Relations between visual and auditory continuous performance tests in a clinical population: a descriptive study

Attrition rate in infant fNIRS research: A meta-analysis

Understanding the trends and predictors of attrition rate, or the proportion of collected data that is excluded from the final analyses, is important for accurate research planning, assessing data integrity, and ensuring generalizability. In this pre-registered meta-analysis, we reviewed 182 publications in infant (0-24 months) functional near-infrared spectroscopy (fNIRS) research published from 1998 to April 9, 2020, and investigated the trends and predictors of attrition. The average attrition rate was 34.23% among 272 experiments across all 182 publications. Among a subset of 136 experiments that reported the specific reasons for subject exclusion, 21.50% of the attrition was infant-driven, while 14.21% was signal-driven. Subject characteristics (e.g., age) and study design (e.g., fNIRS cap configuration, block/trial design, and stimulus type) predicted the total and subject-driven attrition rates, suggesting that modifying the recruitment pool or the study design can meaningfully reduce the attrition rate in infant fNIRS research. Based on the findings, we established guidelines for reporting the attrition rate for scientific transparency and made recommendations to minimize the attrition rates. This research can facilitate developmental cognitive neuroscientists in their quest toward increasingly rigorous and representative research.

Common principles underlie the fluctuation of auditory and visual sustained attention

Sustained attention plays an important role in adaptive behaviours in everyday activities. As previous studies have mostly focused on vision, and attentional resources have been thought to be specific to sensory modalities, it is still unclear how mechanisms of attentional fluctuations overlap between visual and auditory modalities. To reduce the effects of sudden stimulus onsets, we developed a new gradual-onset continuous performance task (gradCPT) in the auditory domain and compared dynamic fluctuation of sustained attention in vision and audition. In the auditory gradCPT, participants were instructed to listen to a stream of narrations and judge the gender of each narration. In the visual gradCPT, they were asked to observe a stream of scenery images and indicate whether the scene was a city or mountain. Our within-individual comparison revealed that auditory and visual attention are similar in terms of the false alarm rate and dynamic properties including fluctuation frequency. Absolute timescales of the fluctuation in the two modalities were comparable, notwithstanding the difference in stimulus onset asynchrony. The results suggest that fluctuations of visual and auditory attention are underpinned by common principles and support models with a more central, modality-general controller.

Relationship between intraindividual auditory and visual attention in children with ADHD

BACKGROUND AND AIM

Most previous attention-deficit/hyperactivity disorder (ADHD) studies have used only a single sensory modality (usually vision) to investigate attentional problems, although patients with ADHD might display deficits of auditory attention similar to their visual attention. This study explored intraindividual auditory and visual attention in children with and without ADHD to examine the relationship between these two dimensions of attention.

METHODS

Attentional performances of 140 children (70 children with ADHD and 70 typically developing peers) were measured through the Test of Variables of Attention (TOVA) in the present study.

RESULTS

For both groups, most attentional indices showed significant differences between the two modalities (d ranging from 0.32 to 0.72). The correlation coefficients of most of the attentional variables in children with ADHD were lower than their typically developing peers. All attentional indices of children with ADHD (ranging from 12.8%-55.7%) were much higher than those of their typically developing peers (ranging from 1.4%-8.6%).

CONCLUSION

These results not only indicate that typically developing children display more consistent attentional performance, but also support the view that children with ADHD may show attention deficiency in one modality but not necessarily in the other.

The Effects of Live-Fire Drills on Visual and Auditory Cognitive Performance among Firefighters

Introduction:

The nature of firefighters’ work is characterized by its unexpected emergencies, sleep deprivation, night shift schedules, and smoke exposure during firefighting.

Methods:

Eighteen firefighters were involved in simulated live-fire activities. Firefighters’ health status in terms of cardiovascular and mental conditions was checked by a physician and through reviewing their medical records. Firefighters’ cognitive functions were evaluated by visual and auditory continuous performance tests (VCPT and ACPT) and paced visual and auditory serial addition tests (PVSAT and PASAT).

Results:

VCPT and ACPT scores were lower after the activity relative to baseline. The results revealed that ACPT appears to be more difficult than VCPT. Also, PVSAT and PASAT scores decreased significantly after the experiment. PASAT scores following firefighting tasks experienced a more significant decline compared to those of the PVSAT.

