Multimethod Assessment of Attention, Executive Functions, and Motor Skills in Children With and Without ADHD: Children's Performance and Parents' Perceptions

Association between visual attention and parent-reported social problems in pediatric cancer survivors

Social deficits in pediatric cancer survivors have been well documented and have been linked to neurocognitive late effects, particularly attention deficits. The purpose of this study was to examine the association between components of attention, both parent-report and a performance-based measure, with parent-reported social functioning in survivors of pediatric cancer. The study included data from outpatient neuropsychological evaluations of 76 survivors of pediatric cancer. The Integrated Visual and Auditory (IVA) continuous performance test was used to evaluate the components of attention with variables corresponding to Posner's model of attention. Assessment of inattention and peer problems were derived from the Conner's Parent Rating Scale, third edition. Parent-reported attention symptoms were significantly associated with worse auditory prudence (r = -0.382, p < .001) and visual consistency (r = -0.234, p = .046) and higher parent-reported peer problems (r = 0.302, p = .008). Auditory attention domains were not significantly predictive of peer problems (p > .05). When controlling for FSIQ and type of cancer, worse visual consistency (p = .029) and visual speed (p = .036) were significantly associated with more peer problems. Parent-reported inattention was associated with only some domains of performance-based attention, highlighting the importance of using multi-modal assessments of attention. This study also revealed an important relationship between visual attention and peer problems.

Sensorimotor Features and Daily Living Skills in Autistic Children With and Without ADHD

Attention-deficit/hyperactivity disorder (ADHD) commonly co-occurs in autistic children. However, additional research is needed to explore the differences in motor skills and sensory features in autistic children with and without ADHD, as well as the impacts of these factors on daily living skills (DLS). This observational study sought to fill this gap with 67 autistic children (6.14-10.84 years-old), 43 of whom had ADHD. Autistic children with ADHD demonstrated higher sensory features and lower motor skills than autistic children without ADHD. In examining autism and ADHD features dimensionally, we found that overall sensory features, seeking, and hyporesponsiveness were driven by both autism and ADHD features, whereas motor skills, enhanced perception, and hyperresponsiveness were driven by only autism features. Additionally, in using these dimensional variables of autism and ADHD features, we found that differences in motor skills, sensory and autism features, but not ADHD features, impact DLS of autistic children, with autism features and motor skills being the strongest individual predictors of DLS. Together, these results demonstrate the uniqueness of motor skills and sensory features in autistic children with and without ADHD, as well as how autism features, sensory features, and motor skills contribute to DLS, emphasizing the importance of a comprehensive understanding of each individual and complexities of human development when supporting autistic children.

Motor performance and attention outcomes in children born very preterm

AIM

To examine the relationship between motor performance and attention in children born very preterm and at term, and investigate the presence of individual profiles of motor and attention performance.

METHOD

Attention and motor performance at 7 and 13 years were assessed in 197 children born very preterm (52.5% male) and 69 children born at term (47.8% male) between 2001 and 2003. Linear regression models were fitted including an interaction term for birth group. Subgroups of children with similar attention and motor performance profiles were identified using latent profile analysis.

RESULTS

Balance was positively associated with all attention outcomes at both ages (p < 0.006). There were specific birth group interactions for aiming and catching and manual dexterity with attention at 13 years, with positive associations observed only for children born very preterm (p < 0.001). At 7 years, three profiles were observed: average attention and motor functioning; average motor functioning and low attention functioning; and low attention and motor functioning. At 13 years, two profiles of average attention and motor functioning emerged, as well as one profile of below-average attention and motor functioning. Children born very preterm were overrepresented in the lower functioning profiles (born very preterm 56%; born at term 29%).

INTERPRETATION

Motor functioning at age 7 years may be a useful marker of later attention skills, particularly for children born very preterm who are at greater risk of poorer long-term cognitive outcomes.

WHAT THIS PAPER ADDS

Balance was positively associated with attention in children born very preterm and at term. Relationships between motor performance and attention at age 13 years differed between children born very preterm and at term. Heterogeneous motor functioning and attention outcomes were noted for children born very preterm and at term. Children born very preterm were more likely to have lower attention and motor functioning profiles than children born at term. There was greater movement in motor functioning and attention profiles between the ages of 7 and 13 years in children born very preterm.

Gait in children with and without ADHD: A systematic literature review

BACKGROUND

There is increasing speculation whether Attention-Deficit/Hyperactivity Disorder (ADHD) has phenotypic or secondary motor symptoms. Some evidence suggests even fundamental motor skills such as walking can differ in ADHD, however, the evidence is limited and has not been reviewed. Therefore, we conducted a systematic review to summarize the findings regarding gait in ADHD compared to typically developing children in (1) normal (i.e., self-paced), (2) paced or complex (i.e., walking backwards), and (3) dual-task contexts.

