Exploring an objective measure of overactivity in children with rare genetic syndromes

BACKGROUND

Overactivity is prevalent in several rare genetic neurodevelopmental syndromes, including Smith-Magenis syndrome, Angelman syndrome, and tuberous sclerosis complex, although has been predominantly assessed using questionnaire techniques. Threats to the precision and validity of questionnaire data may undermine existing insights into this behaviour. Previous research indicates objective measures, namely actigraphy, can effectively differentiate non-overactive children from those with attention-deficit hyperactivity disorder. This study is the first to examine the sensitivity of actigraphy to overactivity across rare genetic syndromes associated with intellectual disability, through comparisons with typically-developing peers and questionnaire overactivity estimates.

METHODS

A secondary analysis of actigraphy data and overactivity estimates from The Activity Questionnaire (TAQ) was conducted for children aged 4-15 years with Smith-Magenis syndrome (N=20), Angelman syndrome (N=26), tuberous sclerosis complex (N=16), and typically-developing children (N=61). Actigraphy data were summarized using the M10 non-parametric circadian rhythm variable, and 24-hour activity profiles were modelled via functional linear modelling. Associations between actigraphy data and TAQ overactivity estimates were explored. Differences in actigraphy-defined activity were also examined between syndrome and typically-developing groups, and between children with high and low TAQ overactivity scores within syndromes.

RESULTS

M10 and TAQ overactivity scores were strongly positively correlated for children with Angelman syndrome and Smith-Magenis syndrome. M10 did not substantially differ between the syndrome and typically-developing groups. Higher early morning activity and lower evening activity was observed across all syndrome groups relative to typically-developing peers. High and low TAQ group comparisons revealed syndrome-specific profiles of overactivity, persisting throughout the day in Angelman syndrome, occurring during the early morning and early afternoon in Smith-Magenis syndrome, and manifesting briefly in the evening in tuberous sclerosis complex.

DISCUSSION

These findings provide some support for the sensitivity of actigraphy to overactivity in children with rare genetic syndromes, and offer syndrome-specific temporal descriptions of overactivity. The findings advance existing descriptions of overactivity, provided by questionnaire techniques, in children with rare genetic syndromes and have implications for the measurement of overactivity. Future studies should examine the impact of syndrome-related characteristics on actigraphy-defined activity and overactivity estimates from actigraphy and questionnaire techniques.

Diurnal variation of motor activity in adult ADHD patients analyzed with methods from graph theory

Attention-deficit /hyperactivity disorder (ADHD) is a common neurodevelopmental syndrome characterized by age-inappropriate levels of motor activity, impulsivity and attention. The aim of the present study was to study diurnal variation of motor activity in adult ADHD patients, compared to healthy controls and clinical controls with mood and anxiety disorders. Wrist-worn actigraphs were used to record motor activity in a sample of 81 patients and 30 healthy controls. Time series from registrations in the morning and evening were analyzed using measures of variability, complexity and a newly developed method, the similarity algorithm, based on transforming time series into graphs. In healthy controls the evening registrations showed higher variability and lower complexity compared to morning registrations, however this was evident only in the female controls. In the two patient groups the same measures were not significantly different, with one exception, the graph measure bridges. This was the measure that most clearly separated morning and evening registrations and was significantly different both in healthy controls and in patients with a diagnosis of ADHD. These findings suggest that actigraph registrations, combined with mathematical methods based on graph theory, may be used to elucidate the mechanisms responsible for the diurnal regulation of motor activity.

Disturbed sleep and activity in toddlers with early signs of attention deficit hyperactivity disorder (ADHD)

This study investigated whether early signs of attention deficit hyperactivity disorder (ADHD) in toddlers aged 2-3 years are associated with disturbed sleep and activity levels. Participants were recruited from the Odense Child Cohort, and children scoring above the 93^rd percentile on the ADHD scale of the Child Behaviour Checklist 1½-5 were categorised as cases and compared with age- and gender-matched normal-scoring controls. Daytime and nocturnal activity for 24 children with ADHD traits (cases) and 25 healthy controls was assessed through 7 days of actigraphy, and parents completed the Children's Sleep Habits Questionnaire (CSHQ) and the ADHD Rating Scale IV Preschool Version (ADHD-RS). Cases differed significantly on actigraphic parameters by having fewer minutes of moderate-to-vigorous physical activity (MVPA), prolonged total sleep time, fewer sleep interruptions, and increased night-to-night variability. A significant association was found between fewer minutes of MVPA and higher parent-reported motor activity on the ADHD-RS. Furthermore, increased night-to-night variability was significantly associated with higher total scores on both CSHQ and ADHD-RS. The findings show that early signs of ADHD are associated with an irregular sleep pattern and lower daytime activity, as illustrated by actigraphy. Studies investigating early ADHD risk factors could lead to a preschool ADHD risk index to help guide future early intervention.

