Disrupted signal variability of spontaneous neural activity in children with attention-deficit/hyperactivity disorder

Advances in the etiology and neuroimaging of children with attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in children, characterized by age-inappropriate inattention, hyperactivity, and impulsivity, which can cause extensive damage to children's academic, occupational, and social skills. This review will present current advancements in the field of attention deficit hyperactivity disorder, including genetics, environmental factors, epigenetics, and neuroimaging features. Simultaneously, we will discuss the highlights of promising directions for further study.

Greater up-modulation of intra-individual brain signal variability makes a high-load cognitive task more arduous for older adults

The extent to which brain responses are less distinctive across varying cognitive loads in older adults is referred to as neural dedifferentiation. Moment-to-moment brain signal variability, an emerging indicator, reveals not only the adaptability of an individual's brain as an inter-individual trait, but also the allocation of neural resources within an individual due to ever-changing task demands, thus shedding novel insight into the process of neural dedifferentiation. However, how the modulation of intra-individual brain signal variability reflects behavioral differences related to cognitively demanding tasks remains unclear. In this study, we employed functional near-infrared spectroscopy (fNIRS) imaging to capture the variability of brain signals, which was quantified by the standard deviation, during both the resting state and an n-back task (n = 1, 2, 3) in 57 healthy older adults. Using multivariate Partial Least Squares (PLS) analysis, we found that fNIRS signal variability increased from the resting state to the task and increased with working memory load in older adults. We further confirmed that greater fNIRS signal variability generally supported faster and more stable response time in the 2- and 3-back conditions. However, the intra-individual level analysis showed that the greater the up-modulation in fNIRS signal variability with cognitive loads, the more its accuracy decreases and mean response time increases, suggesting that a greater intra-individual brain signal variability up-modulation may reflect decreased efficiency in neural information processing. Taken together, our findings offer new insights into the nature of brain signal variability, suggesting that inter- and intra-individual brain signal variability may index distinct theoretical constructs.

Functional connectivity and complexity analyses of resting-state fMRI in pre-adolescents demonstrating the behavioral symptoms of ADHD

Attention deficit hyperactivity disorder (ADHD) has been characterized by impairments among distributed functional brain networks, e.g., the frontoparietal network (FPN), default mode network (DMN), reward and motivation-related circuits (RMN), and salience network (SAL). In the current study, we evaluated the complexity and functional connectivity (FC) of resting state fMRI (rsfMRI) in pre-adolescents with the behavioral symptoms of ADHD, for pathology-relevant networks. We leveraged data from the Adolescent Brain and Cognitive Development (ABCD) Study. The final study sample included 63 children demonstrating the behavioral features of ADHD and 92 healthy control children matched on age, sex, and pubertal development status. For selected regions in the relevant networks, ANCOVA compared multiscale entropy (MSE) and FC between the groups. Finally, differences in the association between MSE and FC were evaluated. We found significantly reduced MSE along with increased FC within the FPN of pre-adolescents demonstrating the behavior symptoms of ADHD compared to matched healthy controls. Significant partial correlations between MSE and FC emerged in the FPN and RMN in the healthy controls however the association was absent in the participants demonstrating the behavior symptoms of ADHD. The current findings of complexity and FC in ADHD pathology support hypotheses of altered function of inhibitory control networks in ADHD.

Transcranial stimulation of alpha oscillations modulates brain state dynamics in sustained attention

The brain operates an advanced complex system to support mental activities. Cognition is thought to emerge from dynamic states of the complex brain system, which are organized spatially through large-scale neural networks and temporally via neural synchrony. However, specific mechanisms underlying these processes remain obscure. Applying high-definition alpha-frequency transcranial alternating-current stimulation (HD α-tACS) in a continuous performance task (CPT) during functional resonance imaging (fMRI), we causally elucidate these major organizational architectures in a key cognitive operation-sustained attention. We demonstrated that α-tACS enhanced both electroencephalogram (EEG) alpha power and sustained attention, in a correlated fashion. Akin to temporal fluctuations inherent in sustained attention, our hidden Markov modeling (HMM) of fMRI timeseries uncovered several recurrent, dynamic brain states, which were organized through a few major neural networks and regulated by the alpha oscillation. Specifically, during sustain attention, α-tACS regulated the temporal dynamics of the brain states by suppressing a Task-Negative state (characterized by activation of the default mode network/DMN) and Distraction state (with activation of the ventral attention and visual networks). These findings thus linked dynamic states of major neural networks and alpha oscillations, providing important insights into systems-level mechanisms of attention. They also highlight the efficacy of non-invasive oscillatory neuromodulation in probing the functioning of the complex brain system and encourage future clinical applications to improve neural systems health and cognitive performance.

Functional Connectivity and Complexity Analyses of Resting-State fMRI in Pre-Adolescents with ADHD

Attention deficit hyperactivity disorder (ADHD) has been characterized by impairments among distributed functional brain networks, e.g., the frontoparietal network (FPN), default mode network (DMN), and reward and motivation-related circuits (RMN). In the current study, we evaluated the complexity and functional connectivity (FC) of resting state fMRI (rsfMRI) in pre-adolescents with ADHD for pathology-relevant networks. We leveraged data from the Adolescent Brain and Cognitive Development (ABCD) Study. The final study sample included 63 children with ADHD and 92 healthy control children matched on age, sex, and pubertal development status. For selected regions in relevant networks, ANCOVA compared multiscale entropy (MSE) and FC between the groups. Finally, differences in the association between MSE and FC were evaluated. We found significantly reduced MSE along with increased FC within the FPN of pre-adolescents with ADHD compared to matched healthy controls. Significant partial correlations between MSE and FC emerged in fewer regions in the participants with ADHD than in the controls. The observation of reduced entropy is consistent with existing literature using rsfMRI and other neuroimaging modalities. The current findings of complexity and FC in ADHD support hypotheses of altered function of inhibitory control networks in ADHD.

Multiscale entropy of ADHD children during resting state condition

This present study aims to investigate neural mechanisms underlying ADHD compared to healthy children through the analysis of the complexity and the variability of the EEG brain signal using multiscale entropy (MSE), EEG signal standard deviation (SDs), as well as the mean, standard deviation (SDp) and coefficient of variation (CV) of absolute spectral power (PSD). For this purpose, a sample of children diagnosed with attention-deficit/hyperactivity disorder (ADHD) between 6 and 17 years old were selected based on the number of trials and diagnostic agreement, 32 for the open-eyes (OE) experimental condition and 25 children for the close-eyes (CE) experimental condition. Healthy control subjects were age- and gender-matched with the ADHD group. The MSE and SDs of resting-state EEG activity were calculated on 34 time scales using a coarse-grained procedure. In addition, the PSD was averaged in delta, theta, alpha, and beta frequency bands, and its mean, SDp, and CV were calculated. The results show that the MSE changes with age during development, increases as the number of scales increases and has a higher amplitude in controls than in ADHD. The absolute PSD results show CV differences between subjects in low and beta frequency bands, with higher variability values in the ADHD group. All these results suggest an increased EEG variability and reduced complexity in ADHD compared to controls.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11571-022-09869-0.

Functional near-infrared spectroscopy in pediatric clinical research: Different pathophysiologies and promising clinical applications

Over its 30 years of existence, functional near-infrared spectroscopy (fNIRS) has matured into a highly versatile tool to study brain function in infants and young children. Its advantages, amongst others, include its ease of application and portability, the option to combine it with electrophysiology, and its relatively good tolerance to movement. As shown by the impressive body of fNIRS literature in the field of cognitive developmental neuroscience, the method's strengths become even more relevant for (very) young individuals who suffer from neurological, behavioral, and/or cognitive impairment. Although a number of studies have been conducted with a clinical perspective, fNIRS cannot yet be considered as a truly clinical tool. The first step has been taken in this direction by studies exploring options in populations with well-defined clinical profiles. To foster further progress, here, we review several of these clinical approaches to identify the challenges and perspectives of fNIRS in the field of developmental disorders. We first outline the contributions of fNIRS in selected areas of pediatric clinical research: epilepsy, communicative and language disorders, and attention-deficit/hyperactivity disorder. We provide a scoping review as a framework to allow the highlighting of specific and general challenges of using fNIRS in pediatric research. We also discuss potential solutions and perspectives on the broader use of fNIRS in the clinical setting. This may be of use to future research, targeting clinical applications of fNIRS in children and adolescents.

Can biomarkers be used to diagnose attention deficit hyperactivity disorder?

Currently, the diagnosis of attention deficit hyperactivity disorder (ADHD) is solely based on behavioral tests prescribed by the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). However, biomarkers can be more objective and accurate for diagnosis and evaluating treatment efficacy. Thus, this review aimed to identify potential biomarkers for ADHD. Search terms “ADHD,” and “biomarker” combined with one of “protein,” “blood/serum,” “gene,” and “neuro” were used to identify human and animal studies in PubMed, Ovid Medline, and Web of Science. Only papers in English were included. Potential biomarkers were categorized into radiographic, molecular, physiologic, or histologic markers. The radiographic analysis can identify specific activity changes in several brain regions in individuals with ADHD. Several molecular biomarkers in peripheral blood cells and some physiologic biomarkers were found in a small number of participants. There were no published histologic biomarkers for ADHD. Overall, most associations between ADHD and potential biomarkers were properly controlled. In conclusion, a series of biomarkers in the literature are promising as objective parameters to more accurately diagnose ADHD, especially in those with comorbidities that prevent the use of DSM-5. However, more research is needed to confirm the reliability of the biomarkers in larger cohort studies.

Different executive function impairments in medication-naïve children with attention-deficit/hyperactivity disorder comorbid with oppositional defiant disorder and conduct disorder

The impairment of executive functions (EFs) in attention-deficit/hyperactivity disorder (ADHD) might vary from one individual to another, indicating high heterogeneity. Comorbidity may contribute to this heterogeneity. Disruptive behavior disorders (DBD), including oppositional defiant disorder (ODD) and conduct disorder (CD), is the most common comorbidity in ADHD. Although many studies suggest that ADHD with CD (ADHD_CD+) and ADHD with ODD (ADHD_ODD+) should be treated differently, little research has attempted to separate these two disorders when studying the EFs and brain imaging of ADHD with DBD (ADHD_DBD+). Thus, based on our ongoing research in ADHD, we have now recruited a large sample size of medication-naïve children to obtain estimates of neurocognitive function and functional brain networks. We found no EF impairment in ADHD_CD+ patients compared with healthy controls (HCs). Correlation analysis showed that more severe CD symptoms were associated with better EFs. The mediation analysis revealed that the relationship between CD symptoms and inhibition function was mediated by the functional connectivity (FC) of SMN(L) - DMN(R) in the younger group. The study suggested that ADHD_CD+ and ADHD_ODD+ are different in their EF impairment. The comorbidity of CD may not worsen the impairments and might even improve EF performance within ADHD individuals.

Longitudinal investigation in children and adolescents with ADHD and healthy controls: A 2-year ERP study

Cross-sectional group comparisons have shown altered neurocognitive and neurophysiological profiles in individuals with attention-deficit/hyperactivity disorder (ADHD). We report a two-year longitudinal observational study of ADHD children and adolescents (N = 239) regarding ADHD symptoms, behavioral metrics, and event-related potentials (ERP) and compared them to healthy controls (N = 91). The participants were assessed up to five times with a cued Go/NoGo task while ERPs were recorded. We fitted the trajectories of our variables of interest with univariate and bivariate latent growth curve models. At baseline, the ADHD group had increased reaction time variability, higher number of omission and commission errors, and attenuated CNV and P3d amplitudes compared to controls. The task performance in terms of behavioral metrics improved in both groups over two years; however, with differential patterns: the decrease in reaction time and omission errors were stronger in the control group, and the reduction of commission errors was more substantial in the ADHD group. The cueP3, CNV, and N2d amplitudes changed slightly over two years, with negligible differences between both groups. Furthermore, the parent-rated symptom burden in the ADHD group decreased by 22 % (DSM-5-based questionnaire). We did not identify any associations between the changes in symptoms and the changes in the behavioral or neurophysiological metrics. The lack of association between the changes in symptoms and the behavioral or ERP metrics supports the trait liability hypothesis, which claims that the neurocognitive deficits are independent of symptom alleviation. Furthermore, the change in symptom burden was substantial, questioning the stability of the reported ADHD symptoms.

Age-related difference in muscle metabolism patterns during upper limb's encircling exercise: a near-infrared spectroscopy study

Aging is usually accompanied by decrease in limb motor function and change in muscle metabolism patterns. However, few studies have investigated the aging effect on muscle hemodynamics of the upper extremity. This study aims to explore the aging effect on muscle metabolism patterns during upper limb's exercise. Twelve middle-aged and elderly subjects and 12 young subjects were recruited, and muscle oxygenation signals from these subjects' biceps brachii muscles were collected during active and passive upper limb's encircling exercise with near-infrared spectroscopy (NIRS). The old group showed stronger muscle hemodynamic metabolism than the young group. The multiscale fuzzy approximate entropy and multiscale transfer entropy analyses indicated higher complexity and stronger interlimb coupling of the muscle oxygenation signals for the old group. Based on the selected muscle metabolism features, the constructed support vector machine model showed a high accuracy rate for classifying the two groups of subjects: 91.6% for the passive mode and 87.5% for the active mode. Our results proved the specific muscle metabolism patterns in the upper limb's exercise for old subjects, promoting the understanding of the aging effect on muscle hemodynamics.