METHOD

Following a thorough literature search and application of stringent exclusion criteria, a total of 12 studies were included in this review. All studies examined normal walking with a variety of gait parameters in children (age range: 5-18), however, selected parameters and group differences were often inconsistent.

RESULTS

In self-paced walking, studies reporting gait with coefficients of variance (CVs) indicated several between-group differences, whereas averages of gait variables were the same for those with ADHD and typically developing children. Paced or complex walking contexts often differed between ADHD and typically developing groups, favoring the ADHD group in some cases, but primarily the typically developing participants. Finally, walking contexts with dual-tasks showed more frequent performance losses in the ADHD group.

DISCUSSION

Children with ADHD seem to have specific patterns of gait variability compared to typically developing children, particularly in complex walking contexts and at faster paces. The influence of age, medication, and method of gait normalization may have influenced the results of studies. Overall, this review highlights the potential for a unique gait profile in children with ADHD.

The Cognitive Orientation to daily Occupational Performance (CO-OP) Approach is superior to ordinary treatment for achievement of goals and transfer effects in children with cerebral palsy and spina bifida - a randomized controlled trial

PURPOSE

Children with cerebral palsy (CP) or spina bifida (SB) often have executive dysfunction affecting activity performance. With the Cognitive Orientation to daily Occupational Performance (CO-OP) Approach, children find their own way to perform activities, using problem-solving strategies and meta-cognitive thinking. The present study aimed to investigate the effectiveness of the CO-OP Approach in children with CP or SB, compared with conventional rehabilitation, in achieving self-identified activity goals, and to explore any generalization and transfer effects.

METHOD

Randomized controlled trial, CO-OP versus treatment as usual, 38 children (7-16 years) participated. Each child identified four goals (to study generalization and transfer, one remained untrained). Primary outcomes: Canadian Occupational Performance Measure (COPM) and Performance Quality Rating Scale (PQRS). Secondary outcomes assessed executive functions and self-rated everyday-life competence.

RESULTS

Self-rated goal attainment (COPM) was significantly greater for both trained and untrained goals in the CO-OP group compared with the control group. The rating of observed performance (PQRS) was significantly higher for trained goals in the CO-OP group. The CO-OP group experienced fewer problems in everyday life after treatment. Executive functions did not differ significantly between groups.

CONCLUSION

CO-OP is more effective than ordinary treatment in achieving both trained and untrained goals.IMPLICATIONS FOR REHABILITATIONCO-OP enables children with CP (MACS levels I-III) or SB without intellectual disabilities to reach self-identified goals.CO-OP shows transfer effects to new activities and situations, which may enhance children's self-efficacy.CO-OP is an important complement to conventional rehabilitation services for children with CP and SB.

Early parenting behaviour is associated with complex attention outcomes in middle to late childhood in children born very preterm

Attention deficits are common in children born very preterm (VP), especially for children with higher social risk. The aim of this study was to examine the association between parenting behavior and attention in children born VP, and whether this association is influenced by familial social risk. Two hundred and twenty-four children born <30 weeks' gestation and/or with a birth weight <1250 g were recruited at birth. At 2 years, social risk was calculated and parenting behaviors were observed during a parent-child interaction task, with children's attention skills assessed at 7 and 13 years using standardized assessments. Higher levels of sensitive parenting at 2 years were positively associated with divided attention at age 7 years, and higher levels of intrusive parenting were negatively associated with divided attention at 13 years. Children born VP with higher social risk were more positively influenced by sensitive parenting behavior for sustained attention at 7 years, selective attention at 13 years, and divided attention at 7 and 13 years than children born VP with lower social risk. Additionally, children born VP with higher social risk were more negatively influenced by intrusive parenting for sustained attention outcomes at 7 years than those with lower social risk. In summary, the evidence for a contribution of early parenting to attention outcomes in children born VP was stronger for more complex attention (divided attention) compared with basic attention domains. Our findings also suggest that early parenting behavior has a particular influence on children born VP from socially disadvantaged environments for attention outcomes.

The Pictorial Interview of Children's Metacognition and Executive Functions (PIC-ME): Cultural Adaptation for Ultra-Orthodox Jewish Populations

Introduction

Executive functions (EFs) are strongly linked to attention deficit hyperactivity disorder (ADHD). The pictorial interview of children's metacognition and executive functions (PIC-ME) assesses children's self-perceptions regarding their EF. This study is aimed at describing the cultural adaptation of the PIC-ME to the ultra-Orthodox (UO) Jewish population in Israel.

