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Csibra B, Reicher V, Csepregi M, Kristóf K, Gácsi M. Towards an Objective Measurement Tool for ADHD-like Traits in Family Dogs: A Comprehensive Test Battery. Animals (Basel) 2024; 14:1841. [PMID: 38997953 PMCID: PMC11240718 DOI: 10.3390/ani14131841] [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: 05/30/2024] [Revised: 06/17/2024] [Accepted: 06/19/2024] [Indexed: 07/14/2024] Open
Abstract
Family dogs exhibit neuropsychological deficits similar to attention-deficit/hyperactivity disorder (ADHD) symptoms in humans. Questionnaire methods have mostly been used to assess ADHD-like behaviours in dogs. In addition to our validated questionnaire (Dog ADHD and Functionality Rating Scale-DAFRS; 2024), we developed a simple behavioural test battery covering the ADHD symptom domains (i.e., inattention, hyperactivity, and impulsivity) in dogs. Our main aim was (i) to provide a final external validation step to the DAFRS by examining its associations with the test variables (N = 59); and (ii) to compare owner- and trainer-rated factor scores' associations with the test variables (n = 38). We developed four tests covering the ADHD symptom domains: the attention test (inattention), the plush dog test (impulsivity), the leash test, and the sit test (hyperactivity). All four behavioural variables correlated with their respective questionnaire scores, i.e., the strongest for hyperactivity, and the least strong for inattention. Both owner- and trainer-rated scores (n = 38) correlated with the relevant test variables in an expected direction. Dogs' training status was linked only to the sit test results. Test-retest analyses (n = 34) indicated moderate-to-excellent agreement across all behavioural variables. Our findings support the validity of our novel human-analogue questionnaire for dogs as the behavioural tests strongly correlate with the relevant questionnaire scores, indicating that the two constructs together can effectively assess inattention, hyperactivity, and impulsivity in dogs.
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Affiliation(s)
- Barbara Csibra
- Department of Ethology, Institute of Biology, Eötvös Loránd University, Pázmány Péter Sétány 1/C, 1117 Budapest, Hungary
- Doctoral School of Biology, Institute of Biology, Eötvös Loránd University, Pázmány Péter Sétány 1/C, 1117 Budapest, Hungary
| | - Vivien Reicher
- Clinical and Developmental Neuropsychology Research Group, Research Centre for Natural Sciences, Institute of Cognitive Neuroscience and Psychology, Magyar Tudósok Körútja 2, 1117 Budapest, Hungary
| | - Melitta Csepregi
- Department of Ethology, Institute of Biology, Eötvös Loránd University, Pázmány Péter Sétány 1/C, 1117 Budapest, Hungary
- Doctoral School of Biology, Institute of Biology, Eötvös Loránd University, Pázmány Péter Sétány 1/C, 1117 Budapest, Hungary
- HUN-REN-ELTE Comparative Ethology Research Group, Pázmány Péter Sétány 1/C, 1117 Budapest, Hungary
| | - Kíra Kristóf
- Department of Ethology, Institute of Biology, Eötvös Loránd University, Pázmány Péter Sétány 1/C, 1117 Budapest, Hungary
| | - Márta Gácsi
- Department of Ethology, Institute of Biology, Eötvös Loránd University, Pázmány Péter Sétány 1/C, 1117 Budapest, Hungary
- HUN-REN-ELTE Comparative Ethology Research Group, Pázmány Péter Sétány 1/C, 1117 Budapest, Hungary
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Rivella C, Bazzurro A, Olla V, Potente C, Vio C, Viterbori P, Usai MC. Impact of Distractors on Sustained Attention and Inhibition in Children With ADHD. J Atten Disord 2024; 28:970-981. [PMID: 38178562 DOI: 10.1177/10870547231218932] [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] [Indexed: 01/06/2024]
Abstract
OBJECTIVE This study examines the impact of visual and auditory distractors on attention and inhibition in children with and without ADHD. METHOD The study used the MOXO d-CPT child version. The sample consisted of 208 children aged 8 to 12 years, including 64 with ADHD and 144 controls. RESULTS Children with ADHD and controls differed in their reaction to distracting stimuli; visual distractors cause a higher decrease in sustained attention and inhibitory control in the ADHD group. Moreover, auditory distractors generate improved performance in the control group but not in the ADHD group. In addition, age-related effects were found in both sustained attention and inhibitory control in all children, regardless of whether the ADHD condition was present. CONCLUSIONS The findings indicate that children with ADHD performed poorer compared to controls, and that distractors differently affected the performance of the two groups.
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García Beristain JC, de Celis Alonso B, Barragan Perez E, Dies-Suarez P, Hidalgo-Tobón S. BOLD Activation During the Application of MOXO-CPT in School Patients With and Without Attention Deficit Hyperactivity Disorder. J Atten Disord 2024; 28:321-334. [PMID: 38153047 PMCID: PMC10838480 DOI: 10.1177/10870547231217093] [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] [Indexed: 12/29/2023]
Abstract
INTRODUCTION Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects 3% of children in the world. OBJECTIVE In this work, we seek to compare the different brain activations of pediatric patients with and without ADHD. METHODS A functional resonance examination with BOLD contrast was applied using the MOXO-CPT test (Continuous Performance test with single and double visual-auditory distractors). RESULTS Differences in BOLD activation were observed indicating that control children regularly presented negative BOLD activations that were not found in children with ADHD. Inhibitory activity in audiovisual association zones in control patients was greater than in patients with ADHD. The inhibition in the frontal and motor regions in the controls contrasted with the overactivation of the motor areas in patients with ADHD, this, together with the detection of cerebellar activation which attempted to modulate the responses of the different areas that lead to executive failure in patients with ADHD. CONCLUSIONS In view of these results, it can be argued that the lack of inhibition of ADHD patients in their executive functions led to a disorganization of the different brain systems.
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Affiliation(s)
| | | | | | - Pilar Dies-Suarez
- Hospital Infantil de México Federico Gomez, Cuauhtémoc, Mexico City, Mexico
| | - Silvia Hidalgo-Tobón
- Universidad Autonoma Metropolitana-Iztapalapa, Mexico City, Mexico
- Hospital Infantil de México Federico Gómez, Cuauhtémoc, Mexico City, Mexico
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Akerman A, Etkovitch A, Kalanthroff E. Global-Local Processing in ADHD Is Not Limited to the Visuospatial Domain: Novel Evidence From the Auditory Domain. J Atten Disord 2023; 27:822-829. [PMID: 36779530 DOI: 10.1177/10870547231153952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
OBJECTIVE Global-local visuospatial processing has been widely investigated in both healthy and clinical populations. Recent studies indicated that individuals with ADHD lack a global processing bias. However, the extant literature regarding global-local processing style focuses solely on the visual modality. METHODS ADHD (N = 21) and typically developed (TD) controls (N = 24) underwent an auditory global-local task, in which they had to decide whether the melody is ascending or descending in global or local conditions. RESULTS TD controls exhibited a classic global processing bias in the auditory task. The ADHD group exhibited no global processing bias, indicating similar processing for global and local dimensions, implying that individuals with ADHD are distracted by incongruent information in global and local conditions similarly, in both visual and auditory tasks. CONCLUSION A lack of global processing bias in ADHD is not limited to the visuospatial modality and likely reflects a broader and more general processing style.