Prefrontal cortical connectivity and coupling of infraslow oscillation in the resting human brain: a 2-channel broadband NIRS study

The resting-state infraslow oscillation (ISO) of the cerebral cortex reflects the neurophysiological state of the human brain. ISO results from distinct vasomotion with endogenic (E), neurogenic (N), and myogenic (M) frequency bands. Quantification of prefrontal ISO in cortical hemodynamics and metabolism in the resting human brain may facilitate the identification of objective features that are characteristic of certain brain disorders. The goal of this study was to explore and quantify the prefrontal ISO of the cortical concentration changes of oxygenated hemoglobin (Δ[HbO]) and redox-state cytochrome c oxidase (Δ[CCO]) as hemodynamic and metabolic activity metrics in all 3 E/N/M bands. Two-channel broadband near-infrared spectroscopy (2-bbNIRS) enabled measurements of the forehead of 26 healthy young participants in a resting state once a week for 5 weeks. After quantifying the ISO spectral amplitude (SA) and coherence at each E/N/M band, several key and statistically reliable metrics were obtained as features: (i) SA of Δ[HbO] at all E/N/M bands, (ii) SA of Δ[CCO] in the M band, (iii) bilateral connectivity of hemodynamics and metabolism across the E and N bands, and (iv) unilateral hemodynamic–metabolic coupling in each of the E and M bands. These features have promising potential to be developed as objective biomarkers for clinical applications in the future.

The potential shared brain functional alterations between adults with ADHD and children with ADHD co-occurred with disruptive behaviors

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder. Many previous studies have shown that the comorbid status of disruptive behaviour disorders (DBD) was a predictor for ADHD persistence into adulthood. However, the brain mechanisms underlying such a relationship remain unclear. Thus, we aim to investigate whether the brain functional alteration in adults with ADHD could also be detected in children with ADHD co-occurring with disruptive behaviours from both quantitative and categorical dimensions.

METHODS

A total of 172 children with ADHD (cADHD), 98 adults with ADHD (aADHD), 77 healthy control children (cHC) and 40 healthy control adults (aHC) were recruited. The whole-brain spontaneous fluctuations in brain activity of each participant were recorded using functional near-infrared spectroscopy (fNIRS), and the functional connectivities (FCs) were calculated. We first compared the FC differences between aADHD and aHC. Then, for the regions with significantly abnormal FCs in aADHD, we further compared these features between cADHD and cHC. In addition, the correlation between these FCs and the conduct disorder (CD)/oppositional defiant disorder (ODD) symptoms were analysed in cADHD. Moreover, to render the results readily interpretable, we compared the FC differences among ADHD_CD-, subthreshold ADHD_CD+ and cHC groups, and among ADHD_ODD-, ADHD_ODD+ and cHC groups. Finally, we repeated the above analysis after controlling for other comorbidities and core symptoms to diminish the potential confounding effects.

RESULTS

We found that compared with aHC, aADHD showed significantly increased FCs in the VN, DMN, SMN, and DAN. The aforementioned abnormal FCs were also detected in cADHD, however, in an opposite orientation. Notably, these abnormal FCs were positively correlated with CD symptoms. Finally, the subthreshold ADHD_CD+ group even exhibited a tendency of adult-like increased FCs compared with the cHC. The results held after controlling for other comorbidities and core symptoms.

CONCLUSION

This study provides functional neuroimaging evidence that CD might be a risk factor for ADHD persistence into adulthood. Our work highlights the importance of differentiating ADHD_CD+ from ADHD and inspiring further understanding of brain development in ADHD.

Hemispheric Lateralization of Visuospatial Attention Is Independent of Language Production on Right-Handers: Evidence From Functional Near-Infrared Spectroscopy

It is well-established that visuospatial attention is mainly lateralized to the right hemisphere, whereas language production is mainly left-lateralized. However, there is a significant controversy regarding how these two kinds of lateralization interact with each other. The present research used functional near-infrared spectroscopy (fNIRS) to examine whether visuospatial attention is indeed right-lateralized, whereas language production is left-lateralized, and more importantly, whether the extent of lateralization in the visuospatial task is correlated with that in the task involving language. Specifically, fifty-two healthy right-handed participants participated in this study. Multiple-channel fNIRS technique was utilized to record the cerebral hemodynamic changes when participants were engaged in naming objects depicted in pictures (the picture naming task) or judging whether a presented line was bisected correctly (the landmark task). The degree of hemispheric lateralization was quantified according to the activation difference between the left and right hemispheres. We found that the picture-naming task predominantly activated the inferior frontal gyrus (IFG) of the left hemisphere. In contrast, the landmark task predominantly activated the inferior parietal sulcus (IPS) and superior parietal lobule (SPL) of the right hemisphere. The quantitative calculation of the laterality index also showed a left-lateralized distribution for the picture-naming task and a right-lateralized distribution for the landmark task. Intriguingly, the correlation analysis revealed no significant correlation between the laterality indices of these two tasks. Our findings support the independent hypothesis, suggesting that different cognitive tasks may engender lateralized processing in the brain, but these lateralized activities may be independent of each other. Meanwhile, we stress the importance of handedness in understanding the relationship between functional asymmetries. Methodologically, we demonstrated the effectiveness of using the multichannel fNIRS technique to investigate the hemispheric specialization of different cognitive tasks and their lateralization relations between different tasks. Our findings and methods may have important implications for future research to explore lateralization-related issues in individuals with neural pathologies.