Microsoft Kinect-based Continuous Performance Test: An Objective Attention Deficit Hyperactivity Disorder Assessment

Background

One of the major challenges in mental medical care is finding out new instruments for an accurate and objective evaluation of the attention deficit hyperactivity disorder (ADHD). Early ADHD identification, severity assessment, and prompt treatment are essential to avoid the negative effects associated with this mental condition.

Objective

The aim of our study was to develop a novel ADHD assessment instrument based on Microsoft Kinect, which identifies ADHD cardinal symptoms in order to provide a more accurate evaluation.

Methods

A group of 30 children, aged 8-12 years (10.3 [SD 1.4]; male 70% [21/30]), who were referred to the Child and Adolescent Psychiatry Unit of the Department of Psychiatry at Fundación Jiménez Díaz Hospital (Madrid, Spain), were included in this study. Children were required to meet the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria of ADHD diagnosis. One of the parents or guardians of the children filled the Spanish version of the Strengths and Weaknesses of ADHD Symptoms and Normal Behavior (SWAN) rating scale used in clinical practice. Each child conducted a Kinect-based continuous performance test (CPT) in which the reaction time (RT), the commission errors, and the time required to complete the reaction (CT) were calculated. The correlations of the 3 predictors, obtained using Kinect methodology, with respect to the scores of the SWAN scale were calculated.

Results

The RT achieved a correlation of -.11, -.29, and -.37 with respect to the inattention, hyperactivity, and impulsivity factors of the SWAN scale. The correlations of the commission error with respect to these 3 factors were -.03, .01, and .24, respectively.

Conclusions

Our findings show a relation between the Microsoft Kinect-based version of the CPT and ADHD symptomatology assessed through parental report. Results point out the importance of future research on the development of objective measures for the diagnosis of ADHD among children and adolescents.

The incremental validity of a computerised assessment added to clinical rating scales to differentiate adult ADHD from autism spectrum disorder

There is a clinical need for objective evidence-based measures that are sensitive and specific to ADHD when compared with other neurodevelopmental disorders. This study evaluated the incremental validity of adding an objective measure of activity and computerised cognitive assessment to clinical rating scales to differentiate adult ADHD from Autism spectrum disorders (ASD). Adults with ADHD (n=33) or ASD (n=25) performed the QbTest, comprising a Continuous Performance Test with motion-tracker to record physical activity. QbTest parameters measuring inattention, impulsivity and hyperactivity were combined to provide a summary score ('QbTotal'). Binary stepwise logistic regression measured the probability of assignment to the ADHD or ASD group based on scores on the Conners Adult ADHD Rating Scale-subscale E (CAARS-E) and Autism Quotient (AQ10) in the first step and then QbTotal added in the second step. The model fit was significant at step 1 (CAARS-E, AQ10) with good group classification accuracy. These predictors were retained and QbTotal was added, resulting in a significant improvement in model fit and group classification accuracy. All predictors were significant. ROC curves indicated superior specificity of QbTotal. The findings present preliminary evidence that adding QbTest to clinical rating scales may improve the differentiation of ADHD and ASD in adults.

Is hyperactivity ubiquitous in ADHD or dependent on environmental demands? Evidence from meta-analysis

