Colour vision in ADHD: part 1--testing the retinal dopaminergic hypothesis

The Random Step Method for Measuring the Point of Subjective Equality

Points of Subjective Equality (PSE) are commonly measured using staircase or constant stimuli methods. However, the staircase method is highly dependent on the step size, and the constant stimuli method is time-consuming. Thus, we wanted to develop an efficient and quick method to estimate both the PSE and the slope of the psychometric function. We developed a random-step algorithm in which a one-up-one-down rule is followed but with a random step size in a pre-defined range of test levels. Each stimulus would be chosen depending on the previous response of the subject. If the subject responded "up", any random level in the lower range would be picked for the next trial. And if the subject responded "down", any random level in the upper range would be picked for the next trial. This procedure would result in a bell-shaped distribution of the test levels around the estimated PSE, while a substantial amount of trials would still be dispersed at both bounds of the range. We then compared this method with traditional constant stimuli procedure on a task based on the Pulfrich phenomenon while the PSEs of participants could be varied using different neutral density filters. Our random-step method provided robust estimates of both the PSE and the slope under various noise levels with small trial counts, and we observed a significant correlation between the PSEs obtained with the two methods. The random-step method is an efficient way to measure the full psychometric function when testing time is critical, such as in clinical settings.

Investigating the influence of visuospatial stimuli on driver's speed perception: a laboratory study

Driving at an inappropriate speed is a major accident cause in the EU. Understanding the underlying sensory mechanisms can help to reduce speed and increase traffic safety. The present study investigated the effect of visuospatial stimuli on speed perception using an adaptive countermeasure to speeding based on a manipulation of optic flow. We added red lights on both sides of a simulated road. We expected speed to be perceived as faster when lights moved toward drivers due to increased optic flow, whereas we expected static light stimuli to not alter the optic flow and thus not influence speed perception. Two experiments applied the method of constant stimuli. To this end, participants encountered several trials of two video sequences on a straight road. A reference sequence showed the same traveling speed while test sequences varied around different traveling speeds. Participants indicated which sequence they perceived as faster, leading to the calculation of the point of subjective equality (PSE). A lower PSE indicates that the speed in this experimental condition is perceived as faster than in another experimental condition. Experiment 1A did not show a difference between PSEs of static and oncoming lights. Because participants had counted reflector posts for speed estimation, we removed these reflector posts in Experiment 1B and found a lower PSE for oncoming lights. Thus, such light stimuli may have an effect only in situations without other competing visual stimuli supporting speed perception. Future research should investigate whether speed perception is indeed a primarily visuospatial control task or whether other sensory information such as auditory factors can have an influence as well.

Elimination of the color discrimination impairment along the blue-yellow axis in patients with hypothyroidism after treatment with levothyroxine as assessed by the Farnsworth-Munsell 100 hue test

Our previous study has shown that individuals with untreated hypothyroidism display significantly higher partial error scores (P E S) along the blue-yellow axis compared to the red-green axis than normal individuals using the Farnsworth-Munsell 100 hue test [J. Opt. Soc. Am. A37, A18 (2020)JOAOD60740-323210.1364/JOSAA.382390]. We wished to determine how color discrimination may change when hypothyroidism has been treated to the point of euthyroidism. Color discrimination was reassessed for 17 female individuals who had undergone treatment for hypothyroidism, and the results were compared with 22 female individuals without thyroid dysfunction. No statistically significant difference was found in the total error score (T E S) for the first and second measurements for both groups (p>0.45). The P E S for the hypothyroid group improved significantly in the previously impaired color regions after the treatment. Color discrimination defects found in untreated hypothyroidism can be negated with treatment of the condition over an appropriate time period.

The Development of Color Perception and Cognition

Color is a pervasive feature of our psychological experience, having a role in many aspects of human mind and behavior such as basic vision, scene perception, object recognition, aesthetics, and communication. Understanding how humans encode, perceive, talk about, and use color has been a major interdisciplinary effort. Here, we present the current state of knowledge on how color perception and cognition develop. We cover the development of various aspects of the psychological experience of color, ranging from low-level color vision to perceptual mechanisms such as color constancy to phenomena such as color naming and color preference. We also identify neurodiversity in the development of color perception and cognition and implications for clinical and educational contexts. We discuss the theoretical implications of the research for understanding mature color perception and cognition, for identifying the principles of perceptual and cognitive development, and for fostering a broader debate in the psychological sciences.

Association between ADHD and vision problems. A systematic review and meta-analysis

AIM

To conduct the first systematic review and meta-analysis assessing whether attention-deficit/hyperactivity disorder (ADHD) is associated with disorders of the eye, and/or altered measures of visual function.