Conclusions:

These findings suggest that firefighters have visual and auditory cognitive function problems following firefighting activities. In conclusion, auditory cognitive function was more influenced than the visual ability as a result of the experiment.

The role of event rate, temporal expectancy, and sensory modality in continuous performance of children and adults

This study explored developmental differences in the effects of event rate, temporal expectancy, and sensory modality on continuous performance. Children (ages 7-8 years) and college-aged adults completed visual and auditory continuous performance tasks (CPTs) that were equated at an intermediate (20 events/min) rate using the perceptual sensitivity index (d') and then were compared at faster (40 events/min) and slower (10 events/min) rates to determine the influence of event rate on continuous performance of children and adults. To investigate the effects of temporal expectancy, 20% of the critical signals and neutral events occurred early or late relative to the regular rhythm of the task. The findings (a) suggest that event rate influences continuous performance differently for children and adults, (b) highlight the role of temporal expectancy in continuous performance, and (c) reveal differences in the effects of event rate and temporal expectancy on visual and auditory continuous performance.

Modeling the Relations Among Sustained Attention, Short-Term Memory, and Language in Down Syndrome

Sustained attention (SA) and short-term memory (STM) contribute to language function in Down syndrome (DS). We proposed models in which relations of SA to language in DS are mediated by STM. Thirty-seven youth with DS aged 10-22 years (M = 15.59) completed SA, STM, and language tasks. Cross-sectional mediation analyses were run with the bootstrapping method. We found significant indirect effects of SA separately on vocabulary and syntax through auditory STM with point estimates of -.30 and -.31, respectively. Results suggest lapses in SA compromise auditory STM, which in turn impacts vocabulary and syntax in youth with DS; however, further research is needed to confirm causality. Addressing SA and STM in language therapy with youth with DS could lead to improved outcomes.

Auditory and Visual Continuous Performance Tests

Elementary school children in three grade groups (Grades K/1, 3, and 5/6) completed either the auditory or the visual 1/9 vigilance task from the Gordon Diagnostic System (GDS) as well as subtests from the Wechsler Intelligence Scale for Children–Third Edition and auditory or visual processing subtests from the Woodcock-Johnson Tests of Cognitive Ability–Revised (WJ-R). Teachers rated the children's classroom attentional and self-control behaviors on the Child Behavior Checklist (CBCL) and the Self-Control Observation Scale (SCOS). Although performance on both auditory and visual continuous performance tests (CPTs) improved with age, gender effects were small and limited to the visual CPT. Neither auditory nor visual CPT scores were related to IQ scores. However, auditory CPT scores were related to classroom behaviors as reported by teachers whereas visual CPT scores were related to visual processing.

Influence of memory, attention, IQ and age on auditory temporal processing tests: preliminary study

PURPOSE

To investigate the existence of correlations between the performance of children in auditory temporal tests (Frequency Pattern and Gaps in Noise--GIN) and IQ, attention, memory and age measurements.

METHOD

Fifteen typically developing individuals between the ages of 7 to 12 years and normal hearing participated in the study. Auditory temporal processing tests (GIN and Frequency Pattern), as well as a Memory test (Digit Span), Attention tests (auditory and visual modality) and intelligence tests (RAVEN test of Progressive Matrices) were applied.

RESULTS

Significant and positive correlation between the Frequency Pattern test and age variable were found, which was considered good (p<0.01, 75.6%). There were no significant correlations between the GIN test and the variables tested.

CONCLUSIONS

Auditory temporal skills seem to be influenced by different factors: while the performance in temporal ordering skill seems to be influenced by maturational processes, the performance in temporal resolution was not influenced by any of the aspects investigated.

