The Attention Network Test Database: ADHD and Cross-Cultural Applications

Stochastic resonance is not required for pink noise to have beneficial effects on ADHD-related performance? The moderate brain arousal model challenged

OBJECTIVE

Random noise, such as white or pink noise, has been shown to have beneficial effects on the performance of individuals with (elevated traits of) ADHD. Both the state regulation deficit (SRD) account and the moderate brain arousal (MBA) model argue that this effect is due to enhanced cognitive arousal. The MBA model specifically attributes this to random noise affecting dopaminergic (DA) transmission via stochastic resonance (SR). However, he requirement of SR and the role of DA have not yet been properly examined. To test this, proper control conditions are needed.

METHOD

To examine the requirement of SR, 60 neurotypical adults with varying levels of ADHD traits performed a slow two-choice reaction time (S1-S2) task in three auditory conditions: pink (random) noise, a pure 100 Hz tone (non-random noise), and silence. All participants also completed the Attention Network Test (ANT) in two conditions (pink noise and silence) to inspect the effect on executive network efficiency which may serve as a proxy measure of DA. ADHD traits were assessed via self-report.

RESULTS

Auditory stimulation improved performance on the S1-S2 task in participants with elevated ADHD traits, however this was the case for both pink noise and the pure tone. Pink noise did not affect executive network efficiency, irrespective of ADHD traits.

CONCLUSIONS

Our results suggest that stochastic resonance is not required for pink noise to have a beneficial effect on ADHD-related performance. Pink noise did not affect our DA proxy measure, however this negative finding should be interpreted with caution. Our results cast doubt on the tenets of the MBA model, warranting further research.

Introducing the portable AttentionTrip: An engaging tool for measuring the networks of attention

BACKGROUND

Measurement of the efficacy of the networks of attention is a frequent component of research in cognitive and clinical neuroscience. Developed in 2002, the Attention Network Test (ANT), has become the most widely used tool for this purpose.

NEW METHOD

In 2017 a more engaging, game-like tool based on the ANT, called the AttentionTrip was described. The network scores from five studies which used AttentionTrip are shown to be robust.

NEWER METHOD

That version of AttentionTrip required a steering wheel and desk-top computer. Here we describe a new, portable version of the AttentionTrip that is administered using a hand-held tablet (iPad) RESULTS: Three samples of participants (total = 44) completed the portable version of AttentionTrip. The network scores generated using the portable AttentionTrip were also robust. Effect sizes compare favourably with those generated by the ANT and the desktop version.

CONCLUSIONS

The findings support the use of the portable AttentionTrip as an alternative to the ANT when user engagement is important, such as when participants are prone to boredom, and when repeated administrations are required.

Real-time cognitive performance metrics derived from a digital therapeutic for inattention predict ADHD-related clinical outcomes: Replication across three independent trials of AKL-T01

AKL-T01 is a digital therapeutic (DTx) that targets attention by generating conflict at dynamically updated difficulty levels during a multitasking game. Clinical trials support AKL-T01's efficacy in attention-deficit/hyperactivity disorder (ADHD), but there is a need to understand how in-game data can be used to monitor patient changes in cognition. We aimed to derive a real-time measure of attention from AKL-T01 gameplay data and validate it against clinical outcomes. Trials of AKL-T01 included: STARS-ADHD-Adult (NCT05183919), a 6-week trial in adults 18 and older (n = 221; M age = 39.9; 70% female); STARS-ADHD-Adolescent (NCT04897074), a 4-week trial in adolescents ages 13-17 (n = 162; M age = 14.4; 41% female); and STARS-ADHD (NCT02674633), a 4-week trial in children ages 8-12 (n = 180; M age = 9.7; 31% female). A cognitive metric was derived from targeting response speed, targeting sensitivity (d-prime), and navigation skill level. Using multiple linear regression models, we analyzed relationships between cognitive metric change and changes in the Test of Variables of Attention (TOVA)-Attention Comparison Score (ACS), controlling for TOVA-ACS baseline, cognitive metric baseline, age, and sex. We explored associations with ADHD symptoms and quality of life. Increases in the cognitive metric significantly predicted increases in TOVA-ACS in the adult (β = 0.16, p < 0.001), adolescent (β = .09, p = 0.007), and pediatric (β = 0.06, p = 0.014) trials. Cognitive metric changes additionally related to self-reported quality of life in adults and clinician-rated ADHD symptoms in adolescents. Findings support the clinical validity of a real-time measure of attention derived from AKL-T01 patient-device interactions.