METHOD

Based on a pre-registered protocol (PROSPERO: CRD42021256352), we searched PubMed, Web of Knowledge/Science, Ovid Medline, Embase and APA PsycINFO up to 16th November 2021, with no language/type of document restrictions. We included observational studies reporting at least one measure of vision in people of any age meeting DSM/ICD criteria for ADHD and in people without ADHD; or the prevalence of ADHD in people with and without vision disorders. Study quality was assessed with the Appraisal tool for Cross-Sectional Studies (AXIS). Random effects meta-analyses were used for data synthesis.

RESULTS

We included 42 studies in the narrative synthesis and 35 studies in the meta-analyses (3,250,905 participants). We found meta-analytic evidence of increased risk of astigmatism (OR = 1.79 [CI: 1.50, 2.14]), hyperopia and hypermetropia (OR = 1.79 [CI: 1.66, 1.94]), strabismus (OR = 1.93 [CI: 1.75, 2.12]), unspecified vision problems (OR = 1.94 [CI: 1.38, 2.73]) and reduced near point of convergence (OR = 5.02 [CI: 1.78, 14.11]); increased lag (Hedge's g = 0.63 [CI: 0.30, 0.96]) and variability (Hedge's g = 0.40 [CI: 0.17, 0.64]) of the accommodative response; and increased self-reported vision problems (Hedge's g = 0.63 [CI: 0.44, 0.82]) in people with ADHD compared to those without ADHD (with no significant heterogeneity). We also found meta-analytic evidence of no differences between people with and without ADHD on retinal nerve fiber layer thickness (Hedge's g = -0.19 [CI: -0.41, 0.02]) and refractive error (Hedge's g = 0.08 [CI: -0.26, 0.42]) (with no significant heterogeneity).

DISCUSSION

ADHD is associated with some self-reported and objectively ascertained functional vision problems, but not with structural alterations of the eye. Further studies should clarify the causal relationship, if any, between ADHD and problems of vision.

TRIAL REGISTRATION

PROSPERO registration: CRD42021256352.

The electroretinogram b-wave amplitude: a differential physiological measure for Attention Deficit Hyperactivity Disorder and Autism Spectrum Disorder

Background

Attention Deficit Hyperactivity Disorder (ADHD) is the most prevalent childhood neurodevelopmental disorder. It shares some genetic risk with Autism Spectrum Disorder (ASD), and the conditions often occur together. Both are potentially associated with abnormal glutamate and GABA neurotransmission, which can be modelled by measuring the synaptic activity in the retina with an electroretinogram (ERG). Reduction of retinal responses in ASD has been reported, but little is known about retinal activity in ADHD. In this study, we compared the light-adapted ERGs of individuals with ADHD, ASD and controls to investigate whether retinal responses differ between these neurodevelopmental conditions.

Methods

Full field light-adapted ERGs were recorded from 15 ADHD, 57 ASD (without ADHD) and 59 control participants, aged from 5.4 to 27.3 years old. A Troland protocol was used with a random series of nine flash strengths from −0.367 to 1.204 log photopic cd.s.m⁻². The time-to-peak and amplitude of the a- and b-waves and the parameters of the Photopic Negative Response (PhNR) were compared amongst the three groups of participants, using generalised estimating equations.

Results

Statistically significant elevations of the ERG b-wave amplitudes, PhNR responses and faster timings of the b-wave time-to-peak were found in those with ADHD compared with both the control and ASD groups. The greatest elevation in the b-wave amplitudes associated with ADHD were observed at 1.204 log phot cd.s.m⁻² flash strength (p < .0001), at which the b-wave amplitude in ASD was significantly lower than that in the controls. Using this measure, ADHD could be distinguished from ASD with an area under the curve of 0.88.

Conclusions

The ERG b-wave amplitude appears to be a distinctive differential feature for both ADHD and ASD, which produced a reversed pattern of b-wave responses. These findings imply imbalances between glutamate and GABA neurotransmission which primarily regulate the b-wave formation. Abnormalities in the b-wave amplitude could provisionally serve as a biomarker for both neurodevelopmental conditions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s11689-022-09440-2.

Color discrimination assessment in patients with hypothyroidism using the Farnsworth-Munsell 100 hue test

There is evidence in the literature that hypofunction of the thyroid gland (hypothyroidism) affects color vision in rodents by influencing the production of the visual pigment opsin. The effect of hypothyroidism on color vision in humans has not been examined in any great detail. In this cross-sectional study we evaluated color discrimination using the Farnsworth-Munsell 100 hue test (FM-100 test) in 25 individuals with pre-treatment hypothyroidism (mean age ${38}\;{\pm }\;{9}.{2}\;\text{yr}$38±9.2yr), and a control euthyroid group, ${ n} ={26}$n=26 (mean age ${39.6}\;{\pm }\;{8}.{4}\;\text{yr}$39.6±8.4yr). There was no statistically significant difference in the total error score ($\surd{\text{TES}}$√TES) between the groups, but the hypothyroid group had a significantly greater partial error score ($\surd{\text{PES}}$√PES) along the blue-yellow (B-Y) axis compared to the red-green (R-G) axis. No statistically significant differences in B-Y and R-G PES were observed in the control group. This study shows that hypothyroidism affects color vision in humans, causing significant impairment in the B-Y color subsystem.

