Electroencephalography correlates of spatial working memory deficits in attention-deficit/hyperactivity disorder: vigilance, encoding, and maintenance

Distinct age-related alterations in alpha-beta neural oscillatory activity during verbal working memory encoding in children and adolescents

Emerging imaging studies of working memory (WM) have identified significant WM-related oscillatory events that are unique to each phase of working memory (e.g. encoding, maintenance). Although many previous imaging studies have shown age-related changes within the frontoparietal network when performing a WM task, understanding of the age-related changes in the oscillatory dynamics underlying each phase of WM during development and their relationships to other cognitive function is still in its infancy. To this end, we enrolled a group of 74 typically-developing youths aged 7-15 years to perform a letter-based Sternberg WM task during magnetoencephalography. Trial-wise data were transformed into the time-frequency domain, and significant oscillatory responses during the encoding and maintenance phases of the task were independently imaged using beamforming. Our results revealed widespread age-related power differences in alpha-beta oscillatory activity during encoding throughout left frontal, parietal, temporal, occipital and cerebellar regions. By contrast, age-related differences in maintenance-related activity were limited to a small area in the superior temporal gyrus and parieto-occipital regions. Follow-up exploratory factor analysis of age-related encoding alpha-beta activity revealed two distinct factors, and these factors were each found to significantly mediate age-related improvements in both verbal and non-verbal cognitive ability. Additionally, late maintenance alpha activity was related to reaction time on the task. Taken together, our results indicate that the neural dynamics in the alpha and beta bands are uniquely sensitive to age-related changes throughout this developmental period and are related to both task performance and other aspects of cognitive development. KEY POINTS: Understanding of the age-related changes in neural oscillatory dynamics serving verbal working memory function is in its infancy. This study identified the age-related neural alterations during each phase of working memory processing in youths. Developmental differences during working memory processing were primarily isolated to alpha-beta activity during the encoding phase. Alpha-beta activity during encoding significantly mediated age-related improvements in both verbal and non-verbal ability. This study establishes new brain-behaviour relationships linking working memory function to other aspects of cognitive development.

A Novel Real-time Phase Prediction Network in EEG Rhythm

Closed-loop neuromodulation, especially using the phase of the electroencephalography (EEG) rhythm to assess the real-time brain state and optimize the brain stimulation process, is becoming a hot research topic. Because the EEG signal is non-stationary, the commonly used EEG phase-based prediction methods have large variances, which may reduce the accuracy of the phase prediction. In this study, we proposed a machine learning-based EEG phase prediction network, which we call EEG phase prediction network (EPN), to capture the overall rhythm distribution pattern of subjects and map the instantaneous phase directly from the narrow-band EEG data. We verified the performance of EPN on pre-recorded data, simulated EEG data, and a real-time experiment. Compared with widely used state-of-the-art models (optimized multi-layer filter architecture, auto-regress, and educated temporal prediction), EPN achieved the lowest variance and the greatest accuracy. Thus, the EPN model will provide broader applications for EEG phase-based closed-loop neuromodulation.

Prefrontal Transcranial Direct Current Stimulation in Pediatric Attention-Deficit/Hyperactivity Disorder: A Randomized Clinical Trial

Importance

Transcranial direct current stimulation (tDCS) has the potential to be a sustainable treatment option in pediatric attention-deficit/hyperactivity disorder (ADHD), but rigorously controlled multicenter clinical trials using state-of-the-art stimulation techniques are lacking.

Objectives

To determine effect sizes of changes in cognitive and clinical measures and to assess safety and tolerability in the course of optimized multichannel tDCS over prefrontal target regions in pediatric ADHD.

Design, Setting, and Participants

In the sham-controlled, double-blind, parallel-group randomized clinical trial E-StimADHD (Improving Neuropsychological Functions and Clinical Course in Children and Adolescents With ADHD With Anodal Transcranial Direct Current Stimulation of the Prefrontal Cortex: A Randomized, Double-Blind, Sham-Controlled, Parallel Group Trial Using an Uncertified Class IIa Device) with 2 independent study arms, participants were enrolled from September 15, 2018, to August 10, 2021, and follow-up was completed October 4, 2021. Data were analyzed January 26, 2022, to November 8, 2023. The trial was conducted at the departments of child and adolescent psychiatry or pediatrics of 5 university hospitals in Portugal and Germany. Youths 10 to 18 years of age with ADHD according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (all presentations), an IQ of at least 80, and the ability to refrain from stimulant medication during participation in the trial were eligible.

Interventions

Optimized multichannel anodal tDCS or sham stimulation (1 mA, 20 minutes) targeting the left dorsolateral prefrontal cortex (lDLPFC; study A) or the right inferior frontal gyrus (rIFG; study B) was applied in 10 sessions, concurrent with performance on a cognitive target task (study A, working memory assessed in the n-back task; study B, interference control assessed in the flanker task).

Main Outcomes and Measures

Effect sizes for changes in accuracy measures (d-prime or flanker effect) in the target tasks assessed after the intervention. Primary analyses were based on the modified intention-to-treat set.

Results

This study included 69 youths (54 [78%] male) with a median age of 13.3 years (IQR, 11.9-14.9 years). Compared with sham tDCS, verum stimulation of the lDLPFC led to significantly lower working memory accuracy (effect size, -0.43 [95% CI, -0.68 to -0.17]; P = .001). Stimulation of the rIFG significantly improved interference control (effect size, 0.30 [95% CI, 0.04-0.56]; P = .02). Adverse events were mostly mild and transient and did not occur more often in the verum group. For example, the most frequent adverse events were headache (sham, n = 30; verum, n = 20), nasopharyngitis (sham, n = 11; verum, n = 5), and feeling of electric discharge (sham, n = 5; verum, n = 3).

Conclusions and Relevance

In this randomized clinical trial, prefrontal anodal tDCS induced small- to medium-sized effects in youths with ADHD, with only mild and transient adverse events. The optimized multichannel montage chosen to target the lDLPFC, however, decreased working memory performance. This unexpected finding stresses the importance of incorporating insights from basic research on the mechanisms and preconditions of successful tDCS in future study designs to advance application of tDCS in pediatric ADHD.

Trial Registration

German Clinical Trials Register ID: DRKS00012659.

Dysfunctional oscillatory bursting patterns underlie working memory deficits in adolescents with ADHD

Identifying neural markers of clinical symptom fluctuations is prerequisite to developing more precise brain-targeted treatments in psychiatry. We have recently shown that working memory (WM) in healthy adults is dependent on the rise and fall interplay between alpha/beta and gamma bursts within frontoparietal regions, and that deviations in these patterns lead to WM performance errors. However, it is not known whether such bursting deviations underlie clinically relevant WM-related symptoms or clinical status in individuals with WM deficits. In adolescents (n=27) with attention deficit hyperactivity disorder (ADHD), we investigated WM-related dynamics between alpha/beta and gamma bursts in relation to clinical status fluctuations. Participants repeatedly completed a visual Sternberg spatial working memory task during EEG recording as part of their participation in two research studies (n=224 person-sessions). Source localizing EEG data to each participant's structural MRI, the rate and volume of alpha, beta, and gamma bursts were examined within the dorsolateral prefrontal cortex (DLPFC) and posterior parietal cortex (PPC). Alpha/beta and gamma bursts at the DLPFC and PPC displayed complimentary roles in WM processes. Alpha/beta bursting decreased during stimuli encoding and increased during the delay, while gamma bursting was elevated during encoding and decreased during the delay. Deviations in bursting patterns were associated with WM errors and clinical symptoms. We conclude that dysfunctional alpha/beta and gamma burst dynamics within the frontoparietal region underlie both intra-individual WM performance and WM symptom fluctuations in adolescents with ADHD. Such burst dynamics reflect a novel target and biomarker for WM-related treatment development.

Oscillatory activity in bilateral prefrontal cortices is altered by distractor strength during working memory processing

Working memory (WM) enables the temporary storage of limited information and is a central component of higher order cognitive function. Irrelevant and/or distracting information can have a negative impact on WM processing and suppressing such incoming stimuli is critical to maintaining adequate performance. However, the neural mechanisms and dynamics underlying such distractor inhibition remain poorly understood. In the current study, we enrolled 46 healthy adults (Mage: 27.92, Nfemale: 28) who completed a Sternberg type WM task with high- and low-distractor conditions during magnetoencephalography (MEG). MEG data were transformed into the time-frequency domain and significant task-related oscillatory responses were imaged to identify the underlying anatomical areas. Whole-brain paired t-tests, with cluster-based permutation testing for multiple comparisons correction, were performed to assess differences between the low- and high-distractor conditions for each oscillatory response. Across conditions, we found strong alpha and beta oscillations (i.e., decreases relative to baseline) and increases in theta power throughout the encoding and maintenance periods. Whole-brain contrasts revealed significantly stronger alpha and beta oscillations in bilateral prefrontal regions during maintenance in high- compared to low-distractor trials, with the stronger beta oscillations being centered on the left dorsolateral prefrontal cortex and right inferior frontal gyrus, while those for alpha being within the right anterior prefrontal cortices and the right middle frontal gyrus. These findings suggest that alpha and beta oscillations in the bilateral prefrontal cortices play a major role in the inhibition of distracting information during WM maintenance. Our results also contribute to prior research on cognitive control and functional inhibition, in which prefrontal regions have been widely implicated.