Test-retest reliability of the attention network test from the perspective of intrinsic network organization

The attention network test (ANT), developed based on the triple-network taxonomy by Posner and colleagues, has been widely used to examine the efficacy of alerting, orienting and executive control in clinical and developmental neuroscience studies. Recent research suggests the imperfect reliability of the behavioural ANT and its variants. However, the classical ANT fMRI task's test-retest reliability has received little attention. Moreover, it remains ambiguous whether the attention-related intrinsic network components, especially the dorsal attention, ventral attention and frontoparietal network, manifest acceptable reliability. The present study approaches these issues by utilizing an openly available ANT fMRI dataset for participants with Parkinson's disease and healthy elderly. The reproducibility of group-level activations across sessions and participant groups and the test-retest reliability at the individual level were examined at the voxel, region and network levels. The intrinsic network was defined using the Yeo-Schaefer atlas. Our results reveal three critical facets: (1) the overlapping of the group-level contrast map between sessions and between participant groups was unsatisfactory; (2) the reliability of alerting, orienting and executive, defined as a contrast between conditions, was worse than estimates of specific conditions. (3) Dorsal attention, ventral attention, visual and somatomotor networks showed acceptable reliability for the congruent and incongruent conditions. Our results suggest that specific condition estimates might be used instead of the contrast map for individual or group-difference studies.

Effects of fruit and vegetable intake on memory and attention: a systematic review of randomized controlled trials

BACKGROUND

Memory and attention are important for daily functioning, and their function deteriorates due to aging. However, fruit and vegetable consumption are one of the protective factors against deterioration in memory and attention. This systematic review of randomized controlled trials (RCTs) aims to identify the effects of fruit and vegetable consumption on memory and attention.

METHODS

We conducted a systematic search in EBSCOhost, ProQuest, PubMed, Embase, and Web of Science from inception up to 06/09/2022. The inclusion criteria were peer-reviewed articles, fruit and vegetable intake measured using randomized controlled trials, and the outcome measures that showed the results of memory and attention scores. Two researchers independently extracted articles that met the selection criteria and evaluated the quality of each study.

RESULTS

There were 70 articles identified from the databases, of which 13 articles met the inclusion criteria and were included in this systematic review. There were 493 participants in total. The results show that consumption of fruit and vegetable intake improved memory and attention in longitudinal studies (10 to 12 weeks). Children showed improvement in immediate recall after supplementation with blueberries. Older adults required a higher dose of fruit and vegetable intake consumption to achieve significant improvement compared with children and younger adults. Furthermore, the effect of fruits and vegetables on memory showed better immediate memory recall than delayed recall.

CONCLUSION

This systematic review showed that there is an improvement in memory and attention with fruit and vegetable intake consumption. Hence, awareness of fruit and vegetable intake consumption is important to maintain cognitive health.

Attentional impairment and altered brain activity in healthcare workers after mild COVID-19

Severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) is highly transmissible and pathogenic. Patients with mild cases account for the majority of those infected with coronavirus disease 2019 (COVID-19). Although there is evidence that many patients with COVID-19 have varying degrees of attentional impairment, little is known about how SARS-COV-2 affects attentional function. This study included a high-risk healthcare population divided into groups of healthcare workers (HCWs) with mild COVID-19 (patient group, n = 45) and matched healthy HCWs controls (HC group, n = 42), who completed general neuropsychological background tests and Attention Network Test (ANT), and underwent resting-state functional magnetic resonance imaging (rs-fMRI) using amplitude of low-frequency fluctuation (ALFF) to assess altered brain activity; Selective impairment occurred in orienting and executive control networks, but not in alert network, in the patient group, and widespread cognitive impairment encompassing general attention, memory, and executive dysfunction. Moreover, the patient group had significantly lower ALFF values in the left superior and left middle frontal gyri than the HC group. SARS-COV-2 infection may have led to reduced brain activity in the left superior and left middle frontal gyri, thus impairing attentional orienting and executive control networks, which may explain the development of attentional deficits after COVID-19.

Molecular signatures of attention networks

Attention network theory proposes three distinct types of attention-alerting, orienting, and control-that are supported by separate brain networks and modulated by different neurotransmitters, that is, norepinephrine, acetylcholine, and dopamine. Here, we explore the extent of cortical, genetic, and molecular dissociation of these three attention systems using multimodal neuroimaging. We evaluated the spatial overlap between fMRI activation maps from the attention network test (ANT) and cortex-wide gene expression data from the Allen Human Brain Atlas. The goal was to identify genes associated with each of the attention networks in order to determine whether specific groups of genes were co-expressed with the corresponding attention networks. Furthermore, we analyzed publicly available PET-maps of neurotransmitter receptors and transporters to investigate their spatial overlap with the attention networks. Our analyses revealed a substantial number of genes (3871 for alerting, 6905 for orienting, 2556 for control) whose cortex-wide expression co-varied with the activation maps, prioritizing several molecular functions such as the regulation of protein biosynthesis, phosphorylation, and receptor binding. Contrary to the hypothesized associations, the ANT activation maps neither aligned with the distribution of norepinephrine, acetylcholine, and dopamine receptor and transporter molecules, nor with transcriptomic profiles that would suggest clearly separable networks. Independence of the attention networks appeared additionally constrained by a high level of spatial dependency between the network maps. Future work may need to reconceptualize the attention networks in terms of their segregation and reevaluate the presumed independence at the neural and neurochemical level.