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Affiliation(s)
- Aviv Akerman
- The Hebrew University of Jerusalem, Jerusalem, Israel
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Clinical Utility of Eye Tracking in Assessing Distractibility in Children with Neurological Disorders or ADHD: A Cross-Sectional Study. Brain Sci 2022; 12:brainsci12101369. [PMID: 36291303 PMCID: PMC9599566 DOI: 10.3390/brainsci12101369] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/01/2022] [Accepted: 10/06/2022] [Indexed: 11/17/2022] Open
Abstract
This study aims to investigate distractibility quantified by recording and analyzing eye movements during task-irrelevant distraction in children with and without ADHD and in children with and without neurological disorders. Gaze behavior data and press latencies of 141 participants aged 6−17 that were collected during a computerized distraction paradigm with task-irrelevant stimuli (IDistrack) were analyzed. Children using attention-regulating medication were excluded from participation. Data were analyzed for subgroups that were formed based on the presence of neurological disorders and the presence of ADHD separately. Participants with ADHD and participants with neurological disorders spent less time fixating on the target stimuli compared to their peers without ADHD (p = 0.025) or their peers without neurological disorders (p < 0.001). Participants with and without ADHD had equal press latencies (p = 0.79). Participants with neurological disorders had a greater press latency compared to their typically developing peers (p < 0.001). Target fixation duration shows a significant association with parent-reported attention problems (r = −0.39, p < 0.001). We conclude that eye tracking during a distraction task reveals potentially valid clinical information that may contribute to the assessment of dysfunctional attentional processes. Further research on the validity and reliability of this paradigm is recommended.
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Yıldırım Demirdöğen E, Esin İS, Turan B, Dursun OB. Assessing sustained attention of children with ADHD in a class flow video task. Nord J Psychiatry 2022; 76:497-506. [PMID: 35521909 DOI: 10.1080/08039488.2022.2064545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate sustained attention performance of children with ADHD and effect of distractors on sustained attention through an eye-tracking during a class-flow video task. METHOD Data were collected using an eye-tracking during a class-flow task conducted with 60 children (ADHD and control groups). Two areas of interest were determined in the task, these are relevant (teacher and whiteboard) and irrelevant (any regions outside the relevant area) areas. The task also included distractors in relevant and irrelevant areas, comprising a brief conversation and dropping of a pencil, respectively. Proportion of total fixation duration on areas of interest (PFDAOI) was used to assess sustained attention. RESULTS Children with ADHD had lower PFDAOI in the relevant area during the whole class than children in the control group. After the relevant area distractor, PFDAOI increased in relevant area in ADHD group, indicating these children may have better attention after the distractor. However, children with ADHD also showed increased PFDAOI in the irrelevant area following the irrelevant area distractor, indicating that it negatively affected them. There was no significant change in the control group following the distractors. CONCLUSION These findings indicate that children with ADHD have poor sustained attention performance during the whole class. Moreover, distractors in distinct areas could affect children with ADHD differently. Thus, students with ADHD could benefit from increased stimuli in the relevant area and this can be a guide for classroom arrangements to improve the academic functionality of these children.
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Affiliation(s)
- Esen Yıldırım Demirdöğen
- Atatürk University Medicine Faculty, Department of Child and Adolescent Psychiatry, Erzurum, Turkey
| | - İbrahim Selçuk Esin
- Health Science University, Department of Child and Adolescent Psychiatry, Trabzon, Turkey
| | - Bahadır Turan
- Karadeniz Technical University, Department of Child and Adolescent Psychiatry, Trabzon
| | - Onur Burak Dursun
- Health Science University, Department of Child and Adolescent Psychiatry, Trabzon, Turkey
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Lancrei HM, Yeshayahu Y, Grossman ES, Berger I. Sweet but sour: Impaired attention functioning in children with type 1 diabetes mellitus. Front Hum Neurosci 2022; 16:895835. [PMID: 36158626 PMCID: PMC9495930 DOI: 10.3389/fnhum.2022.895835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/15/2022] [Indexed: 11/20/2022] Open
Abstract
Children diagnosed with type 1 diabetes mellitus (T1DM) are at risk for neurocognitive sequelae, including impaired attention functioning. The specific nature of the cognitive deficit varies; current literature underscores early age of diabetes diagnosis and increased disease duration as primary risk factors for this neurocognitive decline. Forty-three children with T1DM were evaluated for Attention Deficit/Hyperactivity Disorder (ADHD) symptomatology using the MOXO continuous performance test (MOXO-CPT) performed during a routine outpatient evaluation. The study cohort demonstrated a significant decline in all four domains of attention functioning. The effect was most pronounced with early age at T1DM diagnosis, a longer disease duration and with poorer glycemic control (represented by higher HbA1c values). With increased disease duration (of 5 plus years), acute hyperglycemia was associated with inattention in the real-time setting. These findings highlight the need for routine screening of neurocognitive function in children with T1DM so that early intervention can be employed during this crucial period of cognitive development.
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Affiliation(s)
- Hayley M. Lancrei
- Department of Pediatrics, Samson Assuta-Ashdod University Hospital, Ashdod, Israel
- *Correspondence: Hayley M. Lancrei,
| | - Yonatan Yeshayahu
- Department of Pediatrics, Samson Assuta-Ashdod University Hospital, Ashdod, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
- Pediatric Endocrinology Clinic, Samson Assuta-Ashdod University Hospital, Ashdod, Israel
| | | | - Itai Berger
- Department of Pediatrics, Samson Assuta-Ashdod University Hospital, Ashdod, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
- Pediatric Neurology Clinic, Samson Assuta-Ashdod University Hospital, Ashdod, Israel
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Dakwar-Kawar O, Berger I, Barzilay S, Grossman ES, Cohen Kadosh R, Nahum M. Examining the Effect of Transcranial Electrical Stimulation and Cognitive Training on Processing Speed in Pediatric Attention Deficit Hyperactivity Disorder: A Pilot Study. Front Hum Neurosci 2022; 16:791478. [PMID: 35966992 PMCID: PMC9363890 DOI: 10.3389/fnhum.2022.791478] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 07/05/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveProcessing Speed (PS), the ability to perceive and react fast to stimuli in the environment, has been shown to be impaired in children with attention deficit hyperactivity disorder (ADHD). However, it is unclear whether PS can be improved following targeted treatments for ADHD. Here we examined potential changes in PS following application of transcranial electric stimulation (tES) combined with cognitive training (CT) in children with ADHD. Specifically, we examined changes in PS in the presence of different conditions of mental fatigue.MethodsWe used a randomized double-blind active-controlled crossover study of 19 unmedicated children with ADHD. Participants received either anodal transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex (dlPFC) or transcranial random noise stimulation (tRNS), while completing CT, and the administration order was counterbalanced. PS was assessed before and after treatment using the MOXO-CPT, which measures PS in the presence of various conditions of mental fatigue and cognitive load.ResultstRNS combined with CT yielded larger improvements in PS compared to tDCS combined with CT, mainly under condition of increased mental fatigue. Further improvements in PS were also seen in a 1-week follow up testing.ConclusionThis study provides initial support for the efficacy of tRNS combined with CT in improving PS in the presence of mental fatigue in pediatric ADHD.
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Affiliation(s)
- Ornella Dakwar-Kawar
- School of Occupational Therapy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Itai Berger
- Pediatric Neurology, Assuta-Ashdod University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
- Paul Baerwald School of Social Work and Social Welfare, Hebrew University, Jerusalem, Israel
| | - Snir Barzilay
- School of Occupational Therapy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ephraim S. Grossman
- School of Occupational Therapy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Roi Cohen Kadosh
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Mor Nahum
- School of Occupational Therapy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- *Correspondence: Mor Nahum,
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9
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Büyükkaragöz B, Soysal Acar AŞ, Ekim M, Bayrakçı US, Bülbül M, Çaltık Yılmaz A, Bakkaloğlu SA. Utility of continuous performance test (MOXO-CPT) in children with pre-dialysis chronic kidney disease, dialysis and kidney transplantation. J Nephrol 2022; 35:1873-1883. [DOI: 10.1007/s40620-022-01382-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/10/2022] [Indexed: 10/16/2022]
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10
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Whitehead JC, Neeman R, Doniger GM. Preliminary Real-World Evidence Supporting the Efficacy of a Remote Neurofeedback System in Improving Mental Health: Retrospective Single-Group Pretest-Posttest Study. JMIR Form Res 2022; 6:e35636. [PMID: 35802411 PMCID: PMC9308076 DOI: 10.2196/35636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 05/31/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Neurofeedback training (NFT) has been shown to be effective in treating several disorders (eg, attention-deficit/hyperactivity disorder [ADHD], anxiety, and depression); however, little is currently known regarding the effectiveness of remote NFT systems.
Objective
This retrospective study provides real-world data (N=593) to assess the efficacy of app-based remote NFT in improving brain health and cognitive performance.
Methods
Improvement was measured from pre- to postintervention of in-app assessments that included validated symptom questionnaires (the 12-item General Health Questionnaire, the ADHD Rating Scale IV, the Adult ADHD Self-Report Scale, the 7-item Generalized Anxiety Disorder scale, and the 9-item Patient Health Questionnaire), a cognitive test of attention and executive functioning (ie, continuous performance task), and resting electroencephalography (EEG) markers. Clinically significant improvement was evaluated using standard approaches.
Results
The greatest improvement was reported for the anxiety questionnaire, for which 69% (68/99) of participants moved from abnormal to healthy score ranges. Overall, adult and child participants who engaged in neurofeedback to improve attention and executive functions demonstrated improved ADHD scores and enhanced performance on a cognitive (ie, response inhibition) task. Adults with ADHD additionally demonstrated elevated delta/alpha and theta/alpha ratios at baseline and a reduction in the delta/alpha ratio indicator following neurofeedback.
Conclusions
Preliminary findings suggest the efficacy of app-based remote neurofeedback in improving mental health, given the reduced symptom severity from pre- to postassessment for general psychological health, ADHD, anxiety, and depression, as well as adjusted resting EEG neural markers for individuals with symptoms of ADHD. Collectively, this supports the utility of the in-app assessment in monitoring behavioral and neural indices of mental health.
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Affiliation(s)
- Jocelyne C Whitehead
- Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada
- Myndlift Ltd, Tel Aviv, Israel
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11
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Çetin FH, Uçaryılmaz H, Uçar HN, Artaç H, Güler HA, Duran SA, Kılınç K, Türkoğlu S. Regulatory T cells in children with attention deficit hyperactivity disorder: A case-control study. J Neuroimmunol 2022; 367:577848. [DOI: 10.1016/j.jneuroim.2022.577848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/11/2022] [Accepted: 03/17/2022] [Indexed: 12/29/2022]
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Hong N, Kim JJ, Kwon JH, Eom H, Kim E. Effect of Distractors on Sustained Attention and Hyperactivity in Youth With Attention Deficit Hyperactivity Disorder Using a Mobile Virtual Reality School Program. J Atten Disord 2022; 26:358-369. [PMID: 33430697 DOI: 10.1177/1087054720986229] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study examined whether distractors in virtual reality (VR) environment affected the attention and hyperactivity in children and adolescents with ADHD. METHOD A total of 40 students (21 ADHD, 19 controls) aged between 9 and 17 years participated in this study. A rapid visual information processing task utilizing VR (VR-RVP) was performed under two conditions (no-distractor and distractor condition). Task performance and head movement during each condition were compared, and additional analyses were conducted after grouping participants into two developmental stages. RESULTS Children with ADHD performed comparably to the controls under the distractor condition, but had poorer performance under the no-distractor condition. They displayed more head movement under the distractor condition than in the no-distractor condition. CONCLUSION VR is possibly a useful tool for investigating the effect of distractors on individuals with ADHD, and children with ADHD are more vulnerable to a low-level stimulation situation than normal children in VR.
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Affiliation(s)
- Narae Hong
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Republic of Korea
| | - Jae-Jin Kim
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Republic of Korea.,Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Gangnam-gu, Seoul, Republic of Korea
| | - Joon-Hee Kwon
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Republic of Korea
| | - Hyojung Eom
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Republic of Korea
| | - Eunjoo Kim
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Republic of Korea.,Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Gangnam-gu, Seoul, Republic of Korea
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13
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Lev A, Braw Y, Elbaum T, Wagner M, Rassovsky Y. Eye Tracking During a Continuous Performance Test: Utility for Assessing ADHD Patients. J Atten Disord 2022; 26:245-255. [PMID: 33238787 DOI: 10.1177/1087054720972786] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The use of continuous performance tests (CPTs) for assessing ADHD related cognitive impairment is ubiquitous. Novel psychophysiological measures may enhance the data that is derived from CPTs and thereby improve clinical decision-making regarding diagnosis and treatment. As part of the current study, we integrated an eye tracker with the MOXO-dCPT and assessed the utility of eye movement measures to differentiate ADHD patients and healthy controls. METHOD Adult ADHD patients and gender/age-matched healthy controls performed the MOXO-dCPT while their eye movements were monitored (n = 33 per group). RESULTS ADHD patients spent significantly more time gazing at irrelevant regions, both on the screen and outside of it, than healthy controls. The eye movement measures showed adequate ability to classify ADHD patients. Moreover, a scale that combined eye movement measures enhanced group prediction, compared to the sole use of conventional MOXO-dCPT indices. CONCLUSIONS Integrating an eye tracker with CPTs is a feasible way of enhancing diagnostic precision and shows initial promise for clarifying the cognitive profile of ADHD patients. Pending replication, these findings point toward a promising path for the evolution of existing CPTs.
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Affiliation(s)
- Astar Lev
- Bar-Ilan University, Ramat Gan, Israel
| | | | | | | | - Yuri Rassovsky
- Bar-Ilan University, Ramat Gan, Israel.,University of California, Los Angeles (UCLA), Los Angeles, California, USA
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14
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Lavi E, Maree A, Eisenstein EM, Wexler I, Berger I, Berkun Y. Increased prevalence of attention-deficit hyperactivity disorder symptomatology in patients with familial Mediterranean fever. Mod Rheumatol 2021; 32:422-426. [PMID: 34758078 DOI: 10.1093/mr/roab009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/19/2021] [Accepted: 07/21/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVES Previous studies suggest that exposure to inflammation in infancy may increase the risk for attention-deficit and hyperactivity disorder (ADHD). We studied the ADHD manifestations among 124 familial Mediterranean fever (FMF) patients and examined the relationship between FMF patient characteristics and ADHD. METHODS Clinical, demographic, and genetic data were abstracted from patients' medical records and supplemented by information obtained during clinic visits. ADHD manifestations were assessed using the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) questionnaire. RESULTS ADHD was diagnosed in 42 (32.8%) FMF patients, a rate significantly higher than in unselected populations (∼8%). A majority (n = 27, 64.3%) had combined inattentive, hyperactive-impulsive manifestations. Eight (19%) had predominantly hyperactive-impulsive, and seven (16.6%) had predominantly inattentive symptoms. FMF patients with severe manifestations reported more ADHD symptoms. FMF patients with ADHD symptoms were less adherent to their treatment regimen, with only 61.9% of the patients with ADHD symptoms adhering to colchicine therapy compared to 92.7% of the patients without ADHD symptoms. CONCLUSION The high prevalence of ADHD characteristics in children with FMF may support the neuroimmune hypothesis that chronic inflammation increases the risk for ADHD. Children with FMF should be screened for ADHD as its presence may adversely affect adherence to treatment.