Delayed modulation of alpha band activity increases response inhibition deficits in adolescents with AD(H)D

Deficiencies in inhibitory control are one of the hallmarks of attention-deficit-(hyperactivity) disorder (AD(H)D). Response inhibition demands can become increased through additional conflicts, namely when already integrated representations of perception-action associations have to be updated. Yet, the neural mechanisms of how such conflicts worsen response inhibition in AD(H)D are unknown, but, if identified, could help to better understand the complex nature of AD(H)D-associated impulsivity. We investigated both behavioral performance and EEG activity in the theta and alpha band of adolescents (10-18 years of age) with AD(H)D (n = 28) compared to neurotypical (NT) controls (n = 33) in a conflict-modulated Go/Nogo paradigm. We used multivariate pattern analysis (MVPA) and EEG-beamforming to examine how changes in representational content are coded by oscillatory activity and to delineate the cortical structures involved in it. The presented behavioral and neurophysiological data show that adolescents with AD(H)D are more strongly affected by increased response inhibition demands through additional conflicts than NT controls. Precisely, AD(H)D participants showed higher false alarm rates than NT controls in both, non-overlapping and overlapping Nogo trials, but performed even worse in the latter. This is likely due to an inefficient updating of representations related to delayed modulations of alpha band activity in the ventral stream and orbitofrontal regions. Theta band activity is also modulated by conflict but was not differentially affected in the two groups. By this, the present study provides novel insights into underlying neurophysiological mechanisms of the complex nature of response inhibition deficits in adolescents with AD(H)D, stressing the importance to examine the interplay of theta and alpha band activity more closely to better understand inhibitory control deficits in AD(H)D.

Effects of acute stress on biological motion perception

Biological motion perception is an essential part of the cognitive process. Stress can affect the cognitive process. The present study explored the intrinsic ERP features of the effects of acute psychological stress on biological motion perception. The results contributed scientific evidence for the adaptive behavior changes under acute stress. After a mental arithmetic task was used to induce stress, the paradigm of point-light displays was used to evaluate biological motion perception. Longer reaction time and lower accuracy were found in the inverted walking condition than in the upright walking condition, which was called the "inversion effect". The P2 peak amplitude and the LPP mean amplitude were significantly higher in the local inverted perception than in the local upright walking condition. Compared to the control condition, the stress condition induced lower RT, shorter P1 peak latency of biological motion perception, lower P2 peak amplitude and LPP mean amplitude, and higher N330 peak amplitude. There was an "inversion effect" in biological motion perception. This effect was related to the structural characteristics of biological motion perception but unrelated to the state of acute psychological stress. Acute psychological stress accelerated the reaction time and enhanced attention control of biological motion perception. Attention resources were used earlier, and less attentional investment was made in the early stage of biological motion perception processing. In the late stage, a continuous weakening of inhibition was shown in the parieto-occipital area.

Development of EEG alpha and theta oscillations in the maintenance stage of working memory

Several studies have shown developmental changes in EEG oscillations during working memory tasks. Although the load-modulated theta and alpha activities in adults are well-documented, the findings are inconsistent if children possess the adult-like brain oscillations that are similarly modulated by memory load. The present study compares children's and adults' true theta and alpha EEG oscillations, separated from aperiodic components, in the maintenance stage of working memory. The EEG was recorded in 25 Chinese-speaking children (14 male, Mage = 9.4 yrs) and 31 adults (19 male, Mage = 20.8 yrs) in Hong Kong while they performed an n-back task that included four conditions differing in load (1- vs. 2-back) and stimulus type (Chinese character vs. visual pattern). The results show that aperiodic activities (i.e., broadband power and slope) during the maintenance stage in the n-back task were significantly higher in children than adults. The periodic theta and alpha oscillations also changed with age. More importantly, adults showed significant periodic theta increase with memory load, whereas such an effect was absent in children. Regardless of age, there was a significant alpha power decrease with load increase, and a significant theta power enhancement when maintaining visual patterns than Chinese characters. In adults, load-modulated alpha peak shift (towards higher frequency) was linked to higher behavioral efficiency in the n-back task. In children, higher load-modulated theta enhancement was linked to better behavioral efficiency. The findings suggest that the load-modulated theta power during working memory maintenance matures from childhood to adulthood.

A Network Approach to Understanding the Role of Executive Functioning and Alpha Oscillations in Inattention and Hyperactivity-Impulsivity Symptoms of ADHD

OBJECTIVE

ADHD is a prevalent neurodevelopmental disorder characterized by symptoms of inattention and hyperactivity-impulsivity. Impairments in executive functioning (EF) are central to models of ADHD, while alpha-band spectral power event-related decreases (ERD) have emerged as a putative electroencephalography (EEG) biomarker of EF in ADHD. Little is known about the roles of EF and alpha ERD and their interactions with symptoms of ADHD.

METHOD

We estimated network models of ADHD symptoms and integrated alpha ERD measures into the symptom network.

RESULTS

EF emerges as a bridge network node connecting alpha ERD and the hyperactivity/impulsivity and inattention symptoms. We found that EF most closely relates to a subset of symptoms, namely the motoric symptoms, "seat" (difficulty staying seated), and "runs" (running or climbing excessively).

CONCLUSIONS

EF functions as a bridge node connecting alpha ERD and the ADHD symptom network. Motoric-type symptoms and EF deficits may constitute important nodes in the interplay between behavior/symptoms, cognition, and neurophysiological markers of ADHD.

Age-related changes in brain oscillatory patterns during an n-back task in children and adolescents

The development of brain oscillatory responses and their possible role in the working memory (WM) performance of children, adolescents and young adults was investigated. A set of 0- and 1-back tasks with letter stimuli were administered to a final sample of 131 subjects (between 6 and 20 years of age). A decrease in response times (RTs) and an increase of the sensitivity index d-prime (d') were seen with increased age. RTs increased and d' decreased with load, indicating higher difficulty for higher loads. Event-related synchronization (ERS) and event-related desynchronization (ERD) were obtained by the convolution of Morlet wavelets on the recorded EEG. Statistical analyses were performed of the absolute and relative power of brain oscillations defined by topography, frequency and latency. Posterior alpha and beta ERD, and frontocentral theta ERS, were induced by the stimuli presented during the n-back task. While relative theta ERS increased with age, absolute theta ERS, absolute and relative alpha and, absolute beta ERD, decreased with age. Age-related improvement in behavioral performance was mediated by relative theta. Alpha and beta ERD were more pronounced for the most difficult task (1-back) and for the target condition. Globally, there was high consistency of the effects of target type and task load across development. Theta ERS maturation is a crucial step for improving WM performance during development, while alpha and beta ERD maturation seem to be less critical for behavioral performance improvement with age, possibly due to a sufficient level of alpha-beta ERD for good performance in young children.

Alpha event-related decreases during encoding in adults with ADHD - An investigation of sustained attention and working memory processes

BACKGROUND

Executive functioning deficits are central to established neuropsychological models of ADHD. Oscillatory activity, particularly the alpha rhythm (8-12 Hz) has been associated with cognitive impairments in ADHD. However, most studies to date examined such neural mechanisms underlying executive dysfunction in children and adolescents with ADHD, raising the question of whether and to what extent those ADHD-related working memory impairments are still present in adults. To this end, the current study aimed to investigate the role of alpha event-related decreases (ERD) during working memory processes in adults with and without ADHD.

METHODS

We collected electroencephalographic (EEG) data from 85 adults with a lifetime diagnosis of ADHD and 105 controls (aged 32-64), while they performed a continuous performance (CPT) and a spatial delayed response working memory task (SDRT). Time-frequency and independent component analysis (ICA) was used to identify alpha (8-12 Hz) clusters to examine group and condition effects during the temporal profile of sustained attention and working memory processes (encoding, maintenance, retrieval), loads (low and high) and trial type (go and nogo).

RESULTS

Individuals with ADHD exhibited higher reaction time-variability in SDRT, and slower response times in SDRT and CPT, despite no differences in task accuracy. Although working memory load was associated with stronger alpha ERD in both tasks and both groups (ADHD, controls), we found no consistent evidence for attenuated alpha ERD in adults with ADHD, failing to replicate effects reported in children. In contrast, when looking at the whole sample, the correlations of alpha power during encoding with inattention and hyperactivity-impulsivity symptoms were significant, replicating prior findings in children with ADHD, but suggesting an alternate source for these effects in adults.

CONCLUSIONS

Our results corroborate the robustness of alpha as a marker of visual attention and suggest that occipital alpha ERD normalizes in adulthood, but with unique contributions of centro-occipital alpha ERD, suggesting a secondary source. This implies that deviations in processes other than previously reported visuospatial cortex engagement may account for the persistent symptoms and cognitive deficits in adults with a history of ADHD.

The effect of a cognitive training therapy based on stimulation of brain oscillations in patients with mild cognitive impairment in a Chilean sample: study protocol for a phase IIb, 2 × 3 mixed factorial, double-blind randomised controlled trial

BACKGROUND

The ageing population has increased the prevalence of disabling and high-cost diseases, such as dementia and mild cognitive impairment (MCI). The latter can be considered a prodromal phase of some dementias and a critical stage for interventions to postpone the impairment of functionality. Working memory (WM) is a pivotal cognitive function, representing the fundamental element of executive functions. This project proposes an intervention protocol to enhance WM in these users, combining cognitive training with transcranial electrical stimulation of alternating current (tACS). This technique has been suggested to enhance the neuronal plasticity needed for cognitive processes involving oscillatory patterns. WM stands to benefit significantly from this approach, given its well-defined electrophysiological oscillations. Therefore, tACS could potentially boost WM in patients with neurodegenerative diseases.

METHODS

This study is a phase IIb randomised, double-blind clinical trial with a 3-month follow-up period. The study participants will be 62 participants diagnosed with MCI, aged over 60, from Valparaíso, Chile. Participants will receive an intervention combining twelve cognitive training sessions with tACS. Participants will receive either tACS or placebo stimulation in eight out of twelve training sessions. Sessions will occur twice weekly over 6 weeks. The primary outcomes will be electroencephalographic measurements through the prefrontal theta oscillatory activity, while the secondary effects will be cognitive assessments of WM. The participants will be evaluated before, immediately after, and 3 months after the end of the intervention.

DISCUSSION

The outcomes of this trial will add empirical evidence about the benefits and feasibility of an intervention that combines cognitive training with non-invasive brain stimulation. The objective is to contribute tools for optimal cognitive treatment in patients with MCI. To enhance WM capacity, postpone the impairment of functionality, and obtain a better quality of life.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05291208. Registered on 28 February 2022. ISRCTN87597719 retrospectively registered on 15 September 2023.

Neurophysiological measures and correlates of cognitive load in attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and dyslexia: A scoping review and research recommendations

Working memory is integral to a range of critical cognitive functions such as reasoning and decision-making. Although alterations in working memory have been observed in neurodivergent populations, there has been no review mapping how cognitive load is measured in common neurodevelopmental conditions such as attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and dyslexia. This scoping review explores the neurophysiological measures used to study cognitive load in these specific populations. Our findings highlight that electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) are the most frequently used methods, with a limited number of studies employing functional near-infrared spectroscopy (fNIRs), magnetoencephalography (MEG) or eye-tracking. Notably, eye-related measures are less commonly used, despite their prominence in cognitive load research among neurotypical individuals. The review also highlights potential correlates of cognitive load, such as neural oscillations in the theta and alpha ranges for EEG studies, blood oxygenation level-dependent (BOLD) responses in lateral and medial frontal brain regions for fMRI and fNIRS studies and eye-related measures such as pupil dilation and blink rate. Finally, critical issues for future studies are discussed, including the technical challenges associated with multimodal approaches, the possible impact of atypical features on cognitive load measures and balancing data richness with participant well-being. These insights contribute to a more nuanced understanding of cognitive load measurement in neurodivergent populations and point to important methodological considerations for future neuroscientific research in this area.

Translating Decades of Neuroscience Research into Diagnostic and Treatment Biomarkers for ADHD

In this chapter, we review scientific findings that form the basis for neuroimaging and neurophysiological biomarkers for ADHD diagnosis and treatment. We then highlight the different challenges in translating mechanistic findings into biomarkers for ADHD diagnosis and treatment. Population heterogeneity is a primary barrier for identifying biomarkers of ADHD diagnosis, which requires shifts toward dimensional approaches that identify clinically useful subgroups or prospective biomarkers that can identify trajectories of illness, function, or treatment response. Methodological limitations, including emphasis on group level analyses of treatment effects in small sample sizes, are the primary barriers to biomarker discovery in ADHD treatment. Modifications to clinical trials, including shifting towards testing biomarkers of a priori prediction of functionally related brain targets, treatment response, and side effects, are suggested. Finally, future directions for biomarker work are discussed.

Aberrant oscillatory activity in neurofibromatosis type 1: an EEG study of resting state and working memory

BACKGROUND

Neurofibromatosis type 1 (NF1) is a genetic neurodevelopmental disorder commonly associated with impaired cognitive function. Despite the well-explored functional roles of neural oscillations in neurotypical populations, only a limited number of studies have investigated oscillatory activity in the NF1 population.

METHODS

We compared oscillatory spectral power and theta phase coherence in a paediatric sample with NF1 (N = 16; mean age: 13.03 years; female: n = 7) to an age/sex-matched typically developing control group (N = 16; mean age: 13.34 years; female: n = 7) using electroencephalography measured during rest and during working memory task performance.

RESULTS

Relative to typically developing children, the NF1 group displayed higher resting state slow wave power and a lower peak alpha frequency. Moreover, higher theta power and frontoparietal theta phase coherence were observed in the NF1 group during working memory task performance, but these differences disappeared when controlling for baseline (resting state) activity.

CONCLUSIONS

Overall, results suggest that NF1 is characterised by aberrant resting state oscillatory activity that may contribute towards the cognitive impairments experienced in this population.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03310996 (first posted: October 16, 2017).

Active inhibition of the retro-cue effect in visual working memory: Evidence from event-related potential

This study used the event-related potential (ERP) technique to investigate whether active inhibition exists in retro-cue Effect (RCE) in visual working memory using modified retro-cue tasks. In this modified task, the participants were first asked to memorize six color blocks and then presented with directed remembering or directed forgetting cues; finally, their working memory performance was tested. For behavioral results, due to the extension of the memory interval, this study did not find RCE in accuracy but reflected it in the total reaction time. For ERP results, the frontal late positive potential (LPP) followed by the directed forgetting condition was larger than that followed by directed remembering and baseline conditions, and there was no significant difference between directed remembering and baseline conditions. There was no significant difference in parietal P3 followed by both the directed remembering and directed forgetting conditions, which were significantly larger than the baseline condition. This result reveals that active inhibition plays an important role in directed forgetting RCE. There was a correlation between parietal P3 and frontal LPP with the same time window but different scalp regions in the directed forgetting condition, indicating a potential relationship between active inhibition and retelling in directed forgetting RCE.

Abnormal Reactivity of Brain Oscillations to Visual Search Target in Children With Attention-Deficit/Hyperactivity Disorder

BACKGROUND

Previous studies have shown that impaired goal-directed alpha lateralization and functional disconnection within attention networks during the cue period are significant features of attention-deficit/hyperactivity disorder (ADHD). This study aimed to explore the role of brain oscillations in the visual search process, focusing on target-induced posterior alpha lateralization, midfrontal theta synchronization, and their functional connection in children with ADHD.

METHODS

Electroencephalograms were recorded from typically developing (TD) children (n = 72) and children with ADHD (n = 96) while they performed a visual search task.

RESULTS

Both the TD and ADHD groups showed significant midfrontal theta event-related synchronization (ERS) and posterior alpha lateralization. Compared with TD children, children with ADHD showed significantly lower theta ERS and higher target-induced alpha lateralization. TD children showed a positive trial-based correlation between theta ERS and alpha lateralization and a negative correlation between theta ERS and reaction time variability. However, all these correlations were absent in children with ADHD.

CONCLUSIONS

Abnormal brain oscillations in children with ADHD indicate insufficient executive control function and the compensation of attention networks for attention deficits in visual selective attention. Cross-frequency disconnection reflects the common deficiency of executive control in the gating of target information. Our findings provide novel evidence for interpreting the features of brain oscillations during stimulus-driven selective attention in children with ADHD.

Parietal alpha underlies slower cognitive responses during interference processing in adolescents

Adolescence is a critical period when cognitive control is rapidly maturing across several core dimensions. Here, we evaluated how healthy adolescents (13-17 years of age, n = 44) versus young adults (18-25 years of age, n = 49) differ across a series of cognitive assessments with simultaneous electroencephalography (EEG) recordings. Cognitive tasks included selective attention, inhibitory control, working memory, as well as both non-emotional and emotional interference processing. We found that adolescents displayed significantly slower responses than young adults specifically on the interference processing tasks. Evaluation of EEG event-related spectral perturbations (ERSPs) on the interference tasks showed that adolescents consistently had greater event-related desynchronization in alpha/beta frequencies in parietal regions. Midline frontal theta activity was also greater in the flanker interference task in adolescents, suggesting greater cognitive effort. Parietal alpha activity predicted age-related speed differences during non-emotional flanker interference processing, and frontoparietal connectivity, specifically midfrontal theta - parietal alpha functional connectivity predicted speed effects during emotional interference. Overall, our neuro-cognitive results illustrate developing cognitive control in adolescents particularly for interference processing, predicted by differential alpha band activity and connectivity in parietal brain regions.

Electrophysiological and Clinical Predictors of Methylphenidate, Guanfacine, and Combined Treatment Outcomes in Children With Attention-Deficit/Hyperactivity Disorder

OBJECTIVE

The combination of d-methylphenidate and guanfacine (an α-2A agonist) has emerged as a potential alternative to either monotherapy in children with attention-deficit/hyperactivity disorder (ADHD), but it is unclear what predicts response to these treatments. This study is the first to investigate pretreatment clinical and electroencephalography (EEG) profiles as predictors of treatment outcome in children randomized to these different medications.

METHOD

A total of 181 children with ADHD (aged 7-14 years; 123 boys) completed an 8-week randomized, double-blind, comparative study with d-methylphenidate, guanfacine, or combined treatments. Pretreatment assessments included ratings on ADHD, anxiety, and oppositional behavior. EEG activity from cortical sources localized within midfrontal and midoccipital regions was measured during a spatial working memory task with encoding, maintenance, and retrieval phases. Analyses tested whether pretreatment clinical and EEG measures predicted treatment-related change in ADHD severity.

RESULTS

Higher pretreatment hyperactivity-impulsivity and oppositional symptoms and lower anxiety predicted greater ADHD improvements across all medication groups. Pretreatment event-related midfrontal beta power predicted treatment outcome with combined and monotherapy treatments, albeit in different directions. Weaker beta modulations predicted improvements with combined treatment, whereas stronger modulation during encoding and retrieval predicted improvements with d-methylphenidate and guanfacine, respectively. A multivariate model including EEG and clinical measures explained twice as much variance in ADHD improvement with guanfacine and combined treatment (R2= 0.34-0.41) as clinical measures alone (R2 = 0.14-.21).

CONCLUSION

We identified treatment-specific and shared predictors of response to different pharmacotherapies in children with ADHD. If replicated, these findings would suggest that aggregating information from clinical and brain measures may aid personalized treatment decisions in ADHD.

CLINICAL TRIAL REGISTRATION INFORMATION

Single Versus Combination Medication Treatment for Children With Attention Deficit Hyperactivity Disorder; https://clinicaltrials.gov; NCT00429273.

Child and adolescent development of the brain oscillatory activity during a working memory task

The developmental trajectories of brain oscillations during the encoding and maintenance phases of a Working Memory (WM) task were calculated. The Delayed-Match-to-Sample Test (DMTS) was applied to 239 subjects of 6-29 years, while EEG was recorded. The Event-Related Spectral Perturbation (ERSP) was obtained in the range between 1 and 25 Hz during the encoding and maintenance phases. Behavioral parameters of reaction times (RTs) and response accuracy were simultaneously recorded. The results indicate a myriad of transient and sustained bursts of oscillatory activity from low frequencies (1 Hz) to the beta range (up to 19 Hz). Beta and Low-frequency ERSP increases were prominent in the encoding phase in all age groups, while low-frequency ERSP indexed the maintenance phase only in children and adolescents, but not in late adolescents and young adults, suggesting an age-dependent neural mechanism of stimulus trace maintenance. While the latter group showed Beta and Alpha indices of anticipatory attention for the retrieval phase. Mediation analysis showed an important role of early Delta-Theta and late Alpha oscillations for mediation between age and behavioral responses performance. In conclusion, the results show a complex pattern of oscillatory bursts during the encoding and maintenance phases with a consistent pattern of developmental changes.

Time-frequency neural dynamics of ADHD children and adolescents during a Working Memory task

The present report analyzed the time-frequency changes in Event-Related Spectral perturbations (ERSP) in a sample of ADHD children and adolescents compared to a normodevelopment (ND) sample. A delayed match-to-sample (DMTS) test of working memory (WM) was presented to a group of ADHD subjects (N = 29) and compared with ND group (N = 34) with ages between 6 and 17 years old. Time-frequency decomposition was computed through wavelets. ADHD subjects presented higher Reaction Time (RT), Standard Deviation of RT (Std of RT), and a reduced percentage of correct responses. The results showed a complex pattern of oscillatory bursts during the encoding, maintenance, and recognition phases with similar dynamics in both groups. ADHD children presented a reduced Event-Related Synchronization (ERS) in the Theta range during the encoding phase, and also a reduced Alpha ERS during the late period of the maintenance phase. S1 Early theta ERS was positively correlated with Std of RT. Behavioral data, early Theta, and late Alpha ERS classified correctly above 70 % of ADHD and ND subjects when a linear discriminant analysis was applied. The reduced encoding and maintenance impaired brain dynamics of ADHD subjects would justify the poorer performance of this group of subjects.

Methylphenidate, Guanfacine, and Combined Treatment Effects on Electroencephalography Correlates of Spatial Working Memory in Attention-Deficit/Hyperactivity Disorder

OBJECTIVE

The combination of d-methylphenidate and guanfacine (an α-2A adrenergic agonist) may be an effective alternative to either agent as monotherapy in children with attention-deficit/hyperactivity disorder (ADHD). This study investigated the neural mechanisms underlying medication effects using cortical source analysis of electroencephalography (EEG) data.

METHOD

A total of 172 children with ADHD (aged 7-14; 118 boys) completed an 8-week randomized, double-blind, comparative study with 3 treatment arms: d-methylphenidate, guanfacine, or their combination. EEG modulations of brain oscillations at baseline and end point were measured during a spatial working memory task from cortical sources localized within the anterior cingulate (midfrontal) and primary visual cortex (midoccipital), based on previously reported ADHD and control differences. Linear mixed models examined treatment effects on EEG and performance measures.

RESULTS

Combined treatment decreased midoccipital EEG power across most frequency bands and task phases. Several midoccipital EEG measures also showed significantly greater changes with combined treatment than with monotherapies. D-methylphenidate significantly increased midoccipital theta during retrieval, while guanfacine produced only trend-level reductions in midoccipital alpha during maintenance and retrieval. Task accuracy improved with combined treatment, was unchanged with d-methylphenidate, and worsened with guanfacine. Treatment-related changes in midoccipital power correlated with improvement in ADHD severity.

CONCLUSION

These findings show that combined treatment ameliorates midoccipital neural activity associated with treatment-related behavioral improvements and previously implicated in visuo-attentional deficits in ADHD. Both monotherapies had limited effects on EEG measures, with guanfacine further showing detrimental effects on performance. The identified midoccipital EEG profile may aid future treatment monitoring for children with ADHD.

CLINICAL TRIAL REGISTRATION INFORMATION

Single Versus Combination Medication Treatment for Children With Attention Deficit Hyperactivity Disorder (Project1); https://clinicaltrials.gov/; NCT00429273.

DIVERSITY & INCLUSION STATEMENT

We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure sex and gender balance in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. We actively worked to promote sex and gender balance in our author group.

Simultaneous Gut-Brain Electrophysiology Shows Cognition and Satiety Specific Coupling

Recent studies, using high resolution magnetoencephalography (MEG) and electrogastrography (EGG), have shown that during resting state, rhythmic gastric physiological signals are linked with cortical brain oscillations. Yet, gut-brain coupling has not been investigated with electroencephalography (EEG) during cognitive brain engagement or during hunger-related gut engagement. In this study in 14 young adults (7 females, mean ± SD age 25.71 ± 8.32 years), we study gut-brain coupling using simultaneous EEG and EGG during hunger and satiety states measured in separate visits, and compare responses both while resting as well as during a cognitively demanding working memory task. We find that EGG-EEG phase-amplitude coupling (PAC) differs based on both satiety state and cognitive effort, with greater PAC modulation observed in the resting state relative to working memory. We find a significant interaction between gut satiation levels and cognitive states in the left fronto-central brain region, with larger cognitive demand based differences in the hunger state. Furthermore, strength of PAC correlated with behavioral performance during the working memory task. Altogether, these results highlight the role of gut-brain interactions in cognition and demonstrate the feasibility of these recordings using scalable sensors.

Dissociable neural mechanisms of cognition and well-being in youth versus healthy aging

Mental health, cognition, and their underlying neural processes in healthy aging are rarely studied simultaneously. Here, in a sample of healthy younger (n = 62) and older (n = 54) adults, we compared subjective mental health as well as objective global cognition across several core cognitive domains with simultaneous electroencephalography (EEG). We found significantly greater symptoms of anxiety, depression, and loneliness in youth and in contrast, greater mental well-being in older adults. Yet, global performance across core cognitive domains was significantly worse in older adults. EEG-based source imaging of global cognitive task-evoked processing showed reduced suppression of activity in the anterior medial prefrontal default mode network (DMN) region in older adults relative to youth. Global cognitive performance efficiency was predicted by greater activity in the right dorsolateral prefrontal cortex in younger adults and in contrast, by greater activity in right inferior frontal cortex in older adults. Furthermore, greater mental well-being in older adults related to lesser global task-evoked activity in the posterior DMN. Overall, these results suggest dissociated neural mechanisms underlying global cognition and mental well-being in youth versus healthy aging. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Attentional Orienting in Working Memory in Children with ADHD

Children with attentional-deficit/hyperactivity disorder (ADHD) have impairments in working memory (WM) functioning. Impaired orienting of visual attention during encoding and/or maintenance is hypothesized as the cause of poor performance in visuospatial WM in 10-to-16-year-olds. We used a color-recognition task with valid location cues before encoding (pre-cues) and during maintenance (retro-cues). If ADHD children have an orienting deficit during these processing stages, they should not benefit from the cues. We observed strong pre- and retro-cueing benefits both for ADHD and typically developing controls, with no differences between the groups. This strengthens findings showing that ADHD is not characterized by deficits in orienting attention and provides evidence of retro-cue benefits in this population.

Self-awareness protects working memory in people under chronic stress: An ERP study

Chronic stress impairs working memory (WM), but few studies have explored the protective factors of the impairment. We aimed to investigate the effect of self-awareness on WM processing in people under chronic stress. Participants under chronic stress completed an n-back task after a self-awareness priming paradigm during which electroencephalograms were recorded. The behavioral results showed that participants whose self-awareness was primed reacted faster and more accurately than the controls. Event-related potentials (ERPs) revealed the following (1) P2 was more positive in the self-awareness group than in the controls, indicating that self-awareness enhanced allocation of attention resources at the encoding stage. (2) N2 was attenuated in the self-awareness group compared with the controls, indicating that smaller attention control efforts were required to complete WM tasks adequately after self-awareness priming; and (3) enhanced late positive potential (LPP) was evoked in the self-awareness group compared with the controls, suggesting self-awareness enabled participants to focus attention resources on the information at the maintenance stage. Critically, mediational analyses showed that LPP mediated the relationship between self-awareness and WM response times. This result suggests that the fact that participants whose self-awareness was primed were able to achieve better behavioral performances may be attributed to their mobilization of sustained attention resources at the maintenance stage. In summary, self-awareness exerted a protective effect on WM in those under chronic stress, which may be due to the enhancements in the allocation and mobilization of attention. These results could be used to develop more specific coping strategies for people under chronic stress.

A Dopamine D1 Agonist Versus Methylphenidate in Modulating Prefrontal Cortical Working Memory

Methylphenidate is used widely to treat symptoms of attention-deficit/hyperactivity disorder (ADHD), but like other stimulants has significant side effects. This study used a rodent model (spontaneously hypertensive rat) of spatial working memory (sWM) to compare the effects of methylphenidate with the novel dopamine D1-like receptor agonist 2-methyldihydrexidine. Acute oral administration of methylphenidate (1.5 mg/kg) caused sWM improvement in half of the tested rats, but impairment in the others. Both improvement or impairment were eliminated by administration of the D1 antagonist SCH39266 directly into the prefrontal cortex (PFC). Conversely, 2-methyldihydrexidine showed greater sWM improvement compared with methylphenidate without significant impairment in any subject. Its effects correlated negatively with vehicle-treated baseline performance (i.e., rats with lower baseline performance improved more than rats with higher baseline performance). These behavioral effects were associated with neural activities in the PFC. Single neuron firing rate was changed, leading to the alteration in neuronal preference to correct or error behavioral responses. Overall, 2-methyldihydrexidine was superior to methylphenidate in decreasing the neuronal preference, prospectively, in the animals whose behavior was improved. In contrast, methylphenidate, but not 2-methyldihydrexidine, significantly decreased neuronal preference, retrospectively, in those animals who had impaired performance. These results suggest that a D1 agonist may be more effective than methylphenidate in regulating sWM-related behavior through neural modulation of the PFC, and thus may be superior to methylphenidate or other stimulants as ADHD pharmacotherapy. SIGNIFICANCE STATEMENT: Methylphenidate is effective in ADHD by its indirect agonist stimulation of dopamine and/or adrenergic receptors, but the precise effects on specific targets are unclear. This study compared methylphenidate to a dopamine D1 receptor-selective agonist by investigating effects on working memory occurring via neural modulation in the prefrontal cortex. The data suggest that pharmacological treatment selectively targeting the dopamine D1 may offer a superior approach to ADHD pharmacotherapy.

A Systematic Review on Feature Extraction in Electroencephalography-Based Diagnostics and Therapy in Attention Deficit Hyperactivity Disorder

A systematic review on electroencephalographic (EEG)-based feature extraction strategies to diagnosis and therapy of attention deficit hyperactivity disorder (ADHD) in children is presented. The analysis is realized at an executive function level to improve the research of neurocorrelates of heterogeneous disorders such as ADHD. The Quality Assessment Tool for Quantitative Studies (QATQS) and field-weighted citation impact metric (Scopus) were used to assess the methodological rigor of the studies and their impact on the scientific community, respectively. One hundred and one articles, concerning the diagnostics and therapy of ADHD children aged from 8 to 14, were collected. Event-related potential components were mainly exploited for executive functions related to the cluster inhibition, whereas band power spectral density is the most considered EEG feature for executive functions related to the cluster working memory. This review identifies the most used (also by rigorous and relevant articles) EEG signal processing strategies for executive function assessment in ADHD.

Chronic academic stress facilitates response inhibition: Behavioral and electrophysiological evidence

Previous studies have found that acute stress can modulate response inhibition. However, the effect of chronic stress on response inhibition has not been investigated. A major examination was adopted as a chronic stressor in this study. Both the stress and control groups performed a modified Go/Nogo task. In each trial, a probe stimulus (left or right arrow) was presented immediately after the Go/Nogo task. The probe reaction time (RT) was used as an index of cognitive load during the task. Event-related potentials (ERPs) evoked by Go/Nogo stimuli were investigated. The RTs for the Go stimulus and the probe stimulus were shorter for the stress group than for the control group. This superior performance by stressed participants might suggest a promoted task processing efficiency during the dual task under stress. A smaller probe RT effect (RT_Nogo - RT_Go) was found in the stress group than in the control group, indicating a facilitatory effect of stress on conflict resolution. The ERP results showed that the P2 Go/Nogo effect was smaller for the stress group than for the control group, driven by an increased P2 amplitude after Go trials for the stress group. This might indicate an enhancement of attentional resource allocation to the Go stimuli under stress. Both the Nogo P3 amplitude and the P3 Go/Nogo effect were enhanced in the stress group than in the control group, suggesting that conflict resolution was enhanced under stress. These results demonstrate that chronic academic stress might facilitate response inhibition by promoting conflict resolution.

Event-related brain dynamics during mind wandering in attention-deficit/hyperactivity disorder: An experience-sampling approach

Adults with attention-deficit/hyperactivity disorder (ADHD) report increased spontaneous mind wandering (MW) compared to control adults. Since MW is associated with ADHD severity and functional impairment, elucidating the brain mechanisms underlying MW may inform new interventions targeting MW and point to neural markers to monitor their efficacy. Population-based electroencephalographic (EEG) studies suggest that weaker event-related decreases in occipital alpha power characterise periods of MW, but no study has examined event-related brain oscillations during MW in individuals with ADHD. Using an experience-sampling method, we compared adults with ADHD (N = 23) and controls (N = 25) on event-related EEG measures of power modulations and phase consistency during two tasks with high and low demands on working memory and sustained attention, and during periods of MW and task focus. Compared to controls, individuals with ADHD showed weaker alpha power decreases during high working memory demands and across sustained attention demands, weaker theta power increases and phase consistency across working memory demands and during low sustained attention demands, and weaker beta power decreases during low working memory demands. These EEG patterns suggest broadly deficient attentional and motor response processes in ADHD. During MW episodes, adults with ADHD showed weaker alpha power decreases in the sustained attention task and lower theta phase consistency in the working memory task compared to controls. These findings suggest that atypical EEG patterns thought to reflect reduced inhibition of task-irrelevant processes and inconsistent stimulus processing underlie increased MW in adults with ADHD and may be useful for future real-time monitoring of treatment effects.