Changes in the Networks of Attention across the Lifespan: A Graphical Meta-Analysis

Three Posnerian networks of attention (alerting, orienting, and executive control) have been distinguished on the bases of behavioural, neuropsychological, and neuroscientific evidence. Here, we examined the trajectories of these networks throughout the human lifespan using the various Attention Network Tests (ANTs), which were specifically developed to measure the efficacy of these networks. The ANT Database was used to identify relevant research, resulting in the inclusion of 36 publications. We conducted a graphical meta-analysis using network scores from each study, based on reaction time plotted as a function of age group. Evaluation of attentional networks from childhood to early adulthood suggests that the alerting network develops relatively quickly, and reaches near-adult level by the age of 12. The developmental pattern of the orienting network seems to depend on the information value of the spatial cues. Executive control network scores show a consistent decrease (improvement) with age in childhood. During adulthood (ages 19-75), changes in alerting depend on the modality of the warning signal, while a moderate increase in orienting scores was seen with increasing age. Whereas executive control scores, as measured in reaction time, increase (deterioration) from young adulthood into later adulthood an opposite trend is seen when scores are based on error rates.

Attention deficit in primary-school-age children with attention deficit hyperactivity disorder measured with the attention network test: a systematic review and meta-analysis

Objective

To review and meta-analyze patterns of attention deficit in primary-school-age children with ADHD measured with the neuropsychological attention network test (ANT).

Methods

Six electronic databases were searched to 5.05.2022. Selection criteria included prospective cohort and intervention studies; ANT used; primary-school-age; diagnosis of ADHD/at high risk.

Results

Seven studies met inclusion criteria (N = 3,826). Compared with controls, children with ADHD had higher scores for Reaction Time (Hedges' g = 0.433; 95% CI: 0.135-0.731), Reaction Time Variability (Hedges' g = 0.334; 95% CI: 0.012-0.657), and Alerting Network (Hedges' g = 0.235; 95% CI: 0.021-0.449) while children at high risk had higher Alerting Network scores (Hedges' g = 0.176; 95% CI: 0.003-0.349) and Correctness scores (Hedges' g = 1.956; 95% CI: 0.020-3.892).

Conclusions

Children with ADHD and at risk of ADHD had different ANT results from children without ADHD only for the alerting network. There were no significant differences for executive and orienting outcomes. Children at risk of ADHD also made more errors (commission and omission) measured with the ANT compared with children without ADHD. Reaction time was longer and reaction time variability higher in children with ADHD than in children without ADHD, and in children at risk of ADHD compared with children without ADHD.

Preregistration

A protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO) database (registration number: CRD42021249768).

Alerting network, cognitive flexibility in children with attention deficit hyperactivity disorder and the moderating effect of neuroticism

Attention deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder, and cognitive flexibility is a sub-component of executive functioning. Studies have shown impairments in cognitive flexibility in ADHD, which is affected by attentional processes. Personality, as a long-standing trait, has a profound effect on ADHD. However, previous studies have not assessed the relationship between attentional function, personality traits, and cognitive flexibility in children with ADHD. This study explored the association between attention networks, personality, and cognitive flexibility in ADHD, filling a gap in the related field. We expect our findings will provide insights into and clues for the prevention and interventional treatment of ADHD. This study primarily aimed to analyze differences in cognitive flexibility between individuals with ADHD and those without and further examine associations between attention networks, personality, and cognitive flexibility in children with ADHD. Overall, 55 children aged 7 to 11 years diagnosed with ADHD and 40 children without ADHD participated in this study. Cognitive flexibility, personality traits, and attentional networks were assessed using the Wisconsin Card Sorting Test, Eysenck Personality Questionnaire, and Attention Network Test, respectively. Additionally, the association between personality traits and strong attentional functioning and cognitive flexibility was investigated using multiple regression analysis. Children with ADHD had significant deficits in cognitive flexibility. A multiple regression analysis revealed that the alerting effect was highly associated with cognitive flexibility at high levels of neuroticism. This association was not salient in individuals with low levels of neuroticism. This study demonstrated that the ADHD group experienced lower cognitive flexibility than the control group. In addition, we showed the effect of neuroticism and alerting networks on cognitive flexibility. These findings may help psychiatrists provide intervention strategies to mitigate the impairment of social functioning in ADHD with cognitive spirituality deficits.

Dorsolateral prefrontal cortex dysfunction caused by a go/no-go task in children with attention-deficit hyperactivity disorder: A functional near-infrared spectroscopy study

Background

Children with attention-deficit hyperactivity disorder (ADHD) exhibit executive function deficits, which can be attributed to a dysfunction in the prefrontal region of the brain. Our study aims to evaluate the alteration of brain activity in children with ADHD during the administration of a go/no-go task using functional near-infrared spectroscopy (fNIRS) in comparison to a control group containing typically developing (TD) children.

Methods

32 children with ADHD and 31 of their TD peers were recruited and asked to perform a go/no-go task while undergoing measurements, with the aim of detecting changes in average oxygenated hemoglobin signaling (Δavg oxy-Hb) via fNIRS in the prefrontal lobe.

Results

fNIRS data showed significant differences between the left and right dorsolateral prefrontal cortices, with a lower Δavg oxy-Hb change in the ADHD group compared to the TD group.

Conclusion

Our results indicate that brain dysfunction in children with ADHD is related to functional impairments in the dorsolateral prefrontal cortex. The go/no-go task paired with fNIRS represents a useful measurement tool to assess prefrontal brain dysfunction in children struggling with ADHD.

Searching for a Relationship between Early Breastfeeding and Cognitive Development of Attention and Working Memory Capacity

Previous research consistently reported that subjects that were exclusively breastfed (eBF) vs. not-exclusively breastfed (neBF) during infancy (0-6 months) showed increased scores of general intelligence measures (e.g., the intelligence quotient). However, the existent literature largely neglected whether breastfeeding also affects specific cognitive processes, such as attention and working memory (WM) capacity. We tested whether eBF vs. neBF subjects showed performance differences in relation to these two core cognitive functions. The Attention Network Test (ANT), to measure alerting, orienting, and conflict, and the Change Colour Task (CCT), to measure visuospatial WM capacity, were administered to 144 participants divided according to age (6-, 10-, and 18-year-old participants) and breastfeeding (eBF or neBF during 0-6 months of life). Importantly, the sub-groups were homogenous in terms of maternal education, a factor potentially affecting the relation between breastfeeding and cognition. While we found increased performance as a function of participants' age in both tasks, we failed to observe effects related to breastfeeding, as evidenced by Bayesian analyses. These findings highlight for the first time that the pattern of nutrition provided during early infancy does not appear to affect the development of attention and WM capacity, at least starting from the age considered in the present study.

Exploration of Brain-Computer Interaction for Supporting Children's Attention Training: A Multimodal Design Based on Attention Network and Gamification Design

Recent developments in brain-computer interface (BCI) technology have shown great potential in terms of estimating users' mental state and supporting children's attention training. However, existing training tasks are relatively simple and lack a reliable task-generation process. Moreover, the training experience has not been deeply studied, and the empirical validation of the training effect is still insufficient. This study thusly proposed a BCI training system for children's attention improvement. In particular, to achieve a systematic training process, the attention network was referred to generate the training games for alerting, orienting and executive attentions, and to improve the training experience and adherence, the gamification design theory was introduced to derive attractive training tasks. A preliminary experiment was conducted to set and modify the training parameters. Subsequently, a series of contrasting user experiments were organized to examine the impact of BCI training. To test the training effect of the proposed system, a hypothesis-testing approach was adopted. The results revealed that the proposed BCI gamification attention training system can significantly improve the participants' attention behaviors and concentration ability. Moreover, an immersive, inspiring and smooth training process can be created, and a pleasant user experience can be achieved. Generally, this work is promising in terms of providing a valuable reference for related practices, especially for how to generate BCI attention training tasks using attention networks and how to improve training adherence by integrating multimodal gamification elements.

Visual-Spatial Attentional Performance Identifies Lower Extremity Injury Risk in Adolescent Athletes

OBJECTIVE

Strategies to identify lower extremity musculoskeletal (LEMSK) injury risk have been informed by prospectively identified biomechanical and neuromuscular risk factors. Emergent evidence suggests that cognitive and oculomotor performance may also contribute to LEMSK injury. The purpose of this study was to determine whether prospective cognitive and oculomotor measures identify adolescent athletes who sustain an in-season LEMSK injury.

DESIGN

Prospective longitudinal study.

SETTINGS

Controlled laboratory and athletic event settings.

PARTICIPANTS

Four hundred eighty-eight adolescent male football and female soccer athletes aged 13 to 18 years.

ASSESSMENT OF RISK FACTORS

Preseason baseline cognitive and oculomotor performance: Attention Network Task (ANT), cued task switching, King-Devick test, and near point of convergence.

MAIN OUTCOME MEASURE

Incidence of LEMSK sprains and strains during a single competitive season.

RESULTS

Attention Network Task-orienting network reaction time (RT) was the only cognitive or oculomotor measure significantly associated with LEMSK injury [B = 1.015, 95% confidence interval (CI): 1.01-1.024, P < 0.01]. Every 10 milliseconds increase in orienting network RT was associated with a 15% increased risk for LEMSK injury. Athletes demonstrating an orienting network RT ≥ 32.8 milliseconds had a higher risk for LEMSK injury relative to athletes below the cut-point (relative risk, 2.62; 95% CI, 1.52-4.52; odds ratio, 3.00; 95% CI, 1.63-5.52).

CONCLUSIONS

Deficits in visual-spatial components of attention were associated with 2.62 times greater risk for LEMSK injury in adolescent athletes. The present results add evidence to suggest that visual-spatial attentional processing contributes to LEMSK injury and may supplement previously established LEMSK injury risk assessments.

Attention deficit in children with attention deficit hyperactivity disorder at primary school age measured with the attention network test (ANT): A protocol for a systematic review and meta-analysis

Background

Attentional deficits are among the most bothersome symptoms of attention deficit hyperactivity disorder (ADHD). To date, the neurological basis of attentional deficits has not been fully described according to the diagnostic criteria. ADHD may result from deficits in various attributes of attention. There is no specialist neuropsychological diagnostic method that allows reliable distinction between primary attention disorders in the etiology of ADHD and secondary problems that may arise due to co-morbidities. This protocol aims to systematically review the literature to evaluate patterns of attention common to school-age children either diagnosed with ADHD or at high risk of ADHD, as measured by the neuropsychological attention network test (ANT).

Methods

Our search strategy will consist of electronic databases (PubMed, PsychInfo, Web of Science, EMBASE, and Cochrane Library) and hand searching. Both prospective cohort studies and prospective studies of intervention effects will be included, provided they used the ANT. The primary output variable will be attention deficits. Screening and eligibility will be done independently by two reviewers based on pre-specified eligibility criteria. Data extraction will be based on a pre-pilot data extraction form and conducted by two authors independently. The risk of bias will be assessed by two authors independently. The rating of the certainty of the entire body of evidence will be evaluated using the GRADE approach. Any discrepancies identified at any stage of the review will be resolved by discussion or/and consultation with another reviewer. We plan a narrative synthesis of findings and a quantitative meta-analysis if the data allow.

Discussion

The research will identify patterns of neuropsychological ANT results characteristic of both school-age children diagnosed with ADHD and those at high risk of having ADHD. Our results could be used to check whether the pattern of a child’s performance in the ANT corresponds to the characteristic pattern of the results of children with ADHD. At present, the ANT is used only in research; the results of this review will serve as a useful benchmark. Hopefully, in the future, it will be possible to use the ANT in the wider diagnosis of ADHD.

Systematic review registration

PROSPERO: CRD42021249768.

Goal management training improves executive control in adults with ADHD: an open trial employing attention network theory to examine effects on attention

Background

Adults with Attention-Deficit/Hyperactivity Disorder (ADHD) typically experience poorer attentional control. According to the attention network theory, attentional control relies on three interacting networks of alerting, orienting, and executive control. In ADHD, it is mainly the alerting and executive control networks that are suggested and found to be compromised.

Methods

In the current study, we investigated if a group-based metacognitive remediation program (Goal Management Training [GMT]) in adults with ADHD would enhance attentional control using an experimental measure of the attention network theory. We expected that GMT would specifically enhance the executive control and alerting networks.

Results

Data from post- and follow up-assessments of 21 adults (age: 39.05 [11.93]) with ADHD who had completed GMT were included. Linear mixed-effects modeling revealed significant improvements in the functioning of the executive control network for the majority of the participants, although a small subset of participants showed a negative development following the intervention. Results also showed an improvement in the orienting network at follow up, but no change in the alerting network.

Conclusion

The results may indicate that improvements in the functioning of the executive control network are central to the positive effects of GMT reported in disorders characterized by impaired attentional control.

Trial registration: The study was retrospectively registered in the ISRCTN (Identifier: ISRCTN91988877) on the 18/01/2021.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-022-00902-9.

EXPRESS: Self-Relevance and the Activation of Attentional Networks

Recent theoretical accounts maintain that core components of attentional functioning are preferentially tuned to self-relevant information. Evidence in support of this viewpoint is equivocal, however, with research overly reliant on personally significant (i.e., familiar) stimulus inputs (e.g., faces, forenames) and a diverse range of methodologies. Addressing these limitations, here we utilized arbitrary items (i.e., geometric shapes) and administered the Attention Network Test (ANT) to establish the extent to which self-relevance (vs. friend-relevance) moderates the three subsystems of attentional functioning - alerting, orienting, and executive control. The results revealed that only executive control was sensitive to the meaning of the stimuli, such that conflict resolution was enhanced following the presentation of self-associated compared to friend-associated shapes (i.e., cues). Probing the origin of this effect, a further computational analysis (i.e., Shrinking Spotlight Diffusion Model analysis) indicated that self-relevance facilitated the narrowing of visual attention. These findings highlight when and how the personal significance of otherwise trivial material modulates attentional processing.

Thinking about attention: Successive approximations to a productive taxonomy

Attention, the recruitment of processing resources, is viewed as pivotal for understanding normal behaviour and thought as well as the disorganizations associated with brain damage and disease. A brief history foreshadows aspects of a proposed taxonomy of attention that builds upon Posner's tripartite taxonomy. Posner's influential taxonomy views attention as a set of isolable neural systems (alerting, orienting and executive control), often working together to organize behaviour. For measuring the efficacy of these three networks, Posner and colleagues created the Attention Network Test (ANT). The impact of the taxonomy and this model task for exploring it is illustrated by the facts that they have spawned numerous variants designed for different purposes and that one or another variant has been used in almost a thousand publications. We have previously built upon this conceptual framework by considering: two modes of control over resource allocation which we labelled exogenous and endogenous and three domains over which these modes of control are presumed to operate (space, time and task or activity). The Combined Attention Systems Test (or CAST) was developed to measure the efficacy of the six kinds of attention implied by revised taxonomy. Lastly, this taxonomic effort is further developed by incorporating the distinction between overt, observable behaviour in the "real" world and covert "behaviour" in the realm of thought and imagination.

Cognitive Control Deficits in Children With Subthreshold Attention-Deficit/Hyperactivity Disorder

Subthreshold Attention-Deficit/Hyperactivity Disorder (ADHD) is defined as a neurobiological condition with some core inattentive or hyperactive/impulsive symptoms of ADHD which do not meet the full diagnosis clinically. Although it has been well documented that deficits in cognitive control, a high-level cognitive construct closely related to attention, are frequently found among children with ADHD, whether subthreshold ADHD is also associated with similar deficits remains unclear. In this study, we examined the attention functions and the cognitive control capacity (CCC) in children with ADHD (n = 39), those with subthreshold ADHD (n = 34), and typically developing peers (TD, n = 36). The results showed that the ADHD and subthreshold ADHD groups exhibited similar patterns of the impaired executive function of attention (revealed as an augment in flanker conflict effect) and reduced cognitive control capacity, and no significant difference was found between the two groups. These findings suggest that although children with subthreshold ADHD have not met the full criteria of ADHD, they showed reduced efficiency in cognitive control and attention function, similar to children with ADHD.

Development of attentional networks during childhood and adolescence: A functional MRI study

Attention ability is one of the most important cognitive functions. It develops mainly during school age. However, the neural basis for the typical development of attentional functions has not been fully investigated. To clarify the development of the aforementioned function and its neural basis, this study examined brain function in children and adolescents during the performance of an attention network test (ANT) using functional magnetic resonance imaging. One hundred and sixty‐three volunteers (8‐23 years, 80 female) participated in this study. Using a modified version of ANT, we assessed the efficiency of two attentional functions—orienting and executive attention—by measuring how reaction time is affected by spatial cue location and flanker congruency and examined the functional brain areas—attentional networks—associated with two attentional functions. Consistent with the findings of previous studies, the superior parietal lobule, visual association cortex, left precentral gyrus, and supplementary motor area were activated during the orienting attention, while the anterior cingulate cortex, visual association cortex, lateral prefrontal cortex, thalamus, and caudate were activated during the executive attention. Moreover, negative correlations with age were found for activations in the inferior frontal gyrus, dorsomedial prefrontal cortex, and caudate nucleus in the orienting attention, while no correlations with age related to executive attention were found. In conclusion, this study revealed common and distinct features in the neural basis of the attentional functions in children and adolescents compared with that of adults and their developmental changes with age.

Consistent with the findings of previous studies, the superior parietal lobule, visual association cortex, left precentral gyrus, and supplementary motor area were activated during the orienting process of attention, while the anterior cingulate cortex, visual association cortex, lateral prefrontal cortex, thalamus, and caudate were activated during the executive process. In addition, negative correlations with age were found for activations in the inferior frontal gyrus, dorsomedial prefrontal cortex, and caudate nucleus in the orienting process, while no correlations with age were found during the executive process.