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Affiliation(s)
- Eran Lavi
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Aus Maree
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Eli M Eisenstein
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Isaiah Wexler
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Itai Berger
- Pediatric Neurology, Assuta-Ashdod University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yackov Berkun
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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15
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Dursun P, Fidan U, Karayagiz S. Probable role of listening therapy in the management of ADHD symptoms: Three case studies. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01419-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Werling AM, Walitza S, Drechsler R. Impact of the COVID-19 lockdown on screen media use in patients referred for ADHD to child and adolescent psychiatry: an introduction to problematic use of the internet in ADHD and results of a survey. J Neural Transm (Vienna) 2021; 128:1033-1043. [PMID: 33885969 PMCID: PMC8060336 DOI: 10.1007/s00702-021-02332-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/25/2021] [Indexed: 02/07/2023]
Abstract
The COVID-19 outbreak and lockdown have been associated with multiple consequences for mental health, including an excessive and potentially harmful increase in screen media use. The specific consequences for children, adolescents and young adults with ADHD are still unknown. In the first part of this study, a short review of problematic use of the internet (PUI) in ADHD is presented, showing that patients with ADHD are at risk for different aspects of PUI, such as excessive gaming or problematic social media use. In the second part, we report original data of an online survey on screen media use before, during and after the lockdown completed by parents of children and adolescents clinically referred for ADHD. Parents rated children's/adolescents' media-related behavior and media time on a new screening questionnaire for PUI. Each item was rated three times, referring to the observed behavior before, during and 1-2 months after the lockdown. N = 126 parents of patients referred for ADHD aged 10-18 years participated in the study. Total media time increased by 46% during the lockdown and did not completely return to pre-Corona levels afterwards. Patients with difficulties concentrating, high irritability or deterioration of ADHD problems under lockdown spent more time with screen media than those with milder or no such problems. While the effects of the lockdown on screen media use and its negative impact on everyday life appear to be largely reversible, a small proportion of patients with ADHD apparently continue to show increased media use.
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Affiliation(s)
- Anna Maria Werling
- Department of Child and Adolescent Psychiatry and Psychotherapy, Centre for Child and Adolescent Psychiatric Research, Neuropsychology, University Hospital of Psychiatry Zurich, University of Zurich, Eisengasse 16, 8008, Zurich, Switzerland.
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, Centre for Child and Adolescent Psychiatric Research, Neuropsychology, University Hospital of Psychiatry Zurich, University of Zurich, Eisengasse 16, 8008, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Renate Drechsler
- Department of Child and Adolescent Psychiatry and Psychotherapy, Centre for Child and Adolescent Psychiatric Research, Neuropsychology, University Hospital of Psychiatry Zurich, University of Zurich, Eisengasse 16, 8008, Zurich, Switzerland
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17
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Berger C, Lev A, Braw Y, Elbaum T, Wagner M, Rassovsky Y. Detection of Feigned ADHD Using the MOXO-d-CPT. J Atten Disord 2021; 25:1032-1047. [PMID: 31364437 DOI: 10.1177/1087054719864656] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objective: The objective of this study was to assess the MOXO-d-CPT utility in detecting feigned ADHD and establish cutoffs with adequate specificity and sensitivity. Method: The study had two phases. First, using a prospective design, healthy adults who simulated ADHD were compared with healthy controls and ADHD patients who performed the tasks to the best of their ability (n = 47 per group). Participants performed the MOXO-d-CPT and an established performance validity test (PVT). Second, the MOXO-d-CPT classification accuracy, employed in Phase 1, was retrospectively compared with archival data of 47 ADHD patients and age-matched healthy controls. Results: Simulators performed significantly worse on all MOXO-d-CPT indices than healthy controls and ADHD patients. Three MOXO-d-CPT indices (attention, hyperactivity, impulsivity) and a scale combining these indices showed adequate discriminative capacity. Conclusion: The MOXO-d-CPT showed promise for the detection of feigned ADHD and, pending replication, can be employed for this aim in clinical practice and ADHD research.
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Affiliation(s)
| | - Astar Lev
- Bar-Ilan University, Ramat Gan, Israel
| | | | | | | | - Yuri Rassovsky
- Bar-Ilan University, Ramat Gan, Israel.,University of California, Los Angeles, USA
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18
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Elbaum T, Braw Y, Lev A, Rassovsky Y. Attention-Deficit/Hyperactivity Disorder (ADHD): Integrating the MOXO-dCPT with an Eye Tracker Enhances Diagnostic Precision. SENSORS (BASEL, SWITZERLAND) 2020; 20:E6386. [PMID: 33182303 PMCID: PMC7664925 DOI: 10.3390/s20216386] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 11/17/2022]
Abstract
Clinical decision-making may be enhanced when combining psychophysiological sensors with computerized neuropsychological tests. The current study explored the utility of integrating an eye tracker with a commercially available continuous performance test (CPT), the MOXO-dCPT. As part of the study, the performance of adult attention-deficit/hyperactivity disorder (ADHD) patients and healthy controls (n = 43, n = 42, respectively) was compared in the integrated system. More specifically, the MOXO-dCPT has four stages, which differ in their combinations of ecological visual and auditory dynamic distractors. By exploring the participants' performance in each of the stages, we were able to show that: (a) ADHD patients spend significantly more time gazing at irrelevant areas of interest (AOIs) compared to healthy controls; (b) visual distractors are particularly effective in impacting ADHD patients' eye movements, suggesting their enhanced utility in diagnostic procedures; (c) combining gaze direction data and conventional CPT indices enhances group prediction, compared to the sole use of conventional indices. Overall, the findings indicate the utility of eye tracker-integrated CPTs and their enhanced diagnostic precision. They also suggest that the use of attention-grabbing visual distractors may be a promising path for the evolution of existing CPTs by shortening their duration and enhancing diagnostic precision.
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Affiliation(s)
- Tomer Elbaum
- Department of Industrial Engineering and Management, Ariel University, Ariel 40700, Israel;
| | - Yoram Braw
- Department of Psychology, Ariel University, Ariel 40700, Israel
| | - Astar Lev
- Department of Psychology, Bar-Ilan University, Ramat Gan 5290002, Israel; (A.L.); or (Y.R.)
| | - Yuri Rassovsky
- Department of Psychology, Bar-Ilan University, Ramat Gan 5290002, Israel; (A.L.); or (Y.R.)