Utility of Cognitive Neural Features for Predicting Mental Health Behaviors

Cognitive dysfunction underlies common mental health behavioral symptoms including depression, anxiety, inattention, and hyperactivity. In this study of 97 healthy adults, we aimed to classify healthy vs. mild-to-moderate self-reported symptoms of each disorder using cognitive neural markers measured with an electroencephalography (EEG). We analyzed source-reconstructed EEG data for event-related spectral perturbations in the theta, alpha, and beta frequency bands in five tasks, a selective attention and response inhibition task, a visuospatial working memory task, a Flanker interference processing task, and an emotion interference task. From the cortical source activation features, we derived augmented features involving co-activations between any two sources. Logistic regression on the augmented feature set, but not the original feature set, predicted the presence of psychiatric symptoms, particularly for anxiety and inattention with >80% sensitivity and specificity. We also computed current flow closeness and betweenness centralities to identify the “hub” source signal predictors. We found that the Flanker interference processing task was the most useful for assessing the connectivity hubs in general, followed by the inhibitory control go-nogo paradigm. Overall, these interpretable machine learning analyses suggest that EEG biomarkers collected on a rapid suite of cognitive assessments may have utility in classifying diverse self-reported mental health symptoms.

Event-related brain oscillations in attention-deficit/hyperactivity disorder (ADHD): A systematic review and meta-analysis

Previous studies have associated attention-deficit/hyperactivity disorder (ADHD) with several alterations in electroencephalographic (EEG) activity. Time-frequency analyses capturing event-related power modulations are becoming an increasingly popular approach, but a systematic synthesis of the time-frequency literature in ADHD is currently lacking. We conducted the first systematic review and meta-analysis of time-frequency studies of children and adults with ADHD in comparison to neurotypical controls. Searches via Medline, Embase, and Web of Science, as well as reference lists, identified 28 eligible articles published until March 2021. Of these, 13 articles with relevant data were included in a multi-level meta-analysis. Most studies examined power modulations of alpha, theta and/or beta frequencies (N = 21/28), and focused on children (N = 17/28). Meta-analyses showed significantly weaker theta increases (Cohen's d = -0.25, p = 0.039; NADHD = 346, NCONTROL = 327), alpha decreases (d = 0.44, p < 0.001; NADHD = 564, NCONTROL = 450), and beta increases (Cohen's d = -0.33, p < 0.001; NADHD = 222, NCONTROL = 263) in individuals with ADHD relative to controls. These patterns indicate broad brain-oscillatory alterations in individuals with ADHD with small (theta) and small-to-moderate (alpha and beta) effect sizes. These group differences were partly consistent when repeating analyses by age group (<18 and 18+ years) and task type (cognitive control, working memory, and simple attention tasks). Overall, our findings identify widespread event-related brain-oscillatory alterations in individuals with ADHD during a range of neurocognitive functions. Future research requires larger samples, a broader range of frequency bands (including delta and gamma) during a wider type of cognitive-affective processes, and should clarify whether atypical event-related power profiles are ADHD-specific or shared with other neuropsychiatric conditions.

Systematic Review of the Longitudinal Sensitivity of Precision Tasks in Visual Working Memory

Precision of working memory (WM) refers to the objective performance of individuals when trying to recall the features of the encoded WM items. Studies of precision in VWM aim to identify whether differences in WM performance within individuals are sensitive to individual states or traits. In this systematic review, we study VWM precision and whether it reflects true differences in ability to accurately store information, and thereby possibly a more sensitive measure than discrete VWM span alone. Sifting through 327 abstracts, we identified 34 relevant articles. After assessing these articles with regard to our inclusion criteria to test participants at two separate time points and have a sample size of at least fifteen participants, we found four longitudinal studies regarding VWM precision. One review author and two reviewers independently assessed all studies in the screening and selection process and extracted outcome measures, study characteristics, and, when possible, test-retest reliability metrics. Given the small and heterogeneous sample, this systematic review could not yet provide conclusive evidence on the sensitivity of VWM precision paradigms. Future research of VWM should include longitudinal studies of precision, and address both test-retest reliability in healthy adults and changes in precision during key developmental trajectory periods and in clinical populations.

Event-related brain-oscillatory and ex-Gaussian markers of remission and persistence of ADHD

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) often persists into adolescence and adulthood, but the processes underlying persistence and remission remain poorly understood. We previously found that reaction time variability and event-related potentials of preparation-vigilance processes were impaired in ADHD persisters and represented markers of remission, as ADHD remitters were indistinguishable from controls but differed from persisters. Here, we aimed to further clarify the nature of the cognitive-neurophysiological impairments in ADHD and of markers of remission by examining the finer-grained ex-Gaussian reaction-time distribution and electroencephalographic (EEG) brain-oscillatory measures in ADHD persisters, remitters and controls.

METHODS

A total of 110 adolescents and young adults with childhood ADHD (87 persisters, 23 remitters) and 169 age-matched controls were compared on ex-Gaussian (mu, sigma, tau) indices and time-frequency EEG measures of power and phase consistency from a reaction-time task with slow-unrewarded baseline and fast-incentive conditions ('Fast task').

RESULTS

Compared to controls, ADHD persisters showed significantly greater mu, sigma, tau, and lower theta power and phase consistency across conditions. Relative to ADHD persisters, remitters showed significantly lower tau and theta power and phase consistency across conditions, as well as lower mu in the fast-incentive condition, with no difference in the baseline condition. Remitters did not significantly differ from controls on any measure.

CONCLUSIONS

We found widespread impairments in ADHD persisters in reaction-time distribution and brain-oscillatory measures. Event-related theta power, theta phase consistency and tau across conditions, as well as mu in the more engaging fast-incentive condition, emerged as novel markers of ADHD remission, potentially representing compensatory mechanisms in individuals with remitted ADHD.

What Has Been Learned from Using EEG Methods in Research of ADHD?

Electrophysiological recording methods, including electroencephalography (EEG) and magnetoencephalography (MEG), have an unparalleled capacity to provide insights into the timing and frequency (spectral) composition of rapidly changing neural activity associated with various cognitive processes. The current chapter provides an overview of EEG studies examining alterations in brain activity in ADHD, measured both at rest and during cognitive tasks. While EEG resting state studies of ADHD indicate no universal alterations in the disorder, event-related studies reveal consistent deficits in attentional and inhibitory control and consequently inform the proposed cognitive models of ADHD. Similar to other neuroimaging measures, EEG research indicates alterations in multiple neural circuits and cognitive functions. EEG methods - supported by the constant refinement of analytic strategies - have the potential to contribute to improved diagnostics and interventions for ADHD, underlining their clinical utility.

Electrophysiological Brain Changes Associated With Cognitive Improvement in a Pediatric Attention Deficit Hyperactivity Disorder Digital Artificial Intelligence-Driven Intervention: Randomized Controlled Trial

BACKGROUND

Cognitive stimulation therapy appears to show promising results in the rehabilitation of impaired cognitive processes in attention deficit hyperactivity disorder.

OBJECTIVE

Encouraged by this evidence and the ever-increasing use of technology and artificial intelligence for therapeutic purposes, we examined whether cognitive stimulation therapy implemented on a mobile device and controlled by an artificial intelligence engine can be effective in the neurocognitive rehabilitation of these patients.

METHODS

In this randomized study, 29 child participants (25 males) underwent training with a smart, digital, cognitive stimulation program (KAD_SCL_01) or with 3 commercial video games for 12 weeks, 3 days a week, 15 minutes a day. Participants completed a neuropsychological assessment and a preintervention and postintervention magnetoencephalography study in a resting state with their eyes closed. In addition, information on clinical symptoms was collected from the child´s legal guardians.

RESULTS

In line with our main hypothesis, we found evidence that smart, digital, cognitive treatment results in improvements in inhibitory control performance. Improvements were also found in visuospatial working memory performance and in the cognitive flexibility, working memory, and behavior and general executive functioning behavioral clinical indexes in this group of participants. Finally, the improvements found in inhibitory control were related to increases in alpha-band power in all participants in the posterior regions, including 2 default mode network regions of the interest: the bilateral precuneus and the bilateral posterior cingulate cortex. However, only the participants who underwent cognitive stimulation intervention (KAD_SCL_01) showed a significant increase in this relationship.

