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Areces D, Rodríguez C, Méndez-Freije I, Saura-Carrasco M, Climent G. How does the predictive capacity of a virtual-reality CPT for children with ADHD differ by country? A transcultural study with Argentine and Spanish Children. RESEARCH IN DEVELOPMENTAL DISABILITIES 2024; 156:104898. [PMID: 39708780 DOI: 10.1016/j.ridd.2024.104898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 11/13/2024] [Accepted: 12/13/2024] [Indexed: 12/23/2024]
Abstract
BACKGROUND Although many studies have analyzed the effectiveness of novel Continuous Performance Tests (CPTs) in diagnosing ADHD, very few studies have examined how cultural factors influence that effectiveness. AIMS The present study aimed to analyze performance in a Virtual-Reality CPT in a sample of children resident in Spain and Argentina. METHODS AND PROCEDURES 138 students participated in this study. They were aged between 6 and 16 years old, with a mean age of 10.38 (SD = 2.46) and had been diagnosed with ADHD. OUTCOMES AND RESULTS Commissions was the only significant variable in both discriminant models. In the Spanish population, the commissions variable was shown to correctly classify 49.4 % of the three types of ADHD presentation. However, in the Argentine population, the commissions variable correctly classified 68.3 %. CONCLUSIONS AND IMPLICATIONS These results may have been biased by the severity of the different types of presentation. In fact, it seems reasonable to think that the greater the severity, the better Aula Nesplora would predict the three types of presentation of ADHD. These results emphasize the need to consider other variables with a notable impact on daily life as children develop.
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Affiliation(s)
- Débora Areces
- Department of Psychology, University of Oviedo, Asturias, Spain.
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2
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Osborn AJ, Lange O, Roberts RM. Attention Deficit/Hyperactivity Disorder in Individuals with Non-Syndromic Craniosynostosis: A Systematic Review and Meta-Analysis. Dev Neuropsychol 2024; 49:191-206. [PMID: 38801083 DOI: 10.1080/87565641.2024.2357801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024]
Abstract
It is not yet understood whether, and to what extent, craniosynostosis impacts the development of Attention Deficit/Hyperactivity Disorder (ADHD). This PRISMA compliant and PROSPERO pre-registered (ID: CRD42023458640) systematic review and meta-analysis examines the association of single-suture, non-syndromic craniosynostosis with ADHD and inattention/hyperactivity symptoms. Data from 17 independent studies (Nparticipants = 2,389; Mage = 7.3 years) were analyzed, taking into consideration suture location, surgical status, age, and measures administered, where feasible. Few differences were found between cases and controls, but some studies reported high symptom levels. Additional research is required utilizing larger sample sizes and more comprehensive assessment of ADHD.
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Affiliation(s)
- Amanda J Osborn
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Olivia Lange
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Rachel M Roberts
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
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Roama-Alves RJ, Guimarães VRDA, Fonseca BG, de Andrade GMC, Duarte JL, Crenitte PAP. The Big Five Personality Traits in Dyslexic Adults: An Exploratory Study. ACTAS ESPANOLAS DE PSIQUIATRIA 2024; 52:428-436. [PMID: 39129689 PMCID: PMC11319744 DOI: 10.62641/aep.v52i4.1661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
BACKGROUND Dyslexia is a neurodevelopmental disorder that causes a pattern of learning difficulties that can be characterized by deficits in word reading accuracy, speed or fluency, and reading comprehension. Due to all this damage, emotional difficulties have been described in the literature mainly for childhood and adolescence. Within this emotional component, personality can be included. In Brazil, at the time of carrying out this research, no research had been found that investigated the personality of dyslexic adults. Thus, the present study aimed to investigate the personality of Brazilian adults with dyslexia. METHODS A semi-structured interview was administered and the Factorial Personality Battery, based on the Big Five personality traits. The sample was composed of two groups: one with dyslexia and another control. The first was formed by nine participants, aged between 18 and 47 (M = 31.7; standard deviation (SD) = 11.8), six of whom were women. The control group was formed by 60 participants, aged between 18 and 45 years (M = 26.4; SD = 8.8), 38 of whom were women. RESULTS The data did not show significant differences between the groups in most of the analyzed factors and subfactors. Increased rates of "passivity/lack of energy" and lowered rates of "openness to new ideas" were identified in the group with dyslexia. CONCLUSION These results could be useful for describing personality profiles in dyslexic adults, with these descriptions possibly providing clinical support for diagnoses and intervention procedures.
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Affiliation(s)
- Rauni J. Roama-Alves
- Department of Psychology, Universidade Federal de Mato Grosso, 78060-900 Cuiabá, Mato Grosso, Brazil
| | | | - Beatriz G. Fonseca
- Department of Psychology, Universidade Federal de Mato Grosso, 78060-900 Cuiabá, Mato Grosso, Brazil
| | | | - Janaína L. Duarte
- Department of Speech Therapy, Universidade de São Paulo, 17012-901 Bauru, São Paulo, Brazil
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Katabi G, Shahar N. Exploring the steps of learning: computational modeling of initiatory-actions among individuals with attention-deficit/hyperactivity disorder. Transl Psychiatry 2024; 14:10. [PMID: 38191535 PMCID: PMC10774270 DOI: 10.1038/s41398-023-02717-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 01/10/2024] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is characterized by difficulty in acting in a goal-directed manner. While most environments require a sequence of actions for goal attainment, ADHD was never studied in the context of value-based sequence learning. Here, we made use of current advancements in hierarchical reinforcement-learning algorithms to track the internal value and choice policy of individuals with ADHD performing a three-stage sequence learning task. Specifically, 54 participants (28 ADHD, 26 controls) completed a value-based reinforcement-learning task that allowed us to estimate internal action values for each trial and stage using computational modeling. We found attenuated sensitivity to action values in ADHD compared to controls, both in choice and reaction-time variability estimates. Remarkably, this was found only for first-stage actions (i.e., initiatory actions), while for actions performed just before outcome delivery the two groups were strikingly indistinguishable. These results suggest a difficulty in following value estimation for initiatory actions in ADHD.
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Affiliation(s)
- Gili Katabi
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel.
| | - Nitzan Shahar
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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Li J, Wang W, Cheng J, Li H, Feng L, Ren Y, Liu L, Qian Q, Wang Y. Relationships between sensory integration and the core symptoms of attention-deficit/hyperactivity disorder: the mediating effect of executive function. Eur Child Adolesc Psychiatry 2023; 32:2235-2246. [PMID: 35999304 DOI: 10.1007/s00787-022-02069-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 08/14/2022] [Indexed: 11/03/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is often accompanied by executive function deficits and functional alterations in sensory integration. The present study aimed to investigate the relationship between ADHD core symptoms, executive function, and sensory integration in children with ADHD. A total of 228 children with ADHD were recruited for our study. The Sensory Organization Test (SOT) and Child Sensory Integration Scale (CSIS) evaluated the sensory integration ability from lab-based and scaled-based perspectives, respectively. Three core components of executive functions (inhibition, working memory, and set-shifting) were assessed using both lab-based tests and the relevant factors from the behavior rating inventory of executive function (BRIEF). Partial correlation analysis was performed to explore the correlation of sensory integration with EF and ADHD core symptoms. Based on the observed significant correlation, bootstrap analyses were further conducted to explore the potential mediating effect of EF on the relationship between sensory integration and ADHD core symptoms. ADHD symptoms and EF were significantly correlated with CSIS scores; no factors were significantly correlated with SOT performance. In detail, the vestibular-balance score was negatively correlated with both inattention and hyperactivity/impulsivity symptoms, while the hyper-sensory and proprioception scores were negatively correlated with only inattention symptoms. For the scaled-based EF, vestibular-balance was negatively correlated with inhibition and working memory, and the hyper-sensory score was negatively correlated with shift factor. No correlation was found for the lab-based EF tests. The subsequent mediation analysis found that inhibition partially mediated the relationship between vestibular balance and hyperactivity/impulsivity symptoms. Working memory completely mediated the relationship between vestibular-balance, hyper-sensory, proprioception, and inattention symptoms. These results were well validated in an independent sample. Our present findings demonstrated that the functional alteration in basic sensory integration might be associated with impairments of executive functions and then lead to the behavioral expression of ADHD. The present findings might provide a new perspective to understand the occurrence of ADHD symptoms and potential precise intervention methods.
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Affiliation(s)
- Jing Li
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, 100191, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Wenchen Wang
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, 100191, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
| | - Jia Cheng
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, 100191, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
| | - Haimei Li
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, 100191, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
| | - Lei Feng
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, 100191, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
- National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yuanchun Ren
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, 100191, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Lu Liu
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, 100191, China.
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China.
| | - Qiujin Qian
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, 100191, China.
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China.
| | - Yufeng Wang
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, 100191, China.
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China.
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Haijen ECHM, Hurks PPM, Kuypers KPC. Trait mindfulness and personality characteristics in a microdosing ADHD sample: a naturalistic prospective survey study. Front Psychiatry 2023; 14:1233585. [PMID: 37915796 PMCID: PMC10617390 DOI: 10.3389/fpsyt.2023.1233585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/02/2023] [Indexed: 11/03/2023] Open
Abstract
Background Microdosing (MD), repeatedly taking psychedelics in small, non-hallucinogenic amounts, has been practiced by individuals to relieve attention deficit hyperactivity disorder (ADHD) symptoms. Generally, adults diagnosed with ADHD have lower levels of mindfulness and differ in personality structure from non-ADHD adults. How MD affects mindfulness and personality in adults with ADHD remains unexplored. Aim This study aimed to investigate the effects of 4 weeks of MD on mindfulness and personality traits in adults diagnosed with ADHD and those experiencing severe ADHD symptoms. It was expected that mindfulness and the personality traits conscientiousness, extraversion, agreeableness, and openness would increase and neuroticism would decrease after 4 weeks of MD compared to baseline. It was explored if using conventional ADHD medication alongside MD and/or having comorbidities influenced MD-induced effects. Methods An online prospective naturalistic design was used to measure participants before MD initiation and 2 and 4 weeks later. Validated self-report measures were used assessing mindfulness (15-item Five Facet Mindfulness Questionnaire) and personality traits (10-item version of the Big Five Inventory) at three time points. Results The sample included n = 233, n = 66, and n = 44 participants at the three time points, respectively. Trait mindfulness, specifically description and non-judging of inner experience, was increased, and neuroticism was decreased after 4 weeks of MD compared to baseline. The remaining personality traits remained unchanged. Using conventional medication and/or having comorbid diagnoses did not change the MD-induced effects on mindfulness and personality traits after 4 weeks. Conclusion MD induced changes in otherwise stable traits. Future placebo-controlled studies are warranted to confirm whether these changes occur in a controlled setting.
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Affiliation(s)
- Eline C. H. M. Haijen
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
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Zhang X, Wang S, Liu Q, Wu C, Du Y, Wang Y, Fang J. Alerting network, cognitive flexibility in children with attention deficit hyperactivity disorder and the moderating effect of neuroticism. Medicine (Baltimore) 2023; 102:e35583. [PMID: 37832046 PMCID: PMC10578712 DOI: 10.1097/md.0000000000035583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder, and cognitive flexibility is a sub-component of executive functioning. Studies have shown impairments in cognitive flexibility in ADHD, which is affected by attentional processes. Personality, as a long-standing trait, has a profound effect on ADHD. However, previous studies have not assessed the relationship between attentional function, personality traits, and cognitive flexibility in children with ADHD. This study explored the association between attention networks, personality, and cognitive flexibility in ADHD, filling a gap in the related field. We expect our findings will provide insights into and clues for the prevention and interventional treatment of ADHD. This study primarily aimed to analyze differences in cognitive flexibility between individuals with ADHD and those without and further examine associations between attention networks, personality, and cognitive flexibility in children with ADHD. Overall, 55 children aged 7 to 11 years diagnosed with ADHD and 40 children without ADHD participated in this study. Cognitive flexibility, personality traits, and attentional networks were assessed using the Wisconsin Card Sorting Test, Eysenck Personality Questionnaire, and Attention Network Test, respectively. Additionally, the association between personality traits and strong attentional functioning and cognitive flexibility was investigated using multiple regression analysis. Children with ADHD had significant deficits in cognitive flexibility. A multiple regression analysis revealed that the alerting effect was highly associated with cognitive flexibility at high levels of neuroticism. This association was not salient in individuals with low levels of neuroticism. This study demonstrated that the ADHD group experienced lower cognitive flexibility than the control group. In addition, we showed the effect of neuroticism and alerting networks on cognitive flexibility. These findings may help psychiatrists provide intervention strategies to mitigate the impairment of social functioning in ADHD with cognitive spirituality deficits.
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Affiliation(s)
- Xiang Zhang
- Department of Psychiatry, Ningxia Medical University, Ningxia, China
| | - Shaoxia Wang
- Department of Psychiatry, Ningxia Medical University, Ningxia, China
| | - Qianyun Liu
- Department of Psychiatry, Ningxia Medical University, Ningxia, China
| | - Chujun Wu
- Mental Health Centre, General Hospital of Ningxia Medical University, Ningxia, China
| | - Yunyun Du
- Mental Health Centre, General Hospital of Ningxia Medical University, Ningxia, China
| | - Yanrong Wang
- Mental Health Centre, General Hospital of Ningxia Medical University, Ningxia, China
| | - Jianqun Fang
- Mental Health Centre, General Hospital of Ningxia Medical University, Ningxia, China
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Shokrkon A, Nicoladis E. Mental health in Canadian children and adolescents during COVID-19 pandemic: the role of personality and, coping and stress responses. Front Psychol 2023; 14:1190375. [PMID: 37404585 PMCID: PMC10315680 DOI: 10.3389/fpsyg.2023.1190375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/30/2023] [Indexed: 07/06/2023] Open
Abstract
In December 2019, the Coronavirus Disease (COVID-19) pandemic first emerged in China and quickly spread to other countries. Previous studies have shown that the COVID-19 pandemic and the consequences have negatively impacted the mental health of adults. Individual differences such as personality could contribute to mental health. Furthermore, coping and responses to stress may affect an individual's response to the pandemic. In the past, studies have only investigated this relationship in adults. In the current study, we examine how personality traits (using the Five-Factor Model as our framework) and Coping and Response to COVID-19 stress are related to the mental health of Canadian children and adolescents during the pandemic. Using parent reports of 100 preschoolers and 607 6-18-year-old children, we performed multiple regression analysis to explore how personality traits predict the effects of COVID-19 on mental health. The results showed that personality traits are associated with the mental health of Canadian youth during the COVID-19 pandemic. In preschoolers, Neuroticism and Agreeableness predicted the most mental health problems, and in 6-18-year-old children, Extraversion negatively predicted the most mental health problems. Also, Openness to Experience was the weakest predictor of mental health status in Canadian youth. These findings could be useful in understanding children's responses to the COVID-19 pandemic and could assist public health services delivering mental health services specifically tailored to children's personalities during and after this pandemic.
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Affiliation(s)
- Anahita Shokrkon
- Department of Psychology, University of Alberta, Edmonton, AB, Canada
| | - Elena Nicoladis
- Department of Psychology, University of British Columbia, Kelowna, BC, Canada
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Girard-Joyal O, Gauthier B. Creativity in the Predominantly Inattentive and Combined Presentations of ADHD in Adults. J Atten Disord 2022; 26:1187-1198. [PMID: 34894845 PMCID: PMC9096579 DOI: 10.1177/10870547211060547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: ADHD and its associated inhibition deficits might promote creativity. However, results in the literature are conflicting, possibly due to the heterogeneity of ADHD. To control for this heterogeneity, creativity, and inhibition were investigated in the predominantly inattentive (ADHD-I) and combined (ADHD-C) presentations. Method: Participants were males/females aged 18 to 51, diagnosed with ADHD-I (n = 21), ADHD-C (n = 19), or without ADHD (n = 43). Self-rated Kaufman Domains of Creativity Scale and evaluator-rated figural Torrance Test of Creative Thinking (TTCT) were used for measuring creativity, Stroop task for inhibition, and Conners' Adult ADHD Rating Scales for ADHD symptoms. Results: The ADHD-C group reported higher self-rated creativity than other groups and made more original drawings paired to more abstract titles in the figural TTCT than controls. Conclusion: ADHD-C participants were the most creative. This result was more importantly associated with higher degrees of ADHD symptoms rather than poorer inhibition.
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Affiliation(s)
- Olivier Girard-Joyal
- University of Montreal, Laval, QC, Canada,Olivier Girard-Joyal, Department of Psychology, University of Montreal, 1700 Jacques-Tétreault, Laval, Quebec, H7N 0B6, Canada.
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Krieger V, Amador-Campos JA. Clinical presentations of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents: comparison of neurocognitive performance. Child Neuropsychol 2021; 27:1024-1053. [PMID: 33928840 DOI: 10.1080/09297049.2021.1917530] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study aimed to compare performance in working memory (WM), processing speed (PRS), and attention measures in children and adolescents with typical development (TD) and with Attention deficit hyperactivity disorder (inattentive [ADHD-I] or combined [ADHD-C]) presentations, and to determine the predictive ability of the measures mentioned to discriminate between ADHD presentations and TD. 260 children and adolescents, 138 with ADHD (70 ADHD-I and 68 ADHD-C) and 122 TD in two age cohorts (8-12 years; 13-16 years), were assessed with WM and PRS indexes of Wechsler Intelligence Scale for Children (WISC-IV) and the d2 attention test. Significant differences between ADHD and TD groups in the WISC-IV GAI scores were found in children but not in adolescents. Children and adolescents with both ADHD presentations performed poorly on the PRS index, while on the WM index only children exhibited difficulties. In the attention test, children with ADHD-C showed more impulsivity and more difficulties for processing speed, concentration and accuracy than ADHD-I and TD. In addition, both ADHD presentations had higher inattention scores than TD. ADHD adolescents performed worse than TD in processing speed, concentration and accuracy. ADHD groups showed more impulsivity and inattention than TD. Digit Span and Symbol Search (WISC-IV) and processing speed and accuracy (d2) successfully classified ADHD and TD in children, but in adolescents, only coding (WISC-IV) and accuracy (d2) successfully classified ADHD presentations and TD. The WISC-IV and d2 yield neuropsychological profiles which reflect age-related cognitive changes and may allow the adaptation of more tailored early interventions for ADHD.
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Affiliation(s)
- Virginia Krieger
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain
| | - Juan Antonio Amador-Campos
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain.,Institute of Neuroscience, University of Barcelona (UBneuro), Barcelona, Spain
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