- Leslie and Susan Gonda (Goldschmied) Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat Gan 5290002, Israel
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA
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19
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Peled J, Cassuto H, Berger I. Processing speed as a marker to stimulant effect in clinical sample of children with high functioning autism spectrum disorder. Nord J Psychiatry 2020; 74:163-167. [PMID: 31686565 DOI: 10.1080/08039488.2019.1686063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background: Patients with co-occurring Attention-Deficit/Hyperactivity Disorder (ADHD) and ASD might benefit from stimulants. There is a progressive increase in prescribing ADHD aimed medications for children diagnosed with Autism Spectrum Disorder (ASD), despite scarce knowledge and no distinct clinical guidelines for that matter.Aim: This study aims to analyze the effect of stimulant on processing speed performance and attention indices in children with ASD and ADHD.Methods: Forty children aged 6-18 years diagnosed with ASD who also met the criteria for ADHD were recruited. All children performed a computerized performance test for the assessment of cognitive attention performance three times: twice while they are drug naïve and once an hour after taking a single dose of 10 mg. methylphenidate (MPH). This performance was compared to a group of children diagnosed with 'ADHD only' without ASD.Results: A significant difference (p < 0.001) was found only in the parameter of measuring cognitive processing speed. This effect is significantly different from the response of the 'ADHD only' group.Conclusions: The reaction to MPH among ASD children is different than among ADHD children. In ASD, MPH significantly improved cognitive processing speed without changing other measured attention parameters. Improving processing speed, might improve every day functioning in children with ASD who also met the criteria for ADHD, in other means than expected. This unique response suggests new research targets for treatment with stimulants in ASD and ADHD children and its influence on cognitive parameters.
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Affiliation(s)
- Julia Peled
- The Hebrew University-Hadassah Medical School, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.,Kaplan Medical Center, Rehovot, Israel
| | - Hanoch Cassuto
- Pediatric Neurology Clinics, Leumit HMO, Jerusalem, Israel
| | - Itai Berger
- Pediatric Neurology, Assuta-Ashdod University Medical Center, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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20
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Friso-van den Bos I, van de Weijer-Bergsma E. Classroom versus individual working memory assessment: predicting academic achievement and the role of attention and response inhibition. Memory 2019; 28:70-82. [PMID: 31645187 DOI: 10.1080/09658211.2019.1682170] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Working memory (WM) is an important predictor for academic learning and achievement. Typically, children's WM is assessed in controlled testing situations, which might not reflect functioning in typical classroom learning situations with natural distractions. In this study, we compared WM performance in controlled and classroom situations and their predictive value for academic achievement. Also, we examined whether performance differences between situations were moderated by attention or response inhibition. In a within-subjects design, primary school children completed visuospatial and verbal WM tasks in two settings (classroom versus controlled individual setting). First, WM functioning was lower in the classroom setting. Second, attention moderated individual differences in this discrepancy between settings, but response inhibition did not. Third, classroom obtained verbal WM scores were the strongest predictors of academic achievement. Our results indicate that classroom assessment of verbal WM provides a more ecologically valid measurement of WM abilities in a real-life learning situation.
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Affiliation(s)
- Ilona Friso-van den Bos
- Department of Pedagogical and Educational Sciences, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, Netherlands.,Department of Educational Sciences, Faculty of Behavioural and Management Sciences, University of Twente
| | - Eva van de Weijer-Bergsma
- Department of Pedagogical and Educational Sciences, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, Netherlands
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21
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Gesser-Edelsburg A, Hamade Boukai R. Does the education system serve as a persuasion agent for recommending ADHD diagnosis and medication uptake? A qualitative case study to identify and characterize the persuasion strategies of Israeli teachers and school counselors. BMC Psychiatry 2019; 19:153. [PMID: 31101094 PMCID: PMC6525420 DOI: 10.1186/s12888-019-2120-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 04/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There has been a steady rise in the use of medication by Israeli school children to treat ADHD, partly due to what seems like school teachers' and counselors' tendency to express positive attitudes towards its use. Therfore it is important to examine the involvement of the school teachers and counselors in the parents' decision-making about giving their children medication. METHODS This study used a qualitative constructivist research method of semi-structured interviews. It included individual interviews with 36 teachers and school counselors and 11 parents of students ages 9-14 from the Jewish and Arab populations. RESULTS Teachers and school counselors use different strategies to encourage parents to have their children diagnosed for ADHD and medicated. First they suggest diagnosis as a necessary step in the best interest of the child, distinguishing between diagnosis and medication to mitigate parents' concerns. In the second stage, teachers normalize the use of medication, as well as framing it as a drug that provides not only a medical treatment but also emotional wellbeing. CONCLUSIONS Teachers and counselors are involved in parents' decision-making process about medicating their children to treat ADHD, which contradicts the education system's guidelines. It is necessary to set clear and explicit limits and guidelines for education system employees so that they do not cross professional and ethical limits.
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Affiliation(s)
- Anat Gesser-Edelsburg
- School of Public Health, University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, 3498838, Haifa, Israel. .,The Health and Risk Communication Research Center, University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, 3498838, Haifa, Israel.
| | - Rasha Hamade Boukai
- 0000 0004 1937 0562grid.18098.38School of Public Health, University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, 3498838 Haifa, Israel
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22
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PANDAS: Paediatric Attention-Deficit/Hyperactivity Disorder Application Software. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9081645] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a common neuropsychiatric disorder that impairs social, academic and occupational functioning in children, adolescents and adults. In South Africa, youth prevalence of ADHD is estimated as 10%. It is therefore necessary to further investigate methods that objectively diagnose, treat and manage the disorder. The aim of the study was to develop a novel method that could be used as an aid to provide screening for ADHD. The study comprised of a beta-testing phase that included 30 children (19 non-ADHD and 11 ADHD) between the ages of 5 and 16 years old. The strategy was to use a tablet-based game that gathered real-time user data during game-play. This data was then used to train a linear binary support vector machine (SVM). The objective of the SVM was to differentiate between an ADHD individual versus a non-ADHD individual. A feature set was extracted from the gathered data and sequential forward selection (SFS) was performed to select the most significant features. The test set accuracy of 85.7% and leave-one-out cross-validation (LOOCV) accuracy of 83.5% were achieved. Overall, the classification accuracy of the trained SVM was 86.5%. Finally, the sensitivity of the model was 75% and this was seen as a moderate result. Since the sample size was fairly small, the results of the classifier were only seen as suggestive rather than conclusive. Therefore, the performance of the classifier was indicative that a quantitative tool could indeed be developed to perform screening for ADHD.
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23
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Slobodin O, Cassuto H, Berger I. Age-Related Changes in Distractibility: Developmental Trajectory of Sustained Attention in ADHD. J Atten Disord 2018; 22:1333-1343. [PMID: 25791438 DOI: 10.1177/1087054715575066] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study investigated age-related changes in sustained attention in children with ADHD and in their typically developed peers. METHOD The study used a Continuous Performance Test (CPT) that includes visual and auditory stimuli serving as distractors. The rate of omission errors was used as a measurement of difficulty in sustained attention. Participants were children and adolescents aged 7 to 18 years (478 with ADHD and 361 without ADHD). RESULTS Both groups of adolescents (with and without ADHD) showed reduced distractibility than younger children from the same group. However, distractibility tended to diminish in non-ADHD adolescents, but not in adolescents with ADHD. CONCLUSION Although part of the difficulties in ADHD could be explained by developmental delay that improves with time, other deficits, such as increased distractibility causing more omission errors, do not show a clear developmental trajectory. The results suggest that deficits in inhibitory control might be the core of ADHD.