Method

In the first of three stages, 30 occupational therapists, who were experienced in working with children with ADHD from the UO population, completed a questionnaire about the suitability of PIC-ME for the UO community. In the second stage, six therapists participated in a focus group to discuss the recommendations and the adaptations made following the first stage. In the third stage, 20 UO children aged 5-10 participated in the tool validation process.

Results

First stage: most of the items of the original tool were found to be appropriate in representing the EFs of UO children and did not need to be adapted. No significant differences were found between the boys' and girls' versions regarding the tool's adaptability. However, most of the therapists suggested that the pictures in both versions needed adaptations. Second stage: additional recommendations led to the development of a final adapted version. Third stage: over 70 percent agreement was found among UO children regarding the clarity of the adapted pictures. No significant differences were found between boys and girls or between age groups.

Conclusions

This study presented wide agreement on the necessity for cultural adaptation of the PIC-ME to the UO population and described the adaptation process. Based on its face validity, the UO version may be a useful tool to assess the self-perception of EF among UO children. Further studies are needed to assess its psychometric properties and its usefulness as an outcome measure. The study findings may contribute to the cultural adaptation of other tools for culturally distinct populations.

Assessment of 'Cool' and 'Hot' Executive Skills in Children with ADHD: The Role of Performance Measures and Behavioral Ratings

Executive dysfunction is an underlying characteristic of Attention Deficit/Hyperactivity Disorder (ADHD). Therefore, this study explored which measures of executive functions (EF) may lead to a better diagnostic prediction and evaluated whether participants were adequately assigned to the ADHD group based on the identified predictors. Seventeen 6- to 10-year-old children with ADHD were matched with 17 typically developing peers (TD) by age, gender, and non-verbal intelligence. Performance-based measures and behavior ratings of 'cool' and 'hot' EF were used. As expected, there was a significant group effect on the linear combination of measures, indicating that children with ADHD showed significant difficulties with EF compared to the TD group. In fact, significant differences were found in measures of short-term and working memory, planning, delay aversion, and EF-related behaviors, as reported by parents and teachers. However, the discriminant function analysis only revealed three significant predictors: the General Executive Composite of the Behavior Rating Inventory of Executive Function (Parent and Teacher Forms) and the Delay of Gratification Task, with 97.1% correct classifications. These findings highlight the importance and contribution of both behavioral ratings and 'hot' measures of EF for the characterization of ADHD in children.

The effectiveness of child-centered play therapy for executive functions in children with attention-deficit/hyperactivity disorder

INTRODUCTION

Child-centered play therapy (CCPT) is a practical and recommended non-medication intervention for children with Attention-deficit/hyperactivity disorder (ADHD) but the mechanism in between is unclear.

AIM

This study proposed to examine the effectiveness of CCPT on neuropsychological deficits and behavioral symptoms in ADHD.

METHODS

Participants with ADHD diagnosis were referred from senior child and adolescent psychiatrists, and typical developmental children (TD) were recruited from community as a control group. All participants' executive functions were evaluated using Cambridge Neuropsychological Test Automated Battery. First of all, the participants were evaluated using Child Behavior Checklist (CBCL) by their parents. The ADHD participants were assigned into CCPT (ADHDc) and waitlist (ADHDw) group; and the ADHDc group then received CCPT weekly for 12 sessions, while the ADHDw continuously received their regular treatment (i.e., medication treatment or other alternative treatments) as usual.

RESULTS

Total 52 participants were recruited (17 with ADHD and 35 typically developed children, TD). The results showed that overall the ADHD groups had worse neuropsychological performance and more behavioural disturbance than did the TD (ps < .05). After receiving the CCPT, the results showed that the ADHDc group had significant improvement in the cognitive flexibility (p < .05); while the ADHDw group had no changes.

How can instructions and feedback with external focus be shaped to enhance motor learning in children? A systematic review

AIM

This systematic review investigates the effectiveness of instructions and feedback with external focus applied with reduced frequency, self-controlled timing and/or in visual or auditory form, on the performance of functional gross motor tasks in children aged 2 to 18 with typical or atypical development.

METHODS

Four databases (PubMed, Web of Science, Scopus, Embase) were systematically searched (last updated May 31st 2021). Inclusion criteria were: 1. children aged 2 to 18 years old; 2. Instructions/feedback with external focus applied with reduced frequency, self-controlled timing, and/or visual or auditory form as intervention, to learn functional gross motor tasks; 3. Instructions/feedback with external focus applied with continuous frequency, instructor-controlled timing, and/or verbal form as control; 4. performance measure as outcome; 5. (randomized) controlled studies. Article selection and risk of bias assessment (with the Cochrane risk of bias tools) was conducted by two reviewers independently. Due to heterogeneity in study characteristics and incompleteness of the reported data, a best-evidence synthesis was performed.

