Impaired Memory for Instructions in Children with Attention-Deficit Hyperactivity Disorder Is Improved by Action at Presentation and Recall

Prediction of attention deficit hyperactivity disorder based on explainable artificial intelligence

Accurate assessment of Attention Deficit Hyperactivity Disorder (ADHD) is crucial for the effective treatment of affected individuals. Traditionally, psychometric tests such as the WISC-IV have been utilized to gather evidence and identify patterns or factors contributing to ADHD diagnosis. However, in recent years, the use of machine learning (ML) models in conjunction with post-hoc eXplainable Artificial Intelligence (XAI) techniques has improved our ability to make precise predictions and provide transparent explanations. The objective of this study is twofold: firstly, to predict the likelihood of an individual receiving an ADHD diagnosis using ML algorithms, and secondly, to offer interpretable insights into the decision-making process of the ML model. The dataset under scrutiny comprises 694 cases collected over the past decade in Spain, including information on age, gender, and WISC-IV test scores. The outcome variable is the professional diagnosis. Diverse ML algorithms representing various learning styles were rigorously evaluated through a stratified 10-fold cross-validation, with performance assessed using key metrics, including accuracy, area under the receiver operating characteristic curve, sensitivity, and specificity. Models were compared using both the full set of initial features and a well-suited wrapper-type feature selection algorithm (Boruta). Following the identification of the most suitable model, Shapley additive values were computed to assign weights to each predictor based on their additive contribution to the outcome and to elucidate the predictions. Strikingly, a reduced set of 8 out of the initial 20 variables produced results comparable to using the full feature set. Among the ML models tested, the Random Forest algorithm outperformed others on most metrics (ACC = 0.90, AUC = 0.94, Sensitivity = 0.91, Specificity = 0.92). Notably, the principal predictors, ranked by importance, included GAI - CPI, WMI, CPI, PSI, VCI, WMI - PSI, PRI, and LN. Individual case examples exhibit variations in predictions depending on unique characteristics, including instances of false positives and negatives. Our ML model adeptly predicted ADHD diagnoses in 90% of cases, with potential for further enhancement by expanding our database. Furthermore, the use of XAI techniques enables the elucidation of salient factors in individual cases, thereby aiding inexperienced professionals in the diagnostic process and facilitating comparison with expert assessments. It is important to note that this tool is designed to support the ADHD diagnostic process, where the medical professional always has the final say in decision-making.

Exploring techniques for encoding spoken instructions in working memory: a comparison of verbal rehearsal, motor imagery, self-enactment and action observation

Encoding and recalling spoken instructions is subject to working memory capacity limits. Previous research suggests action-based encoding facilitates instruction recall, but has not directly compared benefits across different types of action-based techniques. The current study addressed this in two experiments with young adults. In Experiment 1, participants listened to instructional sequences containing four action-object pairs, and encoded these instructions using either a motor imagery or verbal rehearsal technique, followed by recall via oral repetition or enactment. Memory for instructions was better when participants used a motor imagery technique during encoding, and when recalling the instructions by enactment. The advantage of using a motor imagery technique was present in both verbal and enacted recall. In Experiment 2, participants encoded spoken instructions whilst implementing one of four techniques (verbal rehearsal, motor imagery, observation of others' actions or self-enactment), and then recalled the instructions by oral repetition or enactment. For both verbal and enacted recall, memory for instructions was least accurate in the rehearsal condition, while the other encoding conditions did not differ from each other. These novel findings indicate similar benefits of imagining, observation and execution of actions in encoding spoken instructions, and enrich current understanding of action-based benefits in working memory.

Key role of Rho GTPases in motor disorders associated with neurodevelopmental pathologies

Growing evidence suggests that Rho GTPases and molecules involved in their signaling pathways play a major role in the development of the central nervous system (CNS). Whole exome sequencing (WES) and de novo examination of mutations, including SNP (Single Nucleotide Polymorphism) in genes coding for the molecules of their signaling cascade, has allowed the recent discovery of dominant autosomic mutations and duplication or deletion of candidates in the field of neurodevelopmental diseases (NDD). Epidemiological studies show that the co-occurrence of several of these neurological pathologies may indeed be the rule. The regulators of Rho GTPases have often been considered for cognitive diseases such as intellectual disability (ID) and autism. But, in a remarkable way, mild to severe motor symptoms are now reported in autism and other cognitive NDD. Although a more abundant litterature reports the involvement of Rho GTPases and signaling partners in cognitive development, molecular investigations on their roles in central nervous system (CNS) development or degenerative CNS pathologies also reveal their role in embryonic and perinatal motor wiring through axon guidance and later in synaptic plasticity. Thus, Rho family small GTPases have been revealed to play a key role in brain functions including learning and memory but their precise role in motor development and associated symptoms in NDD has been poorly scoped so far, despite increasing clinical data highlighting the links between cognition and motor development. Indeed, early impairements in fine or gross motor performance is often an associated feature of NDDs, which then impact social communication, cognition, emotion, and behavior. We review here recent insights derived from clinical developmental neurobiology in the field of Rho GTPases and NDD (autism spectrum related disorder (ASD), ID, schizophrenia, hypotonia, spastic paraplegia, bipolar disorder and dyslexia), with a specific focus on genetic alterations affecting Rho GTPases that are involved in motor circuit development.