Hyperactivity, or excess gross motor activity, is considered a core and ubiquitous characteristic of ADHD. Alternate models question this premise, and propose that hyperactive behavior reflects, to a large extent, purposeful behavior to cope with environmental demands that interact with underlying neurobiological vulnerabilities. The present review critically evaluates the ubiquity and environmental modifiability of hyperactivity in ADHD through meta-analysis of 63 studies of mechanically measured activity level in children, adolescents, and adults with ADHD relative to typically developing groups. Random effects models corrected for publication bias confirmed elevated gross motor activity in ADHD (d=0.86); surprisingly, neither participant age (child vs. adult) nor the proportion of each ADHD sample diagnosed with the inattentive subtype/presentation moderated this effect. In contrast, activity level assessed during high cognitive load conditions in general (d=1.14) and high executive functioning demands in particular (d=1.39) revealed significantly higher effect sizes than activity level during low cognitive load (d=0.36) and in-class schoolwork (d=0.50) settings. Low stimulation environments, more rigorous diagnostic practices, actigraph measurement of movement frequency and intensity, and ADHD samples that included fewer females were also associated with larger effects. Overall, the results are inconsistent with DSM-5 and ADHD models that a) describe hyperactivity as ubiquitous behavior, b) predict a developmental decline in hyperactivity, or c) differentiate subtypes/presentations according to perceived differences in hyperactive behavior. Instead, results suggest that the presence and magnitude of hyperactive behavior in ADHD may be influenced to a considerable extent by environmental factors in general, and cognitive/executive functioning demands in particular.

Motor Activity in Adult Patients with Attention Deficit Hyperactivity Disorder

OBJECTIVE

Hyperactivity is a core symptom of attention-deficit hyperactivity disorder (ADHD), but limited information is available on analysis of activity patterns in this disorder. The aim of the study was to analyze motor activity during daily living in adult patients with ADHD.

METHODS

Patients (n=76) from the private psychiatric practice of two of the authors were recruited, and were compared to patients with other psychiatric disorders and to normal controls. Actigraphs were used to record motor activity for six days, with one minute intervals, and data were analysed using linear and non-linear mathematical methods.

RESULTS

For short recording periods (300 minutes) the activity levels of ADHD patients do not differ from normal controls, but the autocorrelation (lag 1) is lower and Fourier analysis shows higher power in the high frequency range, corresponding to the period from 2-8 min. During recordings for six days there are no significant differences between ADHD patients and the control groups. The combined and inattentive subgroups differ only in the six days recordings. The Fourier analyses show that the combined type has lower power in the high frequency range, corresponding to the period from 4-8 hours, and in the analysis of rhythms the intra-daily variability is lower, compared to the inattentive type.

CONCLUSION

Adult ADHD patients do not show evidence of hyperactivity, but have levels of activity similar to normal controls. However, on several measures ADHD patients display altered activity patterns, indicating that the regulation of motor activity in this disorder is different from controls.

Locomotor activity measures in the diagnosis of attention deficit hyperactivity disorder: Meta-analyses and new findings

INTRODUCTION

Our aim was to assess differences in movement measures in attention-deficit/hyperactivity disorder (ADHD) vs. typically developing (TD) controls.

METHODS

We performed meta-analyses of published studies on motion measures contrasting ADHD with controls. We also conducted a case-control study with children/adolescents (n = 61 TD, n = 62 ADHD) and adults (n = 30 TD, n = 19 ADHD) using the McLean motion activity test, semi-structured diagnostic interviews and the behavior rating inventory of executive function and Conners (parent, teacher; self) rating scales.

RESULTS

Meta-analyses revealed medium-to-large effect sizes for actigraph (standardized mean difference [SMD]: 0.64, 95% confidence interval (CI): 0.43, 0.85) and motion tracking systems (SDM: 0.92, 95% CI: 0.65, 1.20) measures in differentiating individuals with ADHD from controls. Effects sizes were similar in studies of children/adolescents ([SMD]: 0.75, 95% CI: 0.50, 1.01) and of adults ([SMD]: 0.73, 95% CI: 0.46, 1.00). In our sample, ADHD groups differed significantly in number of head movements (p = 0.02 in children; p = 0.002 in adults), displacement (p = 0.009/p < 0.001), head area (p = 0.03/p < 0.001), spatial complexity (p = 0.06/p = 0.02) and temporal scaling (p = 0.05/p = 0.04). Mean effect sizes were non-significantly larger (d = 0.83, 95% CI: 0.20, 1.45) in adults vs. children/adolescents with ADHD (d = 0.45, 95% CI: 0.08, 0.82). In the concurrent go/no-go task, reaction time variability was significantly greater in ADHD (p < 0.05 in both age groups) than controls.

CONCLUSIONS

Locomotor hyperactivity remains core to the construct of ADHD even in adults. Our results suggest that objective locomotion measures may be particularly useful in evaluating adults with possible ADHD.