CONCLUSIONS

The results seem to indicate that smart, digital treatment can be effective in the inhibitory control and visuospatial working memory rehabilitation in patients with attention deficit hyperactivity disorder. Furthermore, the relation of the inhibitory control with alpha-band power changes could mean that these changes are a product of plasticity mechanisms or changes in the neuromodulatory dynamics.

TRIAL REGISTRATION

ISRCTN Registry ISRCTN71041318; https://www.isrctn.com/ISRCTN71041318.

Investigation of the interaction between emotion and working memory load using spatiotemporal pattern similarity analysis

Objective.Accumulating evidence has revealed that emotions can be provided with the modulatory effect on working memory (WM) and WM load is an important factor for the interaction between emotion and WM. However, it remains controversial whether emotions inhibit or facilitate WM and the interaction between cognitive task, processing load and emotional processing remains unclear.Approach.In this study, we used a change detection paradigm wherein memory items have four different load sizes and emotion videos to induce three emotions (negative, neutral, and positive). We performed an event-related spectral perturbation (ERSP) analysis and a spatiotemporal pattern similarity (STPS) analysis on the electroencephalography data.Main results.The ERSP results indicated that alpha and beta oscillations can reflect the difference among WM load sizes and also can reflect the difference among emotions under middle high WM load over posterior brain region in the maintenance stage. Moreover, the STPS results demonstrated a significant interaction between emotion and WM load size in the posterior region and found significantly higher similarity indexes for the negative emotion to the neutral emotion under the middle high WM load during WM maintenance. In addition, The STPS results also revealed that both positive emotion and negative emotion could interfere with the distinction of load sizes.Significance.The consistence of the behavioral, ERSP and STPS results suggested that when the memory load approaches the limit of WM capacity, negative emotion could facilitate WM through the top-down attention modulation promoting the most relevant information storage during WM maintenance.

Dataset of concurrent EEG, ECG, and behavior with multiple doses of transcranial electrical stimulation

We present a dataset combining human-participant high-density electroencephalography (EEG) with physiological and continuous behavioral metrics during transcranial electrical stimulation (tES). Data include within participant application of nine High-Definition tES (HD-tES) types, targeting three cortical regions (frontal, motor, parietal) with three stimulation waveforms (DC, 5 Hz, 30 Hz); more than 783 total stimulation trials over 62 sessions with EEG, physiological (ECG, EOG), and continuous behavioral vigilance/alertness metrics. Experiment 1 and 2 consisted of participants performing a continuous vigilance/alertness task over three 70-minute and two 70.5-minute sessions, respectively. Demographic data were collected, as well as self-reported wellness questionnaires before and after each session. Participants received all 9 stimulation types in Experiment 1, with each session including three stimulation types, with 4 trials per type. Participants received two stimulation types in Experiment 2, with 20 trials of a given stimulation type per session. Within-participant reliability was tested by repeating select sessions. This unique dataset supports a range of hypothesis testing including interactions of tDCS/tACS location and frequency, brain-state, physiology, fatigue, and cognitive performance.

Inter-brain co-activations during mindfulness meditation. Implications for devotional and clinical settings

Mindfulness meditation usually takes place as personal, introspective activity. It is not known if this practice activates the brain differently when done alone or with someone else. Sixteen couples of expert meditators performed mindfulness-oriented meditation (MOM) and instructed mind-wandering (IMW) tasks in two conditions: once sitting in the same room (SR) and once in two different rooms (DR). Spontaneous electroencephalographic (EEG) data was collected during 7-minute recording sessions in the four experimental settings (MOM/SR, MOM/DR, IMW/SR, IMW/DR). Power in band was computed in separate clusters of independent components of the EEG signals. In addition to significant task effects, found in frontolimbic (MOM > IMW in gamma) and frontoparietal locations (MOM < IMW in theta), significant condition effects were found in frontal (SR > DR in delta) and in temporo-occipital regions (SR > DR in theta and alpha). Moreover, a significant interaction between task and condition revealed higher gamma activity in limbic areas during MOM/SR vs. MOM/DR settings. This effect was not attributable to gender, age nor the meditation expertise of participants. We thus show that the brains of two people work differently when they are doing something together or alone; some of these differences are specific to mindfulness meditation. Implications for devotional and clinical settings are discussed.

Associations of Hyperactivity and Inattention Scores with Theta and Beta Oscillatory Dynamics of EEG in Stop-Signal Task in Healthy Children 7-10 Years Old

Simple Summary

Most studies on ADHD have been focused on the comparisons between healthy subjects and clinical patients. The dimensional approaches propose that the main pathological behavioral domains are distributed in the normal population and not only in individual categories of people (as assumed in traditional schemes of comparisons between patients and controls). In the current study, we used a similar approach to identify potential markers of ADHD by studying the EEG dynamics of healthy children with a natural variability in hyperactivity and inattention scores during performance of the Stop-Signal task. We found that hyperactivity/inattention scores were positively associated with RT variability. Hyperactivity/inattention scores were negatively associated with an increase in beta spectral power in the first 200 ms and positively associated with an increase in theta rhythm at about 300 ms after presentation of the Go stimulus. It has been hypothesized that such results imply insufficient vigilance in the early stages of perception and subsequent compensatory enhancing of attention to the stimulus in children with higher hyperactivity and inattention scores.

Abstract

In the current study, we aimed to investigate the associations between the natural variability in hyperactivity and inattention scores, as well as their combination with EEG oscillatory responses in the Stop-Signal task in a sample of healthy children. During performance, the Stop-Signal task EEGs were recorded in 94 Caucasian children (40 girls) from 7 to 10 years. Hyperactivity/inattention and inattention scores positively correlated with RT variability. Hyperactivity/inattention and inattention scores negatively correlated with an increase in beta spectral power in the first 200 ms after presentation of the Go stimulus. Such results are in line with the lack of arousal model in ADHD children and can be associated with less sensory arousal in the early stages of perception in children with symptoms of inattention. The subsequent greater increase in theta rhythm at about 300 ms after presentation of the Go stimulus in children with higher inattention scores may be associated with increased attention processes and compensation for insufficient vigilance in the early stages of perception.

Response inhibition and memory updating in the count/nocount task: an ERP study

The present study aimed to separate the neural activities between response inhibition and memory updating processes in the Count/Nocount task. Memory load was manipulated to investigate the memory updating process. Within each trial, participants were asked to count/withhold counting the number of O/X letters in the Count/Nocount task. The participants were asked to silently add 1 if a Count letter was presented in the low load condition, and add 2 in the high load condition. Data from 28 healthy participants showed that: (1) in both high load and low load conditions, the latencies of P2 and N2 components were shorter for the Nocount than Count trials, indicating faster attentional orienting and conflict monitoring processes for the Nocount stimuli (i.e., inhibition processes triggered by the Nocount stimuli against those response execution processes triggered by Count stimuli); (2) more positive frontal P3 amplitudes were evoked for the Nocount relative to the Count stimuli, indicating a more intensive response inhibition process for the Nocount trials; (3) a more positive parietal P3 component was evoked for the low load relative to high load condition, indicating a more intensive working memory updating process for the high load condition. This load effect was absent for the frontal P3 component, suggesting that the frontal P3 might not be associated with the memory updating process. In sum, both the cognitive inhibition process (reflected by the frontal P3 component) and working memory updating process (reflected by the parietal P3 component) appear to be involved in the Count/Nocount task.

Neurocognitive subprocesses of working memory performance

Working memory (WM) has been defined as the active maintenance and flexible updating of goal-relevant information in a form that has limited capacity and resists interference. Complex measures of WM recruit multiple subprocesses, making it difficult to isolate specific contributions of putatively independent subsystems. The present study was designed to determine whether neurophysiological indicators of proposed subprocesses of WM predict WM performance. We recruited 200 individuals defined by care-seeking status and measured neural responses using electroencephalography (EEG), while participants performed four WM tasks. We extracted spectral and time-domain EEG features from each task to quantify each of the hypothesized WM subprocesses: maintenance (storage of content), goal maintenance, and updating. We then used EEG measures of each subprocess as predictors of task performance to evaluate their contribution to WM. Significant predictors of WM capacity included contralateral delay activity and frontal theta, features typically associated with maintenance (storage of content) processes. In contrast, significant predictors of reaction time and its variability included contingent negative variation and the P3b, features typically associated with goal maintenance and updating. Broadly, these results suggest two principal dimensions that contribute to WM performance, tonic processes during maintenance contributing to capacity, and phasic processes during stimulus processing that contribute to response speed and variability. The analyses additionally highlight that reliability of features across tasks was greater (and comparable to that of WM performance) for features associated with stimulus processing (P3b and alpha), than with maintenance (gamma, theta and cross-frequency coupling).

Personalized machine learning of depressed mood using wearables

Depression is a multifaceted illness with large interindividual variability in clinical response to treatment. In the era of digital medicine and precision therapeutics, new personalized treatment approaches are warranted for depression. Here, we use a combination of longitudinal ecological momentary assessments of depression, neurocognitive sampling synchronized with electroencephalography, and lifestyle data from wearables to generate individualized predictions of depressed mood over a 1-month time period. This study, thus, develops a systematic pipeline for N-of-1 personalized modeling of depression using multiple modalities of data. In the models, we integrate seven types of supervised machine learning (ML) approaches for each individual, including ensemble learning and regression-based methods. All models were verified using fourfold nested cross-validation. The best-fit as benchmarked by the lowest mean absolute percentage error, was obtained by a different type of ML model for each individual, demonstrating that there is no one-size-fits-all strategy. The voting regressor, which is a composite strategy across ML models, was best performing on-average across subjects. However, the individually selected best-fit models still showed significantly less error than the voting regressor performance across subjects. For each individual's best-fit personalized model, we further extracted top-feature predictors using Shapley statistics. Shapley values revealed distinct feature determinants of depression over time for each person ranging from co-morbid anxiety, to physical exercise, diet, momentary stress and breathing performance, sleep times, and neurocognition. In future, these personalized features can serve as targets for a personalized ML-guided, multimodal treatment strategy for depression.

Mapping cognitive brain functions at scale

A fundamental set of cognitive abilities enable humans to efficiently process goal-relevant information, suppress irrelevant distractions, maintain information in working memory, and act flexibly in different behavioral contexts. Yet, studies of human cognition and their underlying neural mechanisms usually evaluate these cognitive constructs in silos, instead of comprehensively in-tandem within the same individual. Here, we developed a scalable, mobile platform, "BrainE" (short for Brain Engagement), to rapidly assay several essential aspects of cognition simultaneous with wireless electroencephalography (EEG) recordings. Using BrainE, we rapidly assessed five aspects of cognition including (1) selective attention, (2) response inhibition, (3) working memory, (4) flanker interference and (5) emotion interference processing, in 102 healthy young adults. We evaluated stimulus encoding in all tasks using the EEG neural recordings, and isolated the cortical sources of the spectrotemporal EEG dynamics. Additionally, we used BrainE in a two-visit study in 24 young adults to investigate the reliability of the neuro-cognitive data as well as its plasticity to transcranial magnetic stimulation (TMS). We found that stimulus encoding on multiple cognitive tasks could be rapidly assessed, identifying common as well as distinct task processes in both sensory and cognitive control brain regions. Event related synchronization (ERS) in the theta (3-7 Hz) and alpha (8-12 Hz) frequencies as well as event related desynchronization (ERD) in the beta frequencies (13-30 Hz) were distinctly observed in each task. The observed ERS/ERD effects were overall anticorrelated. The two-visit study confirmed high test-retest reliability for both cognitive and neural data, and neural responses showed specific TMS protocol driven modulation. We also show that the global cognitive neural responses are sensitive to mental health symptom self-reports. This first study with the BrainE platform showcases its utility in studying neuro-cognitive dynamics in a rapid and scalable fashion.

Shared and unique neural mechanisms underlying pediatric trichotillomania and obsessive compulsive disorder

BACKGROUND

Little is known about the neural underpinnings of pediatric trichotillomania (TTM). We examined error-related negativity (ERN)-amplitude and theta-EEG power differences among youth with TTM, OCD, and healthy controls (HC).

METHODS

Forty channel EEG was recorded from 63 pediatric participants (22 with TTM, 22 with OCD, and 19 HC) during the Eriksen Flanker Task. EEG data from inhibitory control were used to derive estimates of ERN amplitude and event-related spectral power associated with motor inhibition.

RESULTS

TTM and HC were similar in brain activity patterns in frontal and central regions and TTM and OCD were similar in the parietal region. Frontal ERN-amplitude was significantly larger in OCD relative to TTM and HC, who did not differ from each other. The TTM group had higher theta power compared to OCD in frontal and central regions, and higher theta than both comparison groups in right motor cortex and superior parietal regions. Within TTM, flanker task performance was correlated with EEG activity in frontal, central, and motor cortices whereas global functioning and impairment were associated with EEG power in bilateral motor and parietal cortices.

CONCLUSIONS

Findings are discussed in terms of shared and unique neural mechanisms in TTM and OCD and treatment implications.

A preliminary investigation of childhood anxiety/depressive symptomatology and working memory across multiple units of analysis

This exploratory study examined multiple units of working memory (WM) analysis in a transdiagnostic, treatment-seeking, pediatric sample. This included a) an electroencephalography marker of WM (coupling of theta and gamma oscillations [i.e., theta-gamma coupling] in frontal brain regions), b) WM test performance, and c) parent-reported WM symptoms. A composite score combining each of these units of analysis correlated with self-reported depressive and anxiety symptoms, with only theta-gamma coupling independently predicted anxiety/depressive symptoms. Results confirm prior findings on the association between WM and anxiety/depression, although the majority of this variance was explained by frontal theta-gamma coupling during WM demands.

Caudate and cerebellar involvement in altered P2 and P3 components of GO/NoGO evoked potentials in children with attention-deficit/hyperactivity disorder

Previous studies showed reduced activity of the anterior cingulate cortex (ACC) and supplementary motor area during inhibition in children with attention-deficit/hyperactivity disorder (ADHD). This study aimed to investigate deep brain generators underlying alterations of evoked potential components triggered by visual GO/NoGO tasks in children with ADHD compared with typically developing children (TDC). Standardized weighted low-resolution electromagnetic tomography (swLORETA) source analysis showed that lower GO-P3 component in children with ADHD was explained not only by a reduced contribution of the frontal areas but also by a stronger contribution of the anterior part of the caudate nucleus in these children compared with TDC. While the reduction of the NoGO-P3 component in children with ADHD was essentially explained by a reduced contribution of the dorsal ACC, the higher NoGO-P2 amplitude in these children was concomitant to the reduced contribution of the dorsolateral prefrontal cortex, the insula, and the cerebellum. These data corroborate previous findings showed by fMRI studies and offered insight relative to the precise time-related contribution of the caudate nucleus and the cerebellum during the automatic feature of inhibition processes in children with ADHD. These results were discussed regarding the involvement of the fronto-basal ganglia and fronto-cerebellum networks in inhibition and attention alterations in ADHD.

Digital health interventions (DHI) for the treatment of attention deficit hyperactivity disorder (ADHD) in children - a comparative review of literature among various treatment and DHI

The objective of this study is to compare game-based digital therapeutic device and other DHI like (smartphone apps, wearable technologies) for ADHD with the current pharmacological and behavior therapy. The FDA has approved a game-based digital therapeutic device - EndeavorRx, for the treatment of ADHD in pediatric patients belonging to the age group of 8-12 years old. This has been primarily recommended for the treatment of inattentive or combined-type ADHD who have demonstrated an attention issue. This is the first game-based therapeutic device to be approved by the FDA for any type of condition. According to the FDA, this has been shown to improve attention which is measured by computer-based testing. Objective: The objective of this study is to compare a game-based digital therapeutic device and other DHI (smartphone apps, wearable technologies) with the current pharmacological and behavior therapy used in the treatment of ADHD.

Effect of Acute Psychological Stress on Motion-in-Depth Perception: An Event-Related Potential Study

The present study explored the intrinsic event-related potential (ERP) features of the effects of acute psychological stress on the processing of motion-in-depth perception using a dual-task paradigm. After a mental arithmetic task was used to induce acute psychological stress, a collision task was used to evaluate motion-in-depth perception. The error value and average amplitude of late slow waves (SW) were significantly larger for the earlier colliding spheres' than for the later colliding spheres. The P1 peak latency in the left occipital region was significantly shorter than that of the right occipital region in the motion-in-depth perception task. Compared to the control condition, the estimated value of residual time-to-collision and error value were significantly reduced, and the N1 peak amplitude and the SW averaged amplitude were significantly increased in the stress condition. Longer motion-in-depth time improved discrimination accuracy and decreased the investment of cognitive resources. Acute psychological stress increased behavioral performance and enhanced attention resources on the motion-in-depth perception task together with greater investment of cognitive resources.