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Affiliation(s)
- Ortal Slobodin
- 1 Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Itai Berger
- 1 Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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24
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Wigal T, Brams M, Frick G, Yan B, Madhoo M. A randomized, double-blind study of SHP465 mixed amphetamine salts extended-release in adults with ADHD using a simulated adult workplace design. Postgrad Med 2018; 130:481-493. [PMID: 29809075 DOI: 10.1080/00325481.2018.1481712] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
OBJECTIVES The objective of this paper was to evaluate the efficacy, duration of effect, and tolerability of SHP465 mixed amphetamine salts (MAS) extended-release versus placebo and immediate-release MAS (MAS IR) in adults with attention-deficit/hyperactivity disorder (ADHD). METHODS Adults with ADHD Rating Scale, Version IV (ADHD-RS-IV) scores ≥24 were randomized to SHP465 MAS (50 or 75 mg), placebo, or 25 mg MAS IR in a double-blind, three-period, crossover study using a simulated adult workplace environment. On the final day of each 7-day treatment period, efficacy was assessed for 16 h postdose. Primary efficacy analyses for Permanent Product Measure of Performance (PERMP) total score averaged across all postdose assessments and each postdose time point were conducted in the intent-to-treat population using a mixed linear model. Secondary end-points included PERMP problems attempted and answered correctly and ADHD-RS-IV scores based on clinician ratings of counselor observations using the Time Segment Rating System and participant self-report. Tolerability assessments included treatment-emergent adverse events (TEAEs) and vital signs. RESULTS Least squares mean (95% CI) treatment differences (combined 50/75 mg SHP465 MAS-placebo) significantly favored SHP465 MAS over placebo for PERMP total score averaged across all postdose assessments (18.38 [11.28, 25.47]; P < .0001) and at each postdose assessment (all P < .02). Nominal superiority of MAS IR over placebo for PERMP total score averaged across all postdose assessments was observed (nominal P = .0001); treatment differences between SHP465 MAS and MAS IR were not significant (nominal P = .2443). The two most frequently reported TEAEs associated with SHP465 MAS were insomnia (36.5%) and anorexia (21.2%). Mean increases in pulse and blood pressure with SHP465 MAS exceeded those of placebo. CONCLUSIONS SHP465 MAS (combined 50/75 mg) significantly improved PERMP total score versus placebo, with superiority observed from 2 to 16 h postdose. The tolerability profile of SHP465 MAS was similar to previous reports of SHP465 MAS in adults with ADHD. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT00928148 identifier is NCT00928148.
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Affiliation(s)
| | - Matthew Brams
- b Department of Psychiatry & Behavioral Sciences , Baylor College of Medicine , Houston , TX , USA
| | - Glen Frick
- c Formerly of Global Clinical Development , Shire , Lexington , MA , USA
| | - Brian Yan
- d Biostatistics , Shire , Lexington , MA , USA
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25
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Cohen-Cymberknoh M, Tanny T, Breuer O, Blau H, Mussaffi H, Kadosh D, Gartner S, Salinas A, Bentur L, Nir V, Gur M, Reiter J, Shoseyov D, Kerem E, Berger I. Attention deficit hyperactivity disorder symptoms in patients with cystic fibrosis. J Cyst Fibros 2018; 17:281-285. [DOI: 10.1016/j.jcf.2017.11.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 11/29/2017] [Accepted: 11/30/2017] [Indexed: 02/05/2023]
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26
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Shahaf G, Nitzan U, Erez G, Mendelovic S, Bloch Y. Monitoring Attention in ADHD with an Easy-to-Use Electrophysiological Index. Front Hum Neurosci 2018; 12:32. [PMID: 29449806 PMCID: PMC5799268 DOI: 10.3389/fnhum.2018.00032] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 01/19/2018] [Indexed: 11/13/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) involves characteristic electroencephalographic (EEG) activity. We developed a single-channel EEG marker for attention: the Brain Engagement Index (BEI'). In this study, we evaluated the use of BEI' for distinguishing between ADHD patients and controls, and for monitoring the effect of pharmacological treatment on ADHD patients. The BEI' values of 20 ADHD patients and 10 controls were measured using a 1-min auditory oddball paradigm and a continuous performance test (CPT) task. We showed that CPT BEI' is trait-specific and separates controls from ADHD patients. At the same time, oddball BEI' is state-specific and identifies differences in attention level within the two groups of ADHD participants and controls. The oddball BEI' also associates with response to treatment, after distinguishing between treatment effect and learning/time effect. The combined use of this marker with common computerized tests holds promise for research and clinical use in ADHD. Further work is required to confirm the results of the present study.
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Affiliation(s)
| | - Uri Nitzan
- Shalvata Mental Health Center, Hod HaSharon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Galit Erez
- Shalvata Mental Health Center, Hod HaSharon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomo Mendelovic
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Beer Yaakov Mental Health Center, Beer Yaakov, Israel
| | - Yuval Bloch
- Shalvata Mental Health Center, Hod HaSharon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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27
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Cohen R, Halevy A, Aharon S, Shuper A. Attention Deficit Hyperactivity Disorder in Neurofibromatosis Type 1: Evaluation with a Continuous Performance Test. J Clin Neurol 2018; 14:153-157. [PMID: 29629523 PMCID: PMC5897196 DOI: 10.3988/jcn.2018.14.2.153] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 04/26/2017] [Accepted: 04/26/2017] [Indexed: 12/22/2022] Open
Abstract
Background and Purpose The objective of this study was to determine if the MOXO visual- and vocal-distractors-based continuous performance test distinguishes patients with attention deficit hyperactivity disorder (ADHD) and neurofibromatosis type 1 (NF1) from those without NF1. Methods Thirty-five patients (16 males; mean age 9.91 years) attending a multidisciplinary NF1 clinic completed the MOXO test. The findings were compared to 532 healthy age-matched standardized control subjects (285 males) without ADHD. Results The overall performance in the MOXO text was significantly worse in the NF1 group than in controls (p<0.01), but no group-specific pattern was identified. Impulsivity and hyperactivity were significantly more prominent in males than females (p<0.01). Compared to controls, the NF1 group exhibited significantly more failures to respond to target stimuli in the presence of visual distractors. Conclusions MOXO scores are abnormal in patients with NF1, but the test cannot differentiate between NF1 with ADHD characteristics and ADHD. The test highlights sex differences in ADHD characteristics in NF1. Overreactivity to visual distractors may form part of the attention deficit in NF1.
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Affiliation(s)
- Rony Cohen
- Neurofibromatosis Clinic, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Department of Pediatric Neurology and Epilepsy Center, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ayelet Halevy
- Department of Pediatric Neurology and Epilepsy Center, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Aharon
- Department of Pediatric Neurology and Epilepsy Center, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avinoam Shuper
- Neurofibromatosis Clinic, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Department of Pediatric Neurology and Epilepsy Center, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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28
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Lundervold AJ, Bøe T, Lundervold A. Inattention in primary school is not good for your future school achievement-A pattern classification study. PLoS One 2017; 12:e0188310. [PMID: 29182663 PMCID: PMC5705107 DOI: 10.1371/journal.pone.0188310] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 11/03/2017] [Indexed: 02/07/2023] Open
Abstract
Inattention in childhood is associated with academic problems later in life. The contribution of specific aspects of inattentive behaviour is, however, less known. We investigated feature importance of primary school teachers’ reports on nine aspects of inattentive behaviour, gender and age in predicting future academic achievement. Primary school teachers of n = 2491 children (7–9 years) rated nine items reflecting different aspects of inattentive behaviour in 2002. A mean academic achievement score from the previous semester in high school (2012) was available for each youth from an official school register. All scores were at a categorical level. Feature importances were assessed by using multinominal logistic regression, classification and regression trees analysis, and a random forest algorithm. Finally, a comprehensive pattern classification procedure using k-fold cross-validation was implemented. Overall, inattention was rated as more severe in boys, who also obtained lower academic achievement scores in high school than girls. Problems related to sustained attention and distractibility were together with age and gender defined as the most important features to predict future achievement scores. Using these four features as input to a collection of classifiers employing k-fold cross-validation for prediction of academic achievement level, we obtained classification accuracy, precision and recall that were clearly better than chance levels. Primary school teachers’ reports of problems related to sustained attention and distractibility were identified as the two most important features of inattentive behaviour predicting academic achievement in high school. Identification and follow-up procedures of primary school children showing these characteristics should be prioritised to prevent future academic failure.
