Fine motor deficits and attention deficit hyperactivity disorder in primary school children

Disentangling the relationships between motor control and cognitive control in young children with symptoms of ADHD

Children with ADHD experience difficulties with motor and cognitive control. However, the relationships between these symptoms are poorly understood. As a step toward improving treatment, this study investigated associations between specific aspects of motor control and cognitive control in children with varying levels of hyperactive-impulsive symptoms. A heterogeneous sample of 255 children of 4 to 10 years of age (median = 6.50, MAD = 1.36) completed a battery of tests probing motor generation, visuomotor fluency, visuomotor flexibility, cognitive inhibition, verbal and visuospatial working memory, and cognitive flexibