounds, where a substantial proportion were at risk for learning difficulties. Confirmatory factor analytic models separated factors of PS and WM, but the final model did not align with theoretical predictions; rather only measurement factors emerged. Findings extend and refine our understanding of the structure of attention in adolescents.

Relationships among age, socioeconomic status, and distractibility in preschoolers as assessed by the Competitive Attention Test

In children, the ability to attend to relevant auditory information and ignore distracting information is crucial for learning and educational achievement. Distractibility, the propensity to pay attention to irrelevant information, depends on multiple components of cognition (voluntary attention orienting, sustained attention, distraction resulting from the capture of attention by a distractor, phasic arousal, impulsivity, and motor control) that may mature at different ages. Here, we used the Competitive Attention Test (CAT) to measure these components in children aged 3 to 5 years. Our goal was to characterize changes in the efficiency of attention during the preschool period and to determine whether distractibility varies as a function of socioeconomic status (SES). All 3-year-olds (n = 14) and some 4- and 5-year-olds (n = 21) needed to be excluded from the sample due to noncompliance with instructions, suggesting that the CAT might not be suitable for children with poorly developed skills in sustained attention. Among 4- and 5-year-olds who completed the CAT (n = 71), sustained attention improved with age, whereas voluntary attention orienting remained immature. Independent of age, task-irrelevant sounds induced distraction, phasic arousal, and impulsivity. There was no relationship between SES and children's distraction. Finally, children from lower SES backgrounds showed reduced sustained attention abilities and increased impulsivity. Taken together, these findings suggest that distractibility is still developing during the preschool period and is likely to vary depending on the SES background of a child's family.

Neural Correlates of Visual Attention and Short-Term Memory in Children with Reading Difficulty

Visual attention and memory of 20 children with reading difficulty (M_age = 134 months), 24 chronological (M_age = 138 months) and 19 reading-age controls (M_age = 92 months) were examined using object substitution masking; mask offset delay increases visual attention and visual short-term memory demands. ERP amplitude differences in the N1 (alerting), N2pc (N2-posterior-contralateral; selective attention), and SPCN (sustained posterior contralateral negativity; memory load) were expected between groups. Chronological controls performed best, but ERP results were mixed. No group differences were found for N1 or N2pc. SPCN showed enhanced negativity in reading difficulty, indicating greater memory load and anomalous inhibition.

Analgesic and Anxiolytic Effects of Virtual Reality During Minor Procedures in an Emergency Department: A Randomized Controlled Study

STUDY OBJECTIVE

We aimed to assess the analgesic and anxiolytic efficacy of distraction, a nonpharmacologic intervention provided by 3-dimensional (3D) virtual reality (VR) compared with that provided by 2-dimensional (2D) VR during minor emergency department (ED) procedures.

METHODS

This randomized controlled study conducted in the ED of a teaching hospital included patients aged more than or equal to 18 years undergoing minor procedures. The patients watched the same computer-generated VR world either in 3D in a head-mounted display (intervention) or in 2D on a laptop screen (control). Our main outcomes were pain and anxiety during the procedure, assessed on a 100-mm visual analog scale. Secondary outcomes included the impression of telepresence in the computer-generated world assessed using the Igroup Presence Questionnaire, and the prevalence and intensity of cybersickness measured on a 100-mm visual analog scale.

RESULTS

The final analysis included 117 patients. The differences in median procedural pain and anxiety levels between the 2D and 3D VR groups were not significant: -3 mm (95% confidence interval [CI] -14 to 8) and -4 mm (95% CI -15 to 3), respectively; the difference in telepresence was 2.0 point (95% CI 0 to 2.0), and the proportion difference of cybersickness was -4% (95% CI -22 to 14), with an intensity difference of -5 mm (95% CI -9 to 3).

CONCLUSION

During minor procedures in adult patients in the ED, distraction by viewing a 3D virtual world in a head-mounted VR display did not result in lower average levels of procedural pain and anxiety than that by 2D viewing on a screen despite a higher sense of telepresence. There were no significant differences in the prevalence and intensity of cybersickness between the 2 groups.

How do distracting events influence children's arithmetic performance?

To understand how distraction influences children's arithmetic performance, we examined effects of irrelevant sounds on children's performance while they solve arithmetic problems. Third and fifth graders were asked to verify true/false, one-digit addition problems (e.g., 9 + 4 = 12. True? False?) under silence and sound conditions. The sounds began when the problems started to appear on the screen (Experiment 1; N = 76) or slightly after (Experiment 2; N = 92) and continued until participants responded. The results showed that (a) children solved arithmetic problems more quickly in the sound condition than in the silence condition when the sounds started with problem display (phasic arousal effects); (b) children were slower on the arithmetic problem verification task when the sounds was played slightly after the problems started to appear on the screen (distraction effects); (c) phasic arousal effects were found only in third graders, whereas distraction effects were found in both grades, although their magnitudes were smaller in fifth graders; (d) distraction effects increased with increasing latencies in third graders but did not change across the entire latency distribution in fifth graders; and (e) distraction effects on current trials were smaller after sound trials than after silence trials in both age groups (sequential modulations of distraction effects). These findings have important implications for furthering our understanding of effects of irrelevant sounds on arithmetic performance as well as cognitive processes involved in children's arithmetic.

Processing of task-irrelevant sounds during typical everyday activities in children

Our ability to focus on a task and ignore task-irrelevant stimuli is critical for efficient cognitive functioning. Attention control is especially required in the auditory modality as sound has privileged access to perception and consciousness. Despite this important function, little is known about auditory attention during typical everyday activities in childhood. We investigated the impact of task-irrelevant sounds on attention during three everyday activities - playing a game, reading a book, watching a movie. During these activities, environmental novel sounds were presented within a sequence of standard sounds to 7-8-year-old children and adults. We measured ERPs reflecting early sound processing and attentional orienting and theta power evoked by standard and novel sounds during these activities. Playing a game versus reading or watching reduced early encoding of sounds in children and affected ongoing information processing and attention allocation in both groups. In adults, theta power was reduced during playing at mid-central brain areas. Results show a pattern of immature neuronal mechanisms underlying perception and attention of task-irrelevant sounds in 7-8-year-old children. While the type of activity affected the processing of irrelevant sounds in both groups, early stimulus encoding processes were more sensitive to the type of activities in children.

Attentional control in middle childhood is highly dynamic-Strong initial distraction is followed by advanced attention control

The ability to shield against distraction while focusing on a task requires the operation of executive functions and is essential for successful learning. We investigated the short-term dynamics of distraction control in a data set of 269 children aged 4-10 years and 51 adults pooled from three studies using multilevel models. Participants performed a visual categorization task while a task-irrelevant sequence of sounds was presented which consisted of frequently repeated standard sounds and rarely interspersed novel sounds. On average, participants responded slower in the categorization task after novel sounds. This distraction effect was more pronounced in children. Throughout the experiment, the initially strong distraction effects declined to the level of adults in the groups of 6- to 10-year-olds. Such a decline was neither observed in the groups of the 4- and 5-year-olds, who consistently showed a high level of distraction, nor in adults, who showed a constantly low level of distraction throughout the experimental session. Results indicate that distraction control is a highly dynamic process that qualitatively and quantitatively differs between age groups. We conclude that the analysis of short-term dynamics provides valuable insights into the development of attention control and might explain inconsistent findings regarding distraction control in middle childhood. In addition, models of attention control need to be refined to account for age-dependent rapid learning mechanisms. Our findings have implications for the design of learning situations and provide an additional source of information for the diagnosis and treatment of children with attention deficit disorders.

Inattentive and hyperactive traits differentially associate with inter-individual functional synchrony during video viewing in young children without ADHD

Inattention and hyperactivity present on a spectrum and may influence the way children perceive and interact with the world. We investigated whether normative variation in inattentive and hyperactive traits was associated with differences in brain function, while children watched clips from an age-appropriate television program. Functional magnetic resonance imaging (fMRI) data and parent reports of inattention and hyperactivity traits were collected from 81 children 4–7 years of age with no parent-reported diagnoses. Data were analyzed using intersubject correlations (ISCs) in mixed effects models to determine if inattentive and hyperactive traits were associated with idiosyncrasy of fMRI response to the video. We hypothesized that pairs of children with higher average inattention and hyperactivity scores would show less interindividual brain synchrony to one another than pairs with lower average scores on these traits. Video watching engaged widespread visual, auditory, default mode and dorsal prefrontal regions. Inattention and hyperactivity were separably associated with ISC in many of these regions. Our findings suggest that the spectrum of inattention and hyperactivity traits in children without ADHD are differentially associated with neural processing of naturalistic video stimuli, which may have implications for understanding how children with different levels of these traits process audiovisual information in unconstrained conditions.