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Affiliation(s)
- Astri J. Lundervold
- Department of Biological and Medical Psychology University of Bergen, 5009 Bergen, Norway
- K.G. Jebsen Center for Research on Neuropsychiatric Disorders, University of Bergen, Bergen, Norway
- * E-mail:
| | - Tormod Bøe
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway
| | - Arvid Lundervold
- Neuroinformatics and Image Analysis Laboratory, Neural Networks Research Group, Department of Biomedicine, University of Bergen, Bergen, Norway
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29
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Panagiotidi M, Overton PG, Stafford T. Attention-Deficit Hyperactivity Disorder-Like Traits and Distractibility in the Visual Periphery. Perception 2016; 46:665-678. [DOI: 10.1177/0301006616681313] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
We examined the performance of nonclinical subjects with high and low levels of self-reported attention-deficit hyperactivity disorder (ADHD)-like traits in a novel distractibility paradigm with far peripheral visual distractors, the likely origin of many distractors in everyday life. Subjects were tested on a Sustained Attention to Response Task with distractors appearing before some of the target or nontarget stimuli. When the distractors appeared 80 ms before the targets or nontargets, participants with high levels of ADHD-like traits were less affected in their reaction times than those with lower levels. Reducing the distractor-target or nontarget interval to 10 ms removed the reaction time advantage for the high group. We suggest that at 80 ms, the distractors were cueing the arrival of the target or nontarget, and that those with high levels of ADHD-like traits were more sensitive to the cues. Increased sensitivity to stimuli in the visual periphery is consistent with hyperresponsiveness at the level of the superior colliculus.
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Affiliation(s)
| | - Paul G. Overton
- Department of Psychology, University of Sheffield, Western Bank, UK
| | - Tom Stafford
- Department of Psychology, University of Sheffield, Western Bank, UK
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30
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Peijnenborgh JC, Hurks PP, Aldenkamp AP, van der Spek ED, Rauterberg G, Vles JS, Hendriksen JG. A Study on the Validity of a Computer-Based Game to Assess Cognitive Processes, Reward Mechanisms, and Time Perception in Children Aged 4-8 Years. JMIR Serious Games 2016; 4:e15. [PMID: 27658428 PMCID: PMC5054232 DOI: 10.2196/games.5997] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 07/19/2016] [Indexed: 11/13/2022] Open
Abstract
Background A computer-based game, named Timo’s Adventure, was developed to assess specific cognitive functions (eg, attention, planning, and working memory), time perception, and reward mechanisms in young school-aged children. The game consists of 6 mini-games embedded in a story line and includes fantasy elements to enhance motivation. Objective The aim of this study was to investigate the validity of Timo’s Adventure in normally developing children and in children with attention-deficit/hyperactivity disorder (ADHD). Methods A total of 96 normally developing children aged 4-8 years and 40 children with ADHD were assessed using the game. Clinical validity was investigated by examining the effects of age on performances within the normally developing children, as well as performance differences between the healthy controls and the ADHD group. Results Our analyses in the normally developing children showed developmental effects; that is, older children made fewer inhibition mistakes (r=−.33, P=.001), had faster (and therefore better) reaction times (r=−.49, P<.001), and were able to produce time intervals more accurately than younger children (ρ=.35, P<.001). Discriminant analysis showed that Timo’s Adventure was accurate in most classifications whether a child belonged to the ADHD group or the normally developing group: 78% (76/97) of the children were correctly classified as having ADHD or as being in the normally developing group. The classification results showed that 72% (41/57) children in the control group were correctly classified, and 88% (35/40) of the children in the ADHD group were correctly classified as having ADHD. Sensitivity (0.89) and specificity (0.69) of Timo’s Adventure were satisfying. Conclusions Computer-based games seem to be a valid tool to assess specific strengths and weaknesses in young children with ADHD.
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Rodrigues PFS. Processos Cognitivos Visuoespaciais e Ambiente Visual Circundante: Implicações Educacionais. PSICOLOGIA: TEORIA E PESQUISA 2016. [DOI: 10.1590/0102.3772e3244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Nesta revisão de literatura, abordamos a importância da atenção seletiva, da inibição e da memória de trabalho na aprendizagem das crianças. Começamos por apresentar as suas definições e principais mecanismos funcionais. Apresentamos igualmente conclusões de vários estudos que abordam a importância desses processos, sobretudo em tarefas visuoespaciais. Finalmente, abordamos o papel que o ambiente visual circundante desempenha na aprendizagem, chamando a atenção para uma lacuna que se verifica em grande parte dos estudos: a sua pouca validade ecológica. É também defendido que o ambiente visual externo deve ser considerado nos modelos explicativos dos processos cognitivos básicos. Conclui-se o trabalho alertando para a necessidade de se estudar de forma mais sistemática a relação entre estes dois elementos (cognição e ambiente).
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Oja L, Huotilainen M, Nikkanen E, Oksanen-Hennah H, Laasonen M, Voutilainen A, von Wendt L, Alho K. Behavioral and electrophysiological indicators of auditory distractibility in children with ADHD and comorbid ODD. Brain Res 2015; 1632:42-50. [PMID: 26688114 DOI: 10.1016/j.brainres.2015.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 11/27/2015] [Accepted: 12/02/2015] [Indexed: 11/18/2022]
Abstract
Involuntary switching of attention to distracting sounds was studied by measuring effects of these events on auditory discrimination performance and event-related brain potentials (ERPs) in 6-11-year-old boys with Attention Deficit-Hyperactivity Disorder (ADHD) and comorbid Oppositional Defiant Disorder (ODD) and in age-matched controls. The children were instructed to differentiate between two animal calls by pressing one response button, for example, to a dog bark and another button to a cat mew. These task-relevant sounds were presented from one of two loudspeakers in front of the child, and there were occasional task-irrelevant changes in the sound location, that is, the loudspeaker. In addition, novel sounds (e.g., a sound of hammer, rain, or car horn) unrelated to the task were presented from a loudspeaker behind the child. The percentage of correct responses was lower for target sounds preceded by a novel sound than for targets not preceded by such sound in the ADHD group, but not in the control group. In both groups, a biphasic positive P3a response was observed in ERPs to the novel sounds. The later part of the P3a appeared to continue longer over the frontal scalp areas in the ADHD group than in the controls presumably because a reorienting negativity (RON) ERP response following the P3a was smaller in the ADHD group than in the control group. This suggests that the children with ADHD had problems in reorienting their attention to the current task after a distracting novel sound leading to deterioration of performance in this task. The present study also indicates that children with ADHD and comorbid ODD show same kind of distractibility as found in previous studies for children with ADHD without systematic comorbid ODD.