Interactive modulations between congruency sequence effects and validity sequence effects

Sequential modulations have been found in both conflict and spatial orienting tasks. The former is called congruency sequence effects (CSE) and the latter is called validity sequence effects (VSE). Although the two effects have similar phenomenon descriptions, the relationship of the cognitive control mechanisms under the two effects is still unclear. Using a modified attentional network test (ANT), a flanker task and an arrow cueing task are integrated into a single task, which enables the test of the possible interactions between CSE and VSE. Since a confound-minimized design is used, the observed sequence effects cannot be attributed to the feature integration of low-level stimulus features or the contingency learning. It was found that the CSE are only significant when the arrow cue in preceding trial is invalid, and the VSE are only significant when the target letter in preceding trial is congruent with the distractor letters. The findings suggest that the sequential modulations during orienting and executive control of attention networks are highly interacted with each other, and the sequence effects in these networks are possibly controlled by a complex and multifaceted adaptive control mechanism.

Comparing saccadic and manual responses in the attention network test

Attention is proposed to be a system of multiple functional networks, including alertness, orienting and executive control. A popular experimental paradigm for testing these networks and their interactions within a single design is the Attentional Networks Test (ANT) (Fan et al., 2002). The role of the oculomotor system in these various networks, however, has not been tested despite the strong link between attention and eye movements. We modified the executive control component of the manual response ANT version (ANTm) that allows testing the networks' involvement with oculomotor responses. Specifically, we used a central target to signal pro or anti-saccades that allows us to match the saccadic response compatibility of the original ANTm. We conducted three experiments to compare interactions of the networks between the traditional ANTm that used a flanker task response, our new ANTs with saccadic responses signalled with a fixation arrow, and a manual response version with the response arrow at fixation (ANTf). Results for all three experiments showed typical main effects of all three attention networks, but we observed differences in their interactions. The ANTm showed only an interaction of alerting enhancing the orienting; ANTs showed a congruency by orienting interaction with the orienting effect only observed for pro-saccades. The ANTf showed both alerting by orienting, and orienting by congruency. Although the saccadic response did differ from the original ANTm, key differences were also highlighted by the switch from peripheral to central target. Overall the proposed ANTf is a valid tool to test main effects of attentional networks. Further investigation of interaction differences between manual and oculomotor systems is required.

Disentangling language status and country-of-origin explanations of the bilingual advantage in preschoolers

Bilingual preschoolers from East Asia outperform monolingual preschoolers from North America or Europe in executive functioning tasks, which has been interpreted as evidence of a bilingual advantage in executive functioning. This study tested whether these differences actually reflect country-of-origin effects given that East Asian preschoolers frequently outperform North American or European children in executive functioning tasks. Consistent with previous findings, Korean-English bilingual preschoolers made fewer errors in an age-appropriate executive functioning task than did English monolingual children in Canada. However, Korean-English bilingual preschoolers performed comparably to Korean monolingual preschoolers in Korea. Differences between Korean and Canadian children's executive functioning were not attributable to differences in parental cultural values or attitudes. The current findings suggest that differences between East Asian bilingual and North American monolingual preschoolers' executive functioning is related to differences in country of origin rather than language status.

How do we measure attention? Using factor analysis to establish construct validity of neuropsychological tests

We investigated whether standardized neuropsychological tests and experimental cognitive paradigms measure the same cognitive faculties. Specifically, do neuropsychological tests commonly used to assess attention measure the same construct as attention paradigms used in cognitive psychology and neuroscience? We built on the “general attention factor”, comprising several widely used experimental paradigms (Huang et al., 2012). Participants (n = 636) completed an on-line battery (TestMyBrain.org) of six experimental tests [Multiple Object Tracking, Flanker Interference, Visual Working Memory, Approximate Number Sense, Spatial Configuration Visual Search, and Gradual Onset Continuous Performance Task (Grad CPT)] and eight neuropsychological tests [Trail Making Test versions A & B (TMT-A, TMT-B), Digit Symbol Coding, Forward and Backward Digit Span, Letter Cancellation, Spatial Span, and Arithmetic]. Exploratory factor analysis in a subset of 357 participants identified a five-factor structure: (1) attentional capacity (Multiple Object Tracking, Visual Working Memory, Digit Symbol Coding, Spatial Span), (2) search (Visual Search, TMT-A, TMT-B, Letter Cancellation); (3) Digit Span; (4) Arithmetic; and (5) Sustained Attention (GradCPT). Confirmatory analysis in 279 held-out participants showed that this model fit better than competing models. A hierarchical model where a general cognitive factor was imposed above the five specific factors fit as well as the model without the general factor. We conclude that Digit Span and Arithmetic tests should not be classified as attention tests. Digit Symbol Coding and Spatial Span tap attentional capacity, while TMT-A, TMT-B, and Letter Cancellation tap search (or attention-shifting) ability. These five tests can be classified as attention tests.