Recognition of facial emotion and affective prosody in children with ASD (+ADHD) and their unaffected siblings

Autism is a highly heritable and clinically heterogeneous neuropsychiatric disorder that frequently co-occurs with other psychopathologies, such as attention-deficit/hyperactivity disorder (ADHD). An approach to parse heterogeneity is by forming more homogeneous subgroups of autism spectrum disorder (ASD) patients based on their underlying, heritable cognitive vulnerabilities (endophenotypes). Emotion recognition is a likely endophenotypic candidate for ASD and possibly for ADHD. Therefore, this study aimed to examine whether emotion recognition is a viable endophenotypic candidate for ASD and to assess the impact of comorbid ADHD in this context. A total of 90 children with ASD (43 with and 47 without ADHD), 79 ASD unaffected siblings, and 139 controls aged 6-13 years, were included to test recognition of facial emotion and affective prosody. Our results revealed that the recognition of both facial emotion and affective prosody was impaired in children with ASD and aggravated by the presence of ADHD. The latter could only be partly explained by typical ADHD cognitive deficits, such as inhibitory and attentional problems. The performance of unaffected siblings could overall be considered at an intermediate level, performing somewhat worse than the controls and better than the ASD probands. Our findings suggest that emotion recognition might be a viable endophenotype in ASD and a fruitful target in future family studies of the genetic contribution to ASD and comorbid ADHD. Furthermore, our results suggest that children with comorbid ASD and ADHD are at highest risk for emotion recognition problems.

Auditory and visual sustained attention in children with speech sound disorder

Although research has demonstrated that children with specific language impairment (SLI) and reading disorder (RD) exhibit sustained attention deficits, no study has investigated sustained attention in children with speech sound disorder (SSD). Given the overlap of symptoms, such as phonological memory deficits, between these different language disorders (i.e., SLI, SSD and RD) and the relationships between working memory, attention and language processing, it is worthwhile to investigate whether deficits in sustained attention also occur in children with SSD. A total of 55 children (18 diagnosed with SSD (8.11 ± 1.231) and 37 typically developing children (8.76 ± 1.461)) were invited to participate in this study. Auditory and visual sustained-attention tasks were applied. Children with SSD performed worse on these tasks; they committed a greater number of auditory false alarms and exhibited a significant decline in performance over the course of the auditory detection task. The extent to which performance is related to auditory perceptual difficulties and probable working memory deficits is discussed. Further studies are needed to better understand the specific nature of these deficits and their clinical implications.

Using dual tasks to test immediate transfer of training between naturalistic movements: a proof-of-principle study

Theories of motor learning predict that training a movement reduces the amount of attention needed for its performance (i.e., more automatic). If training one movement transfers, then the amount of attention needed for performing a second movement should also be reduced, as measured under dual task conditions. The authors' purpose was to test whether dual task paradigms are feasible for detecting transfer of training between two naturalistic movements. Immediately following motor training, subjects improved performance of a second untrained movement under single and dual task conditions. Subjects with no training did not. Improved performance in the untrained movement was likely due to transfer, and suggests that dual tasks may be feasible for detecting transfer between naturalistic actions.

Visual attention in the first years: typical development and developmental disorders

The development of attention is critical for the young child's competence in dealing with the demands of everyday life. Here we review evidence from infants and preschool children regarding the development of three neural subsystems of attention: selective attention, sustained attention, and attentional (executive) control. These systems overlap with dorsal cortical visual streams and their disorders are related to the general hypothesis of 'dorsal stream vulnerability'. Infants' ability to control spatial selective attention can be measured using the 'Fixation Shift' task. From around 4 months of age, infants start to show cortical control in disengaging to switch between competing targets. Fixation shifts have proved to be an effective early indicator of attentional disorders associated with perinatal brain damage. Executive function emerges slowly, starting around 1 year of age. The new Early Childhood Attention Battery has identified the three attention subsystems as distinct before 5 years of age in typical development and allows assessment of individual attention profiles across these subsystems. The Early Childhood Attention Battery is now being used to identify specific profiles associated with developmental syndromes such as Williams, Down, and fragile X. These new methods offer the possibility of very early identification of attention disorders, raising the challenge of effective remediation and treatment at an early age.

Differences in Performance of ADHD Children on a Visual and Auditory Continuous Performance Test according to IQ

OBJECTIVE

Continuous performance tests (CPTs) are frequently used in clinical practice to assess the attentiveness of ADHD children. Although most CPTs do not categorize T scores by intelligence, there is great diversity of opinion regarding the interrelation between intelligence and CPT performance. This study aimed to determine if ADHD children with superior IQs would perform better than ADHD children with average IQs. Additionally, we aimed to examine the need for CPTs' to categorize according to IQ.

METHODS

Participants were 326 outpatients, aged 5-15 years, diagnosed with ADHD. All participants completed the Wechsler Intelligence Scale for Children-Revised and a CPT. After excluding those who meet exclusion criteria, we had 266 patients for our analysis.

