Psychostimulant and sensory stimulation interventions that target the reading and math deficits of students with ADHD

Severe developmental topographical disorientation associated with ADHD and dyscalculia: A case report

We report the clinical case of AB, a right-handed 19-year-old woman who presents severe developmental topographical disorientation, a relatively rare syndrome, leading to difficulties in navigating in familiar (and novel) environments. This symptomatology appears without acquired cerebral damage (MRI described as normal) nor more global cognitive disability (high degree of education achieved). An extensive assessment of spatial cognition with different aspects of underlying cognitive processes is first presented. Second, the patient's preserved cognitive abilities and her major difficulties in calculation, as well as her attention deficit, as seen in a detailed neuropsychological assessment, are reported. For the first time to our knowledge, we show that developmental topographical disorientation can be associated with other developmental cognitive disorders affecting number processing (dyscalculia) and attention (Attention Deficit-Hyperactivity Disorder (ADHD)). We discuss the links between these different cognitive processes in relation to visuo-spatial working memory and magnitude representation, which could represent common denominators for all these syndromes. This case report highlights the importance of thoroughly assessing potentially associated neurocognitive disorders in developmental topographical disorientation. In addition, it highlights the necessity to keep in mind the prevalence of spatial difficulties in the assessment of children and adolescents with other neurodevelopmental syndromes. Finally, this case study raises a new question about the nosology of developmental disorders affecting the visuo-spatial and spatial domains.

Listening to Mozart Improves Current Mood in Adult ADHD - A Randomized Controlled Pilot Study

Emotional lability is a common problem in adult patients with ADHD and is usually treated with methylphenidate. It is generally known that music can be used to improve mood in healthy adults. Therefore, this study was conducted to test the suitability of music as a possible non-pharmacological measure to improve mood. Forty patients with ADHD and 44 healthy control subjects were randomly assigned to one of two experimental conditions. The first group (music group) listened to Mozart's music (KV 448) for 10 min while the second group remained in a silent room for 10 min (silence group). Subjective arousal and mood were assessed using self-report questionnaires before and after each condition. We showed that music listening led to a decrease in negative mood (sadness and hopelessness) in the ADHD group as well as in healthy controls. This effect was not evident in both silence groups.

Developmental Dyscalculia

Developmental dyscalculia (DD) is a specific learning disorder that affects the acquisition of arithmetic skills and number processing in children. A high comorbidity between DD and other neurodevelopmental disorders (e.g., dyslexia, attention-deficit/hyperactivity disorder [ADHD]) as well as substantial heterogeneity in cognitive profiles have been reported. Current studies indicate that DD is persistent, has a genetic component, and is related to functional and structural alterations of brain areas involved in magnitude representation. Recent neuronal and behavioral evidence is presented, showing that DD entails (a) impairments in two preverbal core systems of number, an approximate system for estimating larger magnitudes and an exact system for representing small magnitudes, (b) deficits in symbolic number processing, (c) aberrant and nonadaptive neuronal activation in basic magnitude processing and calculation, (d) dysfunctional arithmetic fact retrieval and persistent use of counting strategies in calculation, and (e) deficits in visuospatial working memory and the central executive. Finally, open research questions, including the role of domain-general cognitive resources in DD, causes and developmental consequences of comorbidity, as well as design and evaluation of interventions for DD, are briefly discussed.

Effects of methylphenidate on acute math performance in children with attention-deficit hyperactivity disorder

OBJECTIVE

Examine the short-term (acute) effects of methylphenidate (MPH) on math performance in children with attention-deficit hyperactivity disorder (ADHD) and what factors predict improvement in math performance.

METHOD

One hundred ninety-eight children with ADHD participated in a double-blind, placebo-controlled, randomized crossover MPH trial. Math response to MPH was determined through administration of math problems adjusted to their academic level during the Restricted Academic Situation Scale (RASS). Student t tests were conducted to assess change in math performance with psychostimulants. Correlation between change on the RASS and change on the math performance was also examined. Linear regression was performed to determine predictor variables.

RESULTS

Children with ADHD improved significantly in their math with MPH (P < 0.001). The degree of improvement on the RASS (which evaluates motor activity and orientation to task) and on math performance on MPH was highly correlated. A child's age at baseline and Wechsler Individual Achievement Test (WIAT)-Numerical Operations standard scores at baseline accounted for 15% of variances for acute math improvement.

CONCLUSIONS

MPH improves acute math performance in children with ADHD. Younger children with lower math scores (as assessed by the WIAT) improved most on math scores when given psychostimulants.

CLINICAL TRIAL REGISTRATION NUMBER

NCT00483106.

Toward a theory of childhood learning disorders, hyperactivity, and aggression

Learning disorders are often associated with persistent hyperactivity and aggression and are part of a spectrum of neurodevelopmental disorders. A potential clue to understanding these linked phenomena is that physical exercise and passive forms of stimulation are calming, enhance cognitive functions and learning, and are recommended as complementary treatments for these problems. The theory is proposed that hyperactivity and aggression are intense stimulation-seeking behaviors (SSBs) driven by increased brain retinergic activity, and the stimulation thus obtained activates opposing nitrergic systems which inhibit retinergic activity, induce a state of calm, and enhance cognition and learning. In persons with cognitive deficits and associated behavioral disorders, the retinergic system may be chronically overactivated and the nitrergic system chronically underactivated due to environmental exposures occurring pre- and/or postnatally that affect retinoid metabolism or expression. For such individuals, the intensity of stimulation generated by SSB may be insufficient to activate the inhibitory nitrergic system. A multidisciplinary research program is needed to test the model and, in particular, to determine the extent to which applied physical treatments can activate the nitrergic system directly, providing the necessary level of intensity of sensory stimulation to substitute for that obtained in maladaptive and harmful ways by SSB, thereby reducing SSB and enhancing cognitive skills and performance.