Evaluating Perceptual Bias During Geometric Scaling of Scatterplots

Scatterplots are frequently scaled to fit display areas in multi-view and multi-device data analysis environments. A common method used for scaling is to enlarge or shrink the entire scatterplot together with the inside points synchronously and proportionally. This process is called geometric scaling. However, geometric scaling of scatterplots may cause a perceptual bias, that is, the perceived and physical values of visual features may be dissociated with respect to geometric scaling. For example, if a scatterplot is projected from a laptop to a large projector screen, then observers may feel that the scatterplot shown on the projector has fewer points than that viewed on the laptop. This paper presents an evaluation study on the perceptual bias of visual features in scatterplots caused by geometric scaling. The study focuses on three fundamental visual features (i.e., numerosity, correlation, and cluster separation) and three hypotheses that are formulated on the basis of our experience. We carefully design three controlled experiments by using well-prepared synthetic data and recruit participants to complete the experiments on the basis of their subjective experience. With a detailed analysis of the experimental results, we obtain a set of instructive findings. First, geometric scaling causes a bias that has a linear relationship with the scale ratio. Second, no significant difference exists between the biases measured from normally and uniformly distributed scatterplots. Third, changing the point radius can correct the bias to a certain extent. These findings can be used to inspire the design decisions of scatterplots in various scenarios.

Attentional blink and putative noninvasive dopamine markers: Two experiments to consolidate possible associations

Adaptive behavioral control involves a balance between top-down persistence and flexible updating of goals under changing demands. According to the metacontrol state model (MSM), this balance emerges from the interaction between the frontal and the striatal dopaminergic system. The attentional blink (AB) task has been argued to tap into the interaction between persistence and flexibility, as it reflects overpersistence—the too-exclusive allocation of attentional resources to the processing of the first of two consecutive targets. Notably, previous studies are inconclusive about the association between the AB and noninvasive proxies of dopamine including the spontaneous eye blink rate (sEBR), which allegedly assesses striatal dopamine levels. We aimed to substantiate and extend previous attempts to predict individual sizes of the AB in two separate experiments with larger sample sizes (N = 71 & N = 65) by means of noninvasive behavioral and physiological proxies of dopamine (DA), such as sEBR and mood measures, which are likely to reflect striatal dopamine levels, and color discrimination, which has been argued to tap into the frontal dopamine levels. Our findings did not confirm the prediction that AB size covaries with sEBR, mood, or color discrimination. The implications of this inconsistency with previous observations are discussed.

A Low-Level Perceptual Correlate of Behavioral and Clinical Deficits in ADHD

In many studies of attention-deficit hyperactivity disorder (ADHD), stimulus encoding and processing (perceptual function) and response selection (executive function) have been intertwined. To dissociate deficits in these functions, we introduced a task that parametrically varied low-level stimulus features (orientation and color) for fine-grained analysis of perceptual function. It also required participants to switch their attention between feature dimensions on a trial-by-trial basis, thus taxing executive processes. Furthermore, we used a response paradigm that captured task-irrelevant motor output (TIMO), reflecting failures to use the correct stimulus-response rule. ADHD participants had substantially higher perceptual variability than controls, especially for orientation, as well as higher TIMO. In both ADHD and controls, TIMO was strongly affected by the switch manipulation. Across participants, the perceptual variability parameter was correlated with TIMO, suggesting that perceptual deficits are associated with executive function deficits. Based on perceptual variability alone, we were able to classify participants into ADHD and controls with a mean accuracy of about 77%. Participants' self-reported General Executive Composite score correlated not only with TIMO but also with the perceptual variability parameter. Our results highlight the role of perceptual deficits in ADHD and the usefulness of computational modeling of behavior in dissociating perceptual from executive processes.

When attention is intact in adults with ADHD

Is covert visuospatial attention-selective processing of information in the absence of eye movements-preserved in adults with attention-deficit/hyperactivity disorder (ADHD)? Previous findings are inconclusive due to inconsistent terminology and suboptimal methodology. To settle this question, we used well-established spatial cueing protocols to investigate the perceptual effects of voluntary and involuntary attention on an orientation discrimination task for a group of adults with ADHD and their neurotypical age-matched and gender-matched controls. In both groups, voluntary attention significantly improved accuracy and decreased reaction times at the relevant location, but impaired accuracy and slowed reaction times at irrelevant locations, relative to a distributed attention condition. Likewise, involuntary attention improved accuracy and speeded responses. Critically, the magnitudes of all these orienting and reorienting attention effects were indistinguishable between groups. Thus, these counterintuitive findings indicate that spatial covert attention remains functionally intact in adults with ADHD.