RESULTS

The "Highly Intelligent Group" (HIG), patients with IQs 120 and above, performed superiorly to the "Normally Intelligent Group" (NIG) patients, with IQs between 70 and 120, with regard to omission and commission errors on the visual-auditory CPT, even after controlling for age and gender. The HIG had higher ratios of subjects with T scores <65 on the visual and auditory CPT variables than the NIG did.

CONCLUSION

The results of this study suggest this CPT is not sensitive for discerning ADHD in children with superior IQs; thus, there is a need to standardize the variables based on IQ, as well as on age and gender. Moreover, clinicians need to pay attention to the effect of IQ in interpreting CPT scores; that is, a "normal" score does not rule out a diagnosis of ADHD.

A context for normalizing impulsiveness at work for adults with attention deficit/hyperactivity disorder (combined type)

Impaired executive function and impulsiveness or intolerance to boredom in adult attention deficit/hyperactivity disorder (ADHD) are thought to compromise performance at work. Several task parameters help people with ADHD to perform better on computerized cognitive tasks, namely reduced response-to-stimulus interval, discriminative feedback, or a format resembling a videogame. However, still very little is known about how these contexts might be helpful in a real work environment. We developed a computerized task resembling a fast-paced videogame with no response-to-stimulus interval and constant and diverse discriminative error feedback. The task included several measurements of high-order executive function (planning, working memory, and prospective memory) formatted as a single multitask simulating occupational activities (SOA). We also administered the Continuous Performance Test-II (CPT-II), a very simple vigilance task without discriminative feedback and with long response-to-stimulus intervals. We tested 30 adults answering to DSM-IV criteria of ADHD (combined type) and 30 IQ-matched adults without ADHD. As has been reported many times, the ADHD participants made significantly more errors of commission than the control participants on the CPT-II, whereas the two groups made the same number of errors of commission on the SOA. The ADHD group also sought discriminative feedback significantly more actively on the SOA than the control group and performed at par with the control group in all respects. There was no speed/accuracy trade-off, nor was there any evidence of other costs of normalization on the SOA. Impulsiveness in adult ADHD is compensable on a task simulating the work environment.

From genes to brain development to phenotypic behavior: "dorsal-stream vulnerability" in relation to spatial cognition, attention, and planning of actions in Williams syndrome (WS) and other developmental disorders

Visual information is believed to be processed through two distinct, yet interacting cortical streams. The ventral stream performs the computations needed for recognition of objects and faces ("what" and "who"?) and the dorsal stream the computations for registering spatial relationships and for controlling visually guided actions ("where" and "how"?). We initially proposed a model of spatial deficits in Williams syndrome (WS) in which visual abilities subserved by the ventral stream, such as face recognition, are relatively well developed (although not necessarily in exactly the same way as in typical development), whereas dorsal-stream functions, such as visuospatial actions, are markedly impaired. Since these initial findings in WS, deficits of motion coherence sensitivity, a dorsal-stream function has been found in other genetic disorders such as Fragile X and autism, and as a consequence of perinatal events (in hemiplegia, perinatal brain anomalies following very premature birth), leading to the proposal of a general "dorsal-stream vulnerability" in many different conditions of abnormal human development. In addition, dorsal-stream systems provide information used in tasks of visuospatial memory and locomotor planning, and these systems are closely coupled to networks for attentional control. We and several other research groups have previously shown deficits of frontal and parietal lobe function in WS individuals for specific attention tasks [e.g., Atkinson, J., Braddick, O., Anker, S., Curran, W., & Andrew, R. (2003). Neurobiological models of visuospatial cognition in children with Williams Syndrome: Measures of dorsal-stream and frontal function. Developmental Neuropsychology, 23(1/2), 141-174.]. We have used the Test of Everyday Attention for Children (TEA-Ch) which aims to attempt to separate components of attention with distinct brain networks (selective attention, sustained attention, and attention control-executive function) testing a group of older children with WS, but this test battery is too demanding for many children and adults with WS. Consequently, we have devised a new set of tests of attention, the Early Childhood Attention Battery (ECAB). This uses similar principles to the TEA-Ch, but adapted for mental ages younger than 6 years. The ECAB shows a distinctive attention profile for WS individuals relative to their overall cognitive development, with relative strength in tasks of sustained attention and poorer performance on tasks of selective attention and executive control. These profiles, and the characteristic developmental courses, also show differences between children with Down's syndrome and WS. This chapter briefly reviews new research findings on WS in these areas, relating the development of brain systems in WS to evidence from neuroimaging in typically developing infants, children born very preterm, and normal adults. The hypothesis of "dorsal-stream(s) vulnerability" which will be discussed includes a number of interlinked brain networks, subserving not only global visual processing and formulation of visuomotor actions but interlinked networks of attention.