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Affiliation(s)
- L Oja
- Cognitive Brain Research Unit, Institute for Behavioural Sciences, University of Helsinki, Finland.
| | - M Huotilainen
- Cognitive Brain Research Unit, Institute for Behavioural Sciences, University of Helsinki, Finland; Brain Work Research Centre, Finnish Institute of Occupational Health, Helsinki, Finland
| | - E Nikkanen
- Department of Child Neurology, Hospital for Children and Adolescents, Helsinki University Central Hospital, Finland
| | - H Oksanen-Hennah
- Department of Child Neurology, Hospital for Children and Adolescents, Helsinki University Central Hospital, Finland
| | - M Laasonen
- Division of Cognitive Psychology and Neuropsychology, Institute of Behavioural Sciences, University of Helsinki, Finland; Department of Phoniatrics, Helsinki University Central Hospital, Helsinki, Finland
| | - A Voutilainen
- Department of Child Neurology, Hospital for Children and Adolescents, Helsinki University Central Hospital, Finland
| | - L von Wendt
- Department of Child Neurology, Hospital for Children and Adolescents, Helsinki University Central Hospital, Finland
| | - K Alho
- Division of Cognitive Psychology and Neuropsychology, Institute of Behavioural Sciences, University of Helsinki, Finland; Helsinki Collegium for Advanced Studies, University of Helsinki, Finland; Swedish Collegium for Advanced Study, Uppsala, Sweden
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Brace LR, Kraev I, Rostron CL, Stewart MG, Overton PG, Dommett EJ. Auditory responses in a rodent model of Attention Deficit Hyperactivity Disorder. Brain Res 2015; 1629:10-25. [PMID: 26453290 DOI: 10.1016/j.brainres.2015.09.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/28/2015] [Accepted: 09/29/2015] [Indexed: 01/30/2023]
Abstract
A central component of Attention Deficit Hyperactivity Disorder (ADHD) is increased distractibility in response to visual and auditory stimuli, which is linked to the superior colliculus (SC). Furthermore, there is now mounting evidence of altered collicular functioning in ADHD and it is proposed that a hyper-responsive SC could mediate symptoms of ADHD, including distractibility. In the present study we conducted a systematic characterisation of the intermediate and deep layers of the SC in the most commonly used and well-validated model of ADHD, the spontaneously hypertensive rat (SHR), building on prior work showing increased distractible behaviour in this strain using visual distractors. We examined collicular-dependent orienting behaviour, local field potential (LFP) and multiunit activity (MUA) in response to auditory stimuli in the anaesthetised rat, and morphological measures, in the SHR in comparison to the Wistar Kyoto (WKY) and Wistar (WIS). We found no evidence of increased distractibility in the behavioural data but suggest that this may arise due to cochlear hearing loss in the SHR. Furthermore, the electrophysiology data indicate that the SC in the SHR may still be hyper-responsive, normalising the amplitude of auditory responses that would otherwise be reduced due to the hearing impairment. The morphological measures of collicular volume, cell density and ratios did not indicate this potential hyper-responsiveness had a basis at the structural level examined. These findings have implications for future use of the SHR in auditory processing studies and may represent a limitation to the validity of this animal model.
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Affiliation(s)
- Louise R Brace
- Department of Life, Health and Chemical Sciences, The Open University, Milton Keynes MK7 6AA, UK
| | - Igor Kraev
- Department of Life, Health and Chemical Sciences, The Open University, Milton Keynes MK7 6AA, UK
| | - Claire L Rostron
- Department of Life, Health and Chemical Sciences, The Open University, Milton Keynes MK7 6AA, UK
| | - Michael G Stewart
- Department of Life, Health and Chemical Sciences, The Open University, Milton Keynes MK7 6AA, UK
| | - Paul G Overton
- Department of Psychology, University of Sheffield, Western Bank, Sheffield S10 2TN, UK
| | - Eleanor J Dommett
- Department of Life, Health and Chemical Sciences, The Open University, Milton Keynes MK7 6AA, UK; Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King׳s College London, London SE1 3QD, UK.
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Berger I, Remington A, Leitner Y, Leviton A. Brain development and the attention spectrum. Front Hum Neurosci 2015; 9:23. [PMID: 25698956 PMCID: PMC4318270 DOI: 10.3389/fnhum.2015.00023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 01/11/2015] [Indexed: 12/02/2022] Open
Affiliation(s)
- Itai Berger
- The Neuro-Cognitive Center, Hadassah-Hebrew University Medical Center Jerusalem, Israel
| | - Anna Remington
- Department of Psychology and Human Development, Centre for Research in Autism and Education, Institute of Education, University College London London, UK
| | - Yael Leitner
- Tel Aviv Sourasky Medical Center, Dana-Dwek Children's Hospital, Tel Aviv University Tel Aviv, Israel
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Dubnov-Raz G, Khoury Z, Wright I, Raz R, Berger I. The effect of alpha-linolenic acid supplementation on ADHD symptoms in children: a randomized controlled double-blind study. Front Hum Neurosci 2014; 8:780. [PMID: 25339885 PMCID: PMC4188038 DOI: 10.3389/fnhum.2014.00780] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 09/14/2014] [Indexed: 12/03/2022] Open
Abstract
Background: Attention deficit-hyperactivity disorder (ADHD) is the most common neuro-developmental disorder in childhood. Its pharmacologic treatment mostly includes methylphenidate, yet many parents seek alternative, “natural,” therapeutic options, commonly omega-3 fatty acids. Previous studies of supplementation with fish oil or long-chain omega-3 fatty acids to children with ADHD yielded mixed results. The use of alpha-linolenic acid (ALA), a medium-chained, plant-based omega-3 fatty acid (18:3 n-3), has not been sufficiently examined in this population. Methods: Forty untreated children with ADHD, aged 6–16 years, were randomized to receive either 2 g/day of oil containing 1 g ALA or placebo, for 8 weeks. Before and after supplementation, the children underwent a physician assessment of ADHD symptoms and a computerized continuous performance functions test. The children’s parents and teachers filled out Conners’ and DSM questionnaires. Results: Seventeen (42.5%) children completed the study, eight in the supplementation group, nine in the placebo group. Main drop-out reasons were capsule size, poor compliance, and a sense of lack of effect. No significant difference was found in any of the measured variables tested before and after supplementation, in both study groups. No between-group difference was found in the changes of the various measures of ADHD symptoms throughout the study period. Conclusion: Supplementation of 2 g/day of oil containing 1 g ALA did not significantly reduce symptoms in children with ADHD. Future studies in this field should consider an alternative method to deliver the oil, a higher dose, and a larger sample size.
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Affiliation(s)
- Gal Dubnov-Raz
- Lifestyle, Exercise and Nutrition Clinic, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center Tel Hashomer, Israel ; Sackler Faculty of Medicine, Tel Aviv University Tel Aviv, Israel
| | - Zaher Khoury
- Faculty of Medicine, Hadassah Medical Center - Hebrew University Jerusalem, Israel
| | | | - Raanan Raz
- Department of Environmental Health, Harvard School of Public Health Boston, MA, USA
| | - Itai Berger
- The Neuro-Cognitive Center, Pediatric Division, Hadassah Medical Center - Hebrew University Jerusalem, Israel
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