Age-related differences in bottom-up and top-down attention: Insights from EEG and MEG

Attention operates through top‐down and bottom‐up processes, and a balance between these processes is crucial for daily tasks. Imperilling such balance could explain ageing‐associated attentional problems such as exacerbated distractibility. In this study, we aimed to characterize this enhanced distractibility by investigating the impact of ageing upon event‐related components associated with top‐down and bottom‐up attentional processes. MEG and EEG data were acquired from 14 older and 14 younger healthy adults while performing a task that conjointly evaluates top‐down and bottom‐up attention. Event‐related components were analysed on sensor and source levels. In comparison with the younger group, the older mainly displayed (1) reduced target anticipation processes (reduced CMV), (2) increased early target processing (larger P50 but smaller N1) and (3) increased processing of early distracting sounds (larger N1 but reduced P3a), followed by a (4) prolonged reorientation towards the main task (larger RON). Taken together, our results suggest that the enhanced distractibility in ageing could stem from top‐down deficits, in particular from reduced inhibitory and reorientation processes.

Maternal childhood trauma and perinatal distress are related to infants' focused attention from 6 to 18 months

Maternal distress is repeatedly reported to have negative impacts on the cognitive development in children and is linked to neurodevelopmental disorders (e.g. attention-deficit/hyperactivity disorder and autism spectrum disorder). However, studies examining the associations between maternal distress and the development of attention in infancy are few. This study investigated the longitudinal relationships between maternal distress (depressive symptoms, anxiety symptoms, and exposure to childhood trauma) and the development of focused attention in infancy in 118 mother-infant dyads. We found that maternal exposure to non-interpersonal traumatic events in childhood was associated with the less focused attention of the infants to audio-visual stimuli at 6, 10, and 18 months. In addition, exposure to interpersonal traumatic events in childhood was identified as a moderator of the negative effect of maternal anxiety during the 2nd trimester on the development of focused attention in infants. We discuss the possible mechanisms accounting for these cross-generational effects. Our findings underscore the importance of maternal mental health to the development of focused attention in infancy and address the need for early screening of maternal mental health during pregnancy.

High Dream Recall Frequency Is Associated with an Increase of Both Bottom-Up and Top-Down Attentional Processes

Event-related potentials (ERPs) associated with the involuntary orientation of (bottom-up) attention toward an unexpected sound are of larger amplitude in high dream recallers (HR) than in low dream recallers (LR) during passive listening, suggesting different attentional functioning. We measured bottom-up and top-down attentional performance and their cerebral correlates in 18 HR (11 women, age = 22.7 years, dream recall frequency = 5.3 days with a dream recall per week) and 19 LR (10 women, age = 22.3, DRF = 0.2) using EEG and the Competitive Attention Task. Between-group differences were found in ERPs but not in behavior. The results show that HR present larger ERPs to distracting sounds than LR even during active listening, arguing for enhanced bottom-up processing of irrelevant sounds. HR also presented larger contingent negative variation during target expectancy and P3b to target sounds than LR, speaking for an enhanced recruitment of top-down attention. The attentional balance seems preserved in HR since their performances are not altered, but possibly at a higher resource cost. In HR, increased bottom-up processes would favor dream recall through awakening facilitation during sleep and enhanced top-down processes may foster dream recall through increased awareness and/or short-term memory stability of dream content.

Age-Related Intrinsic Functional Connectivity Changes of Locus Coeruleus from Childhood to Older Adults

The locus coeruleus is critical for selective information processing by modulating the brain's connectivity configuration. Increasingly, studies have suggested that LC controls sensory inputs at the sensory gating stage. Furthermore, accumulating evidence has shown that young children and older adults are more prone to distraction and filter out irrelevant information less efficiently, possibly due to the unoptimized LC connectivity. However, the LC connectivity pattern across the life span is not fully examined yet, hampering our ability to understand the relationship between LC development and the distractibility. In this study, we examined the intrinsic network connectivity of the LC using a public fMRI dataset with wide-range age samples. Based on LC-seed functional connectivity maps, we examined the age-related variation in the LC connectivity with a quadratic model. The analyses revealed two connectivity patterns explicitly. The sensory-related brain regions showed a positive quadratic age effect (u-shape), and the frontal regions for the cognitive control showed a negative quadratic age effect (inverted u-shape). Our results imply that such age-related distractibility is possibly due to the impaired sensory gating by the LC and the insufficient top-down controls by the frontal regions. We discuss the underlying neural mechanisms and limitations of our study.