Color vision predicts processing modes of goal activation during action cascading

One of the most important functions of cognitive control is action cascading: the ability to cope with multiple response options when confronted with various task goals. A recent study implicates a key role for dopamine (DA) in this process, suggesting higher D1 efficiency shifts the action cascading strategy toward a more serial processing mode, whereas higher D2 efficiency promotes a shift in the opposite direction by inducing a more parallel processing mode (Stock, Arning, Epplen, & Beste, 2014). Given that DA is found in high concentration in the retina and modulation of retinal DA release displays characteristics of D2-receptors (Peters, Schweibold, Przuntek, & Müller, 2000), color vision discrimination might serve as an index of D2 efficiency. We used color discrimination, assessed with the Lanthony Desaturated Panel D-15 test, to predict individual differences (N = 85) in a stop-change paradigm that provides a well-established measure of action cascading. In this task it is possible to calculate an individual slope value for each participant that estimates the degree of overlap in task goal activation. When the stopping process of a previous task goal has not finished at the time the change process toward a new task goal is initiated (parallel processing), the slope value becomes steeper. In case of less overlap (more serial processing), the slope value becomes flatter. As expected, participants showing better color vision were more prone to activate goals in a parallel manner as indicated by a steeper slope. Our findings suggest that color vision might represent a predictor of D2 efficiency and the predisposed processing mode of goal activation during action cascading.

Perception in attention deficit hyperactivity disorder

A large body of research demonstrated that individuals with attention deficit hyperactivity disorder (ADHD) suffer from various neuropsychological deficits. In contrast, less is known and only divergent evidence exists on perceptual functions of individuals with ADHD. This is problematic as neuropsychological and perceptual functions are closely interrelated and are often difficult to disentangle in behavioral assessments. This study presents the conduct and results of a systematic literature review on perceptual functions in children and adults with ADHD. This review considers studies using psychophysical methods (objective measurements) and self- and informant reports (subjective measurements). Results indicate that individuals with ADHD have altered perceptual functions in various domains as compared to typically developing individuals. Increased perceptual functions in individuals with ADHD were found with regard to olfactory detection thresholds, whereas reduced perceptual functions were evident for aspects of visual and speech perception. Moreover, individuals with ADHD were found to experience discomfort to sensory stimuli at a lower level than typically developing individuals. Alterations of perceptual functions in individuals with ADHD were shown to be moderated by various factors, such as pharmacological treatment, cognitive functions, and symptom severity. We conclude by giving implications for daily life functioning and clinical practice.

In vivo expression of Nurr1/Nr4a2a in developing retinal amacrine subtypes in zebrafish Tg(nr4a2a:eGFP) transgenics

The Nuclear receptor subfamily 4 group A member 2 (Nr4a2) is crucial for the formation or maintenance of dopaminergic neurons in the central nervous system including the retina, where dopaminergic amacrine cells contribute to visual function. Little is known about which cells express Nr4a2 at which developmental stage. Furthermore, whether Nr4a2 functions in combination with other genes is poorly understood. Thus, we generated a novel transgenic to visualize Nr4a2 expression in vivo during zebrafish retinogenesis. A 4.1 kb fragment of the nr4a2a promoter was used to drive green fluorescent protein expression in this Tg(nr4a2a:eGFP) line. In situ hybridization showed that transgene expression follows endogenous RNA expression at a cellular level. Temporal expression and lineages were quantified using in vivo time-lapse imaging in embryos. Nr4a2 expressing retinal subtypes were characterized immunohistochemically. Nr4a2a:eGFP labeled multiple neuron subtypes including 24.5% of all amacrine interneurons. Nr4a2a:eGFP labels all tyrosine hydroxylase labeled dopaminergic amacrine cells, and other nondopaminergic GABAergic amacrine populations. Nr4a2a:eGFP is confined to a specific progenitor lineage identified by sequential expression of the bhlh transcription factor Atonal7 (Atoh7) and Pancreas transcription factor 1a (Ptf1a), and labels postmitotic postmigratory amacrine cells. Thus, developmental Nr4a2a expression indicates a role during late differentiation of specific amacrine interneurons. Tg(nr4a2a:eGFP) is an early marker of distinct neurons including dopaminergic amacrine cells. It can be utilized to assess consequences of gene manipulations and understand whether Nr4a2 only carries out its role in the presence of specific coexpressed genes. This will allow Nr4a2 use to be refined for regenerative approaches.