Large-scale assessment of 7-11-year-olds' cognitive and sensorimotor function within the Born in Bradford longitudinal birth cohort study

Background: Cognitive ability and sensorimotor function are crucial aspects of children's development, and are associated with physical and mental health outcomes and educational attainment. This paper describes cross-sectional sensorimotor and cognitive function data collected on over 15,000 children aged 7-10 years, collected as part of the Born in Bradford (BiB) longitudinal birth-cohort study. Methodological details of the large-scale data collection process are described, along with initial analyses of the data involving the relationship between cognition/sensorimotor ability and age and task difficulty, and associations between tasks. Method: Data collection was completed in 86 schools between May 2016 and July 2019. Children were tested at school, individually, using a tablet computer with a digital stylus or finger touch for input. Assessments comprised a battery of three sensorimotor tasks (Tracking, Aiming, & Steering) and five cognitive tasks (three Working Memory tasks, Inhibition, and Processing Speed), which took approximately 40 minutes. Results: Performance improved with increasing age and decreasing task difficulty, for each task. Performance on all three sensorimotor tasks was correlated, as was performance on the three working memory tasks. In addition, performance on a composite working memory score correlated with performance on both inhibition and processing speed. Interestingly, within age-group variation was much larger than between age-group variation. Conclusions: The current project collected computerised measures of a range of cognitive and sensorimotor functions at 7-10 years of age in over 15,000 children. Performance varied as expected by age and task difficulty, and showed the predicted correlations between related tasks. Large within-age group variation highlights the need to consider the profile of individual children in studying cognitive and sensorimotor development. These data can be linked to the wider BiB dataset including measures of physical and mental health, biomarkers and genome-wide data, socio-demographic information, and routine data from local health and education services.

EXPRESS: Translating words into actions in working memory: the role of spatial-motoric coding

Research from a working memory perspective on the encoding and temporary maintenance of sequential instructions has established a consistent advantage for enacted over verbal recall. This is thought to reflect action planning for anticipated movements at the response phase. We describe five experiments investigating this, comparing verbal and enacted recall of a series of action–object pairings under different potentially disruptive concurrent task conditions, all requiring repetitive movements. A general advantage for enacted recall was observed across experiments, together with a tendency for concurrent action to impair sequence memory performance. The enacted recall advantage was reduced by concurrent action for both fine and gross concurrent movement with the degree of disruption influenced by both the complexity and the familiarity of the movement. The results are discussed in terms of an output buffer store of limited capacity capable of holding motoric plans for anticipated action.

Attention Deficit Hyperactivity Disorder (ADHD) among elementary students in rural China: Prevalence, correlates, and consequences

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is a widely recognized mental health problem in developed countries but remains under-investigated in developing settings. This study examines the prevalence, correlates, and consequences of ADHD symptoms among elementary school students in rural China.

METHODS

Cross-sectional data were collected from 6,719 students across 120 rural primary schools in China on ADHD symptoms, demographic characteristics, and academic performance in reading and math. ADHD symptoms were evaluated using the caregiver-reported ADHD Rating Scale-IV.

RESULTS

The prevalence of ADHD symptoms was 7.5% in our sample. Male students, students in lower grade levels, and students with lower cognitive ability showed a significantly higher prevalence of ADHD symptoms (ORs = 2.56, 2.06, and 1.84, respectively; p<0.05). Left-behind children showed a significantly lower prevalence of ADHD symptoms than did children who were living with their parents (OR = 0.74, p < 0.05). Adjusted regressions show that students with ADHD symptoms scored 0.12 standardized deviations lower in reading (p < 0.05) and 0.19 standardized deviations lower in math (p < 0.01).

LIMITATIONS

The ADHD Rating Scale-IV is a screening scale rather than a diagnostic test. Caregiver self-report measures also may underestimate ADHD symptoms for our sample.

CONCLUSIONS

ADHD is a common disorder among rural students in China and appears to be contributing to poor academic outcomes. The higher prevalence of ADHD among students with low cognitive ability also suggests that many rural children in China face multifactorial learning challenges. Taken together, the findings indicate a need for educators and policymakers in rural China to develop programs to reduce risk and support students with ADHD symptoms.

Following Instructions in Working Memory: Do Older Adults Show the Enactment Advantage?

OBJECTIVES

In young adults, the ability to verbally recall instructions in working memory is enhanced if the sequences are physically enacted by the participant (self-enactment) or the experimenter (demonstration) during encoding. Here we examine the effects of self-enactment and demonstration at encoding on working memory performance in older and younger adults.

METHOD

Fifty young (18-23 years) and 40 older (60-89 years) adults listened to sequences of novel action-object pairs before verbally recalling them in the correct order. There were three different encoding conditions: spoken only, spoken + demonstration, and spoken + self-enactment. We included two different levels of difficulty to investigate whether task complexity moderated the effect of encoding condition and whether this differed between age groups.

RESULTS

Relative to the spoken only condition, demonstration significantly improved young and older adults' serial recall performance, but self-enactment only enhanced performance in the young adults, and this boost was smaller than the one gained through demonstration.

DISCUSSION

Our findings suggest that additional spatial-motoric information is beneficial for older adults when the actions are demonstrated to them, but not when the individual must enact the instructions themselves.

Large-scale assessment of 7-11-year-olds’ cognitive and sensorimotor function within the Born in Bradford longitudinal birth cohort study

Background: Cognitive ability and sensorimotor function are crucial aspects of children’s development, and are associated with physical and mental health outcomes and educational attainment. The current project forms part of the Born in Bradford (BiB) longitudinal birth-cohort study, and involved measuring sensorimotor and cognitive function in over 15,000 children aged 7-10 years. This paper describes the large-scale data collection process and presents initial analyses of the data, including the relationship between cognition/sensorimotor ability and age and task difficulty, and associations between tasks. Method: Data collection was completed in 86 schools between May 2016 and July 2019. Children were tested at school, individually, using a tablet computer with a digital stylus or finger touch for input. Assessments comprised a battery of three sensorimotor tasks (Tracking, Aiming, & Steering) and five cognitive tasks (three Working Memory tasks, Inhibition, and Processing Speed), which took approximately 40 minutes. Results: Performance improved with increasing age and decreasing task difficulty, for each task. Performance on all three sensorimotor tasks was correlated, as was performance on the three working memory tasks. In addition, performance on a composite working memory score correlated with performance on both inhibition and processing speed. Interestingly, within age-group variation was much larger than between age-group variation. Conclusions: The current project collected computerised measures of a range of cognitive and sensorimotor functions at 7-10 years of age in over 15,000 children. Performance varied as expected by age and task difficulty, and showed the predicted correlations between related tasks. Large within-age group variation highlights the need to consider the profile of individual children in studying cognitive and sensorimotor development. These data can be linked to the wider BiB dataset including measures of physical and mental health, biomarkers and genome-wide data, socio-demographic information, and routine data from local health and education services.

Age-related differences in adults' ability to follow spoken instructions

A growing body of research illustrates that working memory capacity is a crucial limiting factor in our ability to follow spoken instructions. Despite the ubiquitous nature of instruction following throughout the lifespan, how the natural ageing process affects the ability to do so is not yet fully understood. In this study, we investigated the consequences of action at encoding and recall on the ability to follow spoken instructions. Younger (< 30 y/o) and older (> 65 y/o) adults recalled sequences of spoken action commands under presentation and recall conditions that either did or did not involve their physical performance. Both groups showed an enacted-recall advantage, with superior recall by physical performance than oral repetition. When both encoding and recall were purely verbal, older adults' recall accuracy was comparable to that of their younger counterparts. When action was involved at either encoding or recall, however, the difference in performance between the two age groups became pronounced: enactment-based encoding significantly improved younger adults' ability to follow spoken instructions; there was no such advantage for older adults. These data show that spatial-motoric representations disproportionately benefit younger adults' memory performance. We discuss the practical implications of these findings in the context of lifelong learning.

Comparing motor imagery and verbal rehearsal strategies in children's ability to follow spoken instructions

The ability to follow spoken instructions is critical for children's learning in school and relies on the storage and processing of information in working memory. This study compared the effects of two encoding strategies (motor imagery and verbal rehearsal) on children's ability to follow spoken instructions in a working memory paradigm. A total of 146 children aged 7-12 years completed an instruction span task. In this task, children listened to a series of action-object commands and encoded them by either motor imagery or verbal rehearsal. They then attempted to recall the sequence in serial order by either enacted recall or verbal recall. Overall, children's ability to follow spoken instructions increased with age. In all age groups, children showed superior recall of instructions when they imagined the actions compared with verbal rehearsal of the actions during encoding, and this benefit of motor imagery was similar for verbal recall and enacted recall. Younger children reported motor imagery as more helpful than verbal rehearsal for remembering instructions, whereas older children considered verbal rehearsal as more useful. The study provides novel evidence for motor imagery as a superior strategy (relative to verbal rehearsal) for remembering spoken instructions in school-age children.

Brain Mapping Performance as an Occupational Therapy Assessment Aid in Attention Deficit Hyperactivity Disorder

IMPORTANCE

Brain mapping performance (BMP) may provide strong predictors to analyze primary functional outcomes and support occupational therapy with clients with attention deficit hyperactivity disorder (ADHD).

OBJECTIVE

To clarify the value of quantitative electroencephalography to indicate BMP in children with ADHD.

DESIGN

One-year cross-sectional study.

SETTING

Brain Computer Interface Laboratory, Mahidol University, Salaya, Nakhon Pathom, Thailand.

PARTICIPANTS

Thai school-age children with and without ADHD (N = 305).

OUTCOMES AND MEASURES

We used θ relative power in concordance with stepwise multiple regression analysis. Outcomes included measures of 12 brain locations that were compared between children with and without ADHD.

RESULTS

Significant differences were found between the groups, especially for Cz, T3, Fp1, Fz, F4, and F7. According to BMP, the group with ADHD had higher emotional awareness and language comprehension than the group without ADHD.

CONCLUSIONS AND RELEVANCE

Occupational therapy practitioners can use BMP as a valuable tool for setting occupational goals to help children with ADHD improve their social-emotional learning performance in school and in the community. BMP may provide an evaluation to support occupational therapy services for clients with ADHD. The result can be applied in clinical settings by quantitative electroencephalography training.

WHAT THIS ARTICLE ADDS

BMP can be used as a neuropsychological and behavioral assessment tool for setting SMART (specific, measurable, attainable, relevant, and time-oriented) goals for occupational therapy services for clients with ADHD.

Exploring the effects of demonstration and enactment in facilitating recall of instructions in working memory

Across the lifespan the ability to follow instructions is essential for the successful completion of a multitude of daily activities. This ability will often rely on the storage and processing of information in working memory, and previous research in this domain has found that self-enactment at encoding or observing other-enactment at encoding (demonstration) improves performance at recall. However, no working memory research has directly compared these manipulations. Experiment 1 explored the effects of both self-enactment and demonstration on young adults’ (N=48) recall of action-object instruction sequences (e.g. ‘spin the circle, tap the square’). Both manipulations improved recall, with demonstration providing relatively larger boosts to performance across conditions. More detailed analyses suggested that this improvement was driven by improving the representations of actions, rather than objects, in these action-object sequences. Experiment 2 (N=24) explored this further, removing the objects from the physical environment and comparing partial demonstration (i.e. action-only or object-only) with no or full demonstration. The results showed that partial demonstration only benefitted features that were demonstrated, while full demonstration improved memory for actions, objects and their pairings. Overall these experiments indicate how self-enactment, and particularly demonstration, can benefit verbal recall of instruction sequences through the engagement of visuo-motor processes that provide additional forms of coding to support working memory performance.

Forward and backward recall of serial actions: Exploring the temporal dynamics of working memory for instruction

The ability to flexibly retrieve and implement sequences of actions is essential to motor learning and planning. Recent research has indicated that serial memory for instructions is influenced by presentation modality (spoken vs. visual demonstration) and recall modality (verbal vs. enacted recall). The present study extended this work by investigating the impact of recall direction (forward vs. backward), in addition to that of presentation and recall modality, on working memory for instruction sequences in healthy young adults. Experiment 1 (N = 24) showed that adults were more accurate in backward than forward verbal recall following spoken instructions. In contrast, enacted recall was not influenced by recall direction. Experiment 2 (N = 24) used visual demonstration of instruction sequences and found similar performance levels in forward and backward recall. Experiment 3 (N = 24) replicated the findings from Experiment 1 and 2, along with the previous observation of an advantage for demonstrated over spoken presentation. In addition, the beneficial effects of enacted recall and visual demonstration also emerged in an analysis of response times, specifically in reduced preparation and recall duration. Demonstrated instructions improved maintenance of all items while backward recall enhanced memory of later items in the sequence. These findings provide new insights into the cognitive processes and temporal dynamics of working memory for serial actions and instructions.

Following Instructions in Patients With Schizophrenia: The Benefits of Actions at Encoding and Recall

The ability to follow spoken instructions is important to everyday functioning but has seldom been studied in patients with schizophrenia (SZ). Recent evidence suggests that action-based processing may facilitate the ability to follow instructions, which relies largely on working memory. In this study, we tested the hypothesis that SZ patients may also benefit from action-based advantages in following instructions. Forty-eight clinically stable SZ patients and 48 demographic- and IQ-matched controls completed a following spoken instruction span task involving varied encoding and recall conditions. While SZ patients were impaired in the overall performance of following spoken instructions, this deficit could be attributed to working memory impairment. More importantly, SZ patients showed action-based advantages both at the encoding and retrieval stage to the same extent as healthy controls. Specifically, both healthy controls and SZ patients showed improved memory performance when they additionally performed the actions, or watched the experimenter carrying out the actions compared with simply listening to spoken instructions during the encoding stage. During the retrieval stage, memory was improved when they recalled the instructions by physical enactment compared with oral repetition. The present study provides the first empirical evidence for the impairment in the ability to follow instructions in SZ. We have shown that involving action-based processing in the encoding and retrieval stage facilitated memory of instructions, indicating that the enactment advantage in working memory also applies to SZ patients. These findings provide useful insights for clinical interventions and cognitive remediation for SZ patients.

Following instructions in a dual-task paradigm: Evidence for a temporary motor store in working memory

Evidence from dual-task studies suggests that working memory supports the retention and implementation of verbal instructions. One key finding that is not readily accommodated by existing models of working memory is that participants are consistently more accurate at physically performing rather than verbally repeating a sequence of commands. This action advantage has no obvious source within the multi-component model of working memory and has been proposed to be driven by an as yet undetected limited-capacity store dedicated to the temporary maintenance of spatial, motoric, and temporal features of intended movements. To test this hypothesis, we sought to selectively disrupt the action advantage with concurrent motor suppression. In three dual-task experiments, young adults' immediate memory for sequences of spoken instructions was assessed by both action-based and spoken recall. In addition to classic interference tasks known to tax the phonological loop and central executive, motor suppression tasks designed to impair the encoding and retention of motoric representations were included. These required participants to produce repetitive sequences of either fine motor gestures (Experiment 1, N = 16) or more basic ones (Experiments 2, N = 16, and 3, N = 16). The benefit of action-based recall was reduced following the production of basic gestures but remained intact under all other interference conditions. These results suggest that the mnemonic advantage of enacted recall depends on a cognitive system dedicated to the temporary maintenance of motoric representations of planned action sequences.

Hey Teacher, Don't Leave Them Kids Alone: Action Is Better for Memory than Reading

There is no consensus on how the enactment effect (EE), although it is robust, enhances memory. Researchers are currently investigating the cognitive processes underlying this effect, mostly during adulthood; the link between EE and crucial function identified in adulthood such as episodic memory and binding process remains elusive. Therefore, this study aims to verify the existence of EE in 6-10 years old and assess cognitive functions potentially linked to this effect in order to shed light on the mechanisms underlying the EE during childhood. Thirty-five children (15 second graders and 20 fifth graders) were included in this study. They encoded 24 action phrases from a protocol adapted from Hainselin et al. (2014). Encoding occurred under four conditions: Verbal Task, Listening Task, Experimenter-Performed Task, and Subject-Performed Task. Memory performance was assessed for free and cued recall, as well as source memory abilities. ANOVAS were conducted to explore age-related effects on the different scores according to encoding conditions. Correlations between EE scores (Subject-Performed Task/Listening Task) and binding memory scores (short-term binding and episodic memory) were run. Both groups benefited from EE. However, in both groups, performance did not significantly differ between Subject-Performed Task and Experimenter-Performed Task. A positive correlation was found between EE and episodic memory score for second graders and a moderate negative correlation was found between EE and binding scores for fifth graders. Our results confirm the existence of EE in 6 and 10 year olds, but they do not support the multimodal theory (Engelkamp, 2001) or the "glue" theory (Kormi-Nouri and Nilsson, 2001). This suggests instead that episodic memory might not underlie EE during early childhood.