Diverse patterns of vulnerability to visual illusions in children with neurodevelopmental disorders

Research on how children with neurodevelopmental disorders perceive, process, and interpret visual illusions (VIs) has been extensively focused on children with autism spectrum disorder providing controversial findings. In this study, we investigated the patterns of vulnerability to a wide set of VIs comprising 23 standard text book VIs and their variations in a clinical sample of children with neurodevelopmental disorders compared to typically developing children (TD). A total of 176 children, aged between 4.6 and 13.8 years old, were distributed into four groups: high-functioning autism (HFA; N = 23), attention-deficit/hyperactivity disorder (ADHD; N = 42), specific learning disorder (SLD; N = 70), and TD (N = 41). Regression models, adjusted for sex, age, and non-verbal IQ, showed that HFA was associated with greater responses accuracy than TD children to the full battery of VIs, to the cognitive illusions, to the distortions, and to both geometrical illusions of size/shape (cognitive distortions) and lightness contrast effects (physical distortions). The susceptibility of ADHD children was found attenuated for illusory contours and greater for paradoxical illusions in comparison with TD children. No significant differences were shown between the SLD group and the TD children. Our findings, which were adjusted for the same duration of visual working memory across groups, showed that there is a potential specific tendency of HFA children to failure of processing visual information in context. Contrarily, children with ADHD showed in general normal global processing such as children diagnosed with SLD.

Attentional networks, vigilance, and distraction as a function of attention-deficit/hyperactivity disorder symptoms in an adult community sample

Attentional difficulties are a core axis in attention-deficit/hyperactivity disorder (ADHD). However, establishing a consistent and detailed pattern of these neurocognitive alterations has not been an easy endeavour. Based on a dimensional approach to ADHD, the present study aims at comprehensively characterizing three key attentional domains: the three attentional networks (alerting, orienting, and executive attention), two components of vigilance (executive and arousal vigilance), and distraction. To do so, we modified a single, fine-grained task (the ANTI-Vea) by adding irrelevant distractors. One hundred and twenty undergraduates completed three self-reports of ADHD symptoms in childhood and adulthood and performed the ANTI-Vea. Despite the low reliability of some ANTI-Vea indexes, the task worked successfully. While ADHD symptoms in childhood were related to alerting network and arousal vigilance, symptoms in adulthood were linked to executive vigilance. No association between ADHD symptom severity and executive attention and distraction was found. In general, our hypotheses about the relationships between ADHD symptoms and attentional processes were partially supported. We discuss our findings according to ADHD theories and attention measurement.

The efficacy of real-time functional magnetic resonance imaging neurofeedback for psychiatric illness: A meta-analysis of brain and behavioral outcomes

Real-time functional magnetic resonance imaging neurofeedback (rtfMRI-NF) has gained popularity as an experimental treatment for a variety of psychiatric illnesses. However, there has yet to be a quantitative review regarding its efficacy. Here, we present the first meta-analysis of rtfMRI-NF for psychiatric disorders, evaluating its impact on brain and behavioral outcomes. Our literature review identified 17 studies and 105 effect sizes across brain and behavioral outcomes. We find that rtfMRI-NF produces a medium-sized effect on neural activity during training (g = .59, 95 % CI [.44, .75], p < .0001), a large-sized effect after training when no neurofeedback is provided (g = .84, 95 % CI [.37, 1.31], p = .005), and small-sized effects for behavioral outcomes (symptoms g = .37, 95 % CI [.16, .58], p = .002; cognition g = .23, 95 % CI [-.33, .78], p = .288). Mixed-effects analyses revealed few moderators. Together, these data suggest a positive impact of rtfMRI-NF on brain and behavioral outcomes, although more research is needed to determine how rtfMRI-NF works, for whom, and under what circumstances.

Effects of fatigue on attention and vigilance as measured with a modified attention network test

As part of a larger study on the effects of fatigue on various attentional and behavioural measures, we had participants complete a modified version of Luna et al.'s (J Neurosci Methods 306:77-87, Luna et al., J Neurosci Methods 306:77-87, 2018) ANTI-Vea task (mANTI-Vea) at the beginning and end (pre/post) of each of two 8-h testing sessions. Between these administrations of the mANTI-Vea our participants spent ~ 6 h performing an intervening task. Our intent in this project was two-fold: first, to replicate the pattern of effects reported in Luna et al.'s original presentation of the ANTI-Vea; second, to assay the impact of fatigue on vigilance and attention by observing shifts in mANTI-Vea performance as a function of time on task and before versus after the intervening task. With time-on-task (the mANTI-Vea is divided into six sub-blocks) we observed that participants became increasingly conservative in their biases to respond towards infrequent targets, showed a decline in sensitivity, and lapsed in responding in the psychomotor vigilance task with greater frequency. In the pre/post comparison, we observed an increase in the proportion of lapses, but not in participants' response biases. Attentional network scores were found to be somewhat insensitive to our fatigue manipulations; the effect of time-on-task was only significant for orienting scores on RT, and our pre/post comparison was only significant for RT derived executive functioning scores.