Maturation of visual and auditory temporal processing in school-aged children

PURPOSE

To examine development of sensitivity to auditory and visual temporal processes in children and the association with standardized measures of auditory processing and communication. Methods Normative data on tests of visual and auditory processing were collected on 18 adults and 98 children aged 6-10 years of age. Auditory processes included detection of pitch from temporal cues using iterated rippled noise and frequency modulation detection at 2 Hz, 40 Hz, and 240 Hz. Visual processes were coherent form and coherent motion detection. Test-retest data were gathered on 21 children.

RESULTS

Performance on perceptual tasks improved with age, except for fine temporal processing (iterated rippled noise) and coherent form perception, both of which were relatively stable over the age range. Within-subject variability (as assessed by track width) did not account for age-related change. There was no evidence for a common temporal processing factor, and there were no significant associations between perceptual task performance and communication level (Children's Communication Checklist, 2nd ed.; D. V. M. Bishop, 2003) or speech-based auditory processing (SCAN-C; R. W. Keith, 2000).

CONCLUSIONS

The auditory tasks had different developmental trajectories despite a common procedure, indicating that age-related change was not solely due to responsiveness to task demands. The 2-Hz frequency modulation detection task, previously used in dyslexia research, and the visual tasks had low reliability compared to other measures.

Is there a selective relationship between language functioning and auditory attention in children?

This study explores the selectivity of the relationship between auditory attention and language in children. A total of 42 children (16 females) between 7.0 and 10.0 years of age were administered a battery of cognitive, language, and behavioral measures along with 3 auditory and 3 visual continuous performance tests (CPTs). Omission errors on auditory CPTs were related to language skills whereas commission errors on CPTs in both modalities were related to behavioral ratings. The finding of a specific relationship between language functioning and auditory attention indicates that the contribution of auditory attention to language acquisition, processing, and breakdown should be more fully explored.

Relating children's attentional capabilities to intelligence, memory, and academic achievement: a test of construct specificity in children with asthma

The relationship between attention, intelligence, memory, achievement, and behavior in a large population (N = 939) of children without neuropsychologic problems was investigated in children with mild and moderate asthma. It was hypothesized that different levels of children's attentional capabilities would be associated with different levels of intellectual, memory, and academic abilities. Children ages 6-12 at the eight clinical centers of the Childhood Asthma Management Program (CAMP) were enrolled in this study. Standardized measures of child neuropsychological and behavioral performance were administered to all participants, with analyses examining both the developmental trajectory of child attentional capabilities and the associations between Continuous Performance Test (CPT) scores and intellectual functioning, and measures of memory, academic achievement, and behavioral functioning. Findings demonstrated that correct responses on the CPT increase significantly with age, while commission errors decrease significantly with age. Performance levels on the CPT were associated with differences in child intellectual function, memory, and academic achievement. Overall these findings reveal how impairments in child attention skills were associated with normal levels of performance on measures of children's intelligence, memory, academic achievement, and behavioral functioning, suggesting that CPT performance is a salient marker of brain function.

Tympanostomy tubes and developmental outcomes at 9 to 11 years of age

BACKGROUND

Developmental impairments in children have been attributed to persistent middle-ear effusion in their early years of life. Previously, we reported that among children younger than 3 years of age with persistent middle-ear effusion, prompt as compared with delayed insertion of tympanostomy tubes did not result in improved cognitive, language, speech, or psychosocial development at 3, 4, or 6 years of age. However, other important components of development could not be assessed until the children were older.

METHODS

We enrolled 6350 infants soon after birth and evaluated them regularly for middle-ear effusion. Before 3 years of age, 429 children with persistent effusion were randomly assigned to undergo the insertion of tympanostomy tubes either promptly or up to 9 months later if effusion persisted. We assessed literacy, attention, social skills, and academic achievement in 391 of these children at 9 to 11 years of age.