RESULTS

Thirteen studies of low methodological quality were included, investigating effectiveness of reduced frequencies (n = 8), self-controlled timing (n = 5) and visual form (n = 1) on motor performance of inexperienced typically (n = 348) and atypically (n = 195) developing children, for acquisition, retention and/or transfer. For accuracy, conflicting or no evidence was found for most comparisons, at most time points. However, there was moderate evidence that self-controlled feedback was most effective for retention, and limited evidence that visual analogy was most effective for retention and transfer. To improve quality of movement, there was limited evidence that continuous frequency was most effective for retention and transfer.

CONCLUSION

More methodologically sound studies are needed to draw conclusions about the preferred frequency, timing or form. However, we cautiously advise considering self-controlled feedback, visual instructions, and continuous frequency.

TRIAL REGISTRATION

Registration: Prospero CRD42021225723. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021225723.

Capturing daily-life executive impairments in adults: Does the choice of neuropsychological tests matter?

OBJECTIVE

Standardized executive functioning (EF) measures do not reliably capture EF-related difficulties reported in daily life. We aim to determine if an ecologically relevant neuropsychological battery is more strongly associated with self-reported everyday EF impairments than classically used tests.

METHOD

Fifty-nine adults aged 18-49 self-rated their EF abilities using the Barkley Deficits in EF Scale (BDEFS) and were randomly assigned to complete either a test battery composed of EF measures with hypothesized ecological relevance (Six Elements, Zoo Map, Hayling Sentence Completion, Iowa Gambling, and Auditory Startle Tasks) or one composed of traditional EF tasks (Card Sorting, Trail Making, Color-Word Interference, and Verbal Fluency). Associations were examined using linear regression.

RESULTS

There were no strong associations between BDEFS subscales and performance on either test battery. Only the regression model predicting Emotional Regulation from ecological tasks was significant. Iowa Gambling Task performance and corrugator muscle contraction in the Auditory Startle Task individually contributed significantly to the model, with small and moderate effect sizes respectively.

CONCLUSION

Results align with evidence that self-reported EF difficulties are not adequately captured by formal neuropsychological measures, even for performance-based measures which directly tap everyday constructs. Findings are interpreted cautiously in the context of a small, high-functioning sample.

The Association between Sleep Problems and Neuropsychological Deficits in Medication-naïve Children with ADHD

BACKGROUND

Children with ADHD are reported to have sleep problems and neuropsychological deficits, but studies examining a potential association between the two are scarce and the use of varying methodology can complicate conclusions.

PARTICIPANTS

A clinical sample of 59 medication-naïve children with ADHD between the ages of 6 and 14 years (71% male).

METHODS

Children underwent polysomnography and multiple sleep latency test, and parent rated sleep habits on the Children's Sleep Habits Questionnaire. Children also completed an extensive neuropsychological battery of executive function and delay aversion tasks, and parents and teachers rated executive function behavior on the Behavior Rating Inventory of Executive Function. Linear regression analyses were conducted with each of the neuropsychological outcomes included as the outcome variable and the sleep parameters as the predictor variables.

RESULTS

The correlations between sleep and neuropsychological outcomes were generally modest, but some sleep parameters (primarily sleep stages and sleep latencies) were associated with objectively and subjectively measured executive function and delay aversion.

CONCLUSIONS

Using objective and subjective gold standard assessment procedures this study supports a (modest) association between sleep and neuropsychological function in children with ADHD.

Neonatal spectral EEG is prognostic of cognitive abilities at school age in premature infants without overt brain damage

Prematurity is a prototype of biological risk that could affect the late neurocognitive outcome; however, the condition itself remains a non-specific marker. This longitudinal 6-year study aimed to evaluate the prognostic role of neonatal spectral EEG in premature infants without neurological complications. The study cohort was 26 children born 23-34 gestational ages; all neonates underwent multichannel EEG recordings at 35 weeks post-conception. EEG data were transformed into the frequency domain and divided into delta (0.5-4 Hz), theta (5-7 Hz), alpha (8-13 Hz), and beta (14-20 Hz) frequency bands. At 6 years, a neuropsychological and behavioral evaluation was performed. Correlations between spectral bands and neuropsychological assessments were performed with a conservative and robust Bayesian correlation model using weakly informative priors. The correlation of neuropsychological tasks to spectral frequency bands highlighted a significant association with visual and auditory attention tests. The performance on the same tests appears to be mainly impaired.Conclusions: We found that spectral EEG frequencies are independent predictors of performance in attention tasks. We hypothesized that spectral EEG might reflect early circuitries' imbalance in the reticular ascending system and cumulative effect on ongoing development, pointing to the importance of early prognostic instruments. What is Known: • Prematurity is a non-specific marker of late neurocognitive risk. • Precise prognostic instruments are lacking, mostly in patients with low-grade conditions. What is New: • Longitudinal long-term studies are scarce but crucial for the inferential attributive process. • Spectral EEG frequencies are independent predictors of performance in attention tasks.