RESULTS

Mean (+/-SD) scores on 48 developmental measures in the group of children who were assigned to undergo early insertion of tympanostomy tubes did not differ significantly from the scores in the group that was assigned to undergo delayed insertion. These measures included the Passage Comprehension subtest of the Woodcock Reading Mastery Tests (mean score, 98+/-12 in the early-treatment group and 99+/-12 in the delayed-treatment group); the Spelling, Writing Samples, and Calculation subtests of the Woodcock-Johnson III Tests of Achievement (96+/-13 and 97+/-16; 104+/-14 and 105+/-15; and 99+/-13 and 99+/-13, respectively); and inattention ratings on visual and auditory continuous performance tests.

CONCLUSIONS

In otherwise healthy young children who have persistent middle-ear effusion, as defined in our study, prompt insertion of tympanostomy tubes does not improve developmental outcomes up to 9 to 11 years of age. (ClinicalTrials.gov number, NCT00365092 [ClinicalTrials.gov].).

Remembering the Past and Foreseeing the Future while Dealing with the Present: A Comparison of Young Adult and Elderly Cohorts on a Multitask Simulation of Occupational Activities

Thirty-five young adult and 38 elderly cybernauts, matched for education, sex, alcohol consumption, and time/day of computer use were compared on a computerized simulation of professional activities of daily living (ADLs). The program quantified performance in terms of speed and accuracy on four major constructs: (1) planning (a 30-item office party script); (2) prospective memory (injections, sleep, phone); (3) working memory (PASAT, D2, and CES analogs); and (4) retrospective memory. Participants had to organize an office party, self inject insulin and go to bed at requisite times of day, do "office work" at unpredictable times of day, and answer the phone that blinked but did not ring (near threshold stimulus). The elderly were markedly and equally impaired on all four constructs (F = 24.3, p < .000). The elderly were also equally and markedly impaired on slave and central executive systems (c.f. Baddeley's model) and on event-based and time-based prospective memory (c.f. McDaniel's model)-findings arguing against a "frontal" model of cognitive decline. This supports Salthouse's concept of a "general factors" decline in normal aging due to diffuse deterioration of the brain. On the other hand, as expected from previous findings, the balance of omissiveness/commissiveness was significantly increased in the elderly sample's error profile. Furthermore, the balance of speed and accuracy was significantly increased in the elderly. This defines limits of the "general factors" model. The elderly also markedly underused a clock icon which had to be clicked on to get the virtual time of day necessary for integrating all the required actions. Prospective memory explained 11% of the aging variance despite partialing out of the three other constructs, making it appear as a golden standard of sensititivity to normal aging-though perhaps provided it be implemented in a distracting, multitask, strategically demanding context.

Construct validity of the auditory continuous performance test for preschoolers

Development of diagnostic instruments directed toward neuropsychological assessment of preschoolers lags significantly behind those available for school-age children (DeWolfe, Byrne, & Bawden, 2000). This is particularly true for measures of executive function (EF). The Auditory Continuous Performance Test for Preschoolers (ACPT-P; Mahone, Pillion, & Hiemenz, 2001) is a computerized, Go-No-go test developed to measure selected EF skills in preschoolers. First, to determine whether performance on the ACPT-P is associated with hearing impairment, we compared performance of children with mild hearing loss (MHL) to controls on the ACPT-P, and measures of spatial working memory (SWM) and motor persistence (MP). There were no differences between performance of the MHL group and controls on any of these measures. Second, to examine the construct validity of the ACPT-P, we compared performance of 40 preschoolers with ADHD to 40 age- and sex-matched controls, using the ACPT-P to measure response preparation, sustained attention, and inhibitory control. We also compared these groups on measures of SWM and MP. The group with attention deficit hyperactivity disorder (ADHD) performed significantly worse than controls on the ACPT-P (omissions, mean response time, variability) and MP. The ACPT-P was correlated with the MP, but not with the SWM measure. Both the ACPT-P and the MP measures showed low to moderate correlations with parent ratings of behavior associated with ADHD. These findings support the use of performance-based assessment of executive control skills in preschoolers suspected of having ADHD. In this age group, the ACPT-P may be particularly useful in assessing sustained attention and response preparation and may complement behavior rating scales.