Spontaneous age-related changes of attention in unmedicated boys with attention deficit hyperactivity disorder

OBJECTIVE

Neuropsychological, neuroanatomical, and electrophysiological studies have reported a steady increase in the different attention types until the age of 10 years. Moreover, differences between healthy control (HC) boys and those with attention deficit hyperactivity disorder (ADHD) become nonsignificant in late childhood. This cross-sectional study aimed to perform a comparative analysis of attentional processing in boys with ADHD and HC in the 6:00-10:11 years age range. Methods: Age-related changes in attentional processing were compared between Caucasian Turkic boys (72-131 months of age) with ADHD (n = 144) and HC (n = 112). Selective, focused, and inhibitory attention were measured using the Stroop Test (5 scores); sustained attention was measured using the Cancellation Test (3 scores); and attention span was measured using the Visual Aural Digit Span Test-Revised (6 scores). Results: At the age of 6 years, the ADHD group had a significantly lower performance for all attention types. By the age of 10 years, there were no significant between-group differences. However, the component structure of the neuropsychological test scores in the ADHD group differed from that in the HC group and previous studies. Conclusions: Attentional processing in boys with ADHD changes within the age-range of 6:00-10:00 years where it finally becomes similar to that in HC boys. This delayed maturation is consistent with the maturational lag model of ADHD. However, there was a between-group difference in the component structure of attentional processing, which is consistent with the maturational deviance model of ADHD.

Physical Fitness and Dynamic Balance in Medication Naïve Turkish Children with ADHD

This study investigated physical fitness levels and dynamic balance in medication-naïve children with Attention-Deficit/Hyperactivity Disorder (ADHD). Participants were 24 medication-naïve Turkish children with ADHD (4 girls, 20 boys) and 19 typically developing (TD) Turkish children (4 girls, 15 boys). We measured physical fitness levels with the Eurofit Test Battery, body composition with the Inbody 720 Body Composition Analyzer, cognitive attention with the Stroop Test, and dynamic balance with the Y-Balance Test. We found significantly poorer dynamic balance and both upper extremity and running fitness problems among the medication-naïve Turkish children with ADHD compared to the TD group (p = 0.002; p = 0.032; p = 0.002). It may be important to adress dynamic balance and physical fitness when treating children with ADHD.

Executive Functioning and Activity in Children: a Multimethod Examination of Working Memory, Inhibition, and Hyperactivity

Two primary methods of quantifying executive functioning include self- or other-reports (i.e., questionnaire-based EF) and cognitive test performance (i.e., task-based EF). Despite their lack of concordance with one another and relatively inconsistent associations with attention-deficit/hyperactivity disorder (ADHD) symptoms, both approaches have been utilized in attempts to advance our understanding of the role of EF in symptoms of ADHD. The current study is the first to incorporate a direct assessment of behavior (i.e., actigraphy) to further clarify the relation between EF and hyperactivity using a multi-method approach in a sample of children with a range of ADHD symptoms. Fifty-two children between the ages of 8 and 12 completed a testing session during which performance on working memory and inhibition computerized tasks, as well as actigraphy data, were collected. Additionally, parent reports of hyperactivity/impulsivity, working memory, and inhibition were obtained. As expected, questionnaire-based measures of working memory and inhibition were strongly associated with parent-reported hyperactivity/impulsivity, whereas only the latter was associated significantly with mechanically assessed movement. In contrast, task-based working memory performance was more strongly associated with parent-reported hyperactivity/impulsivity relative to task-based inhibition. Further, both task-based working memory and task-based inhibition were similarly associated with mechanically-assessed movement. Finally, compared to questionnaire-based EF, both measures of task-based EF accounted for more variance in objectively-assessed movement. Collectively, these results highlight the measurement issues in the present literature, the importance of careful task and questionnaire design, and the value that alternative approaches (e.g., actigraphy) may provide with respect to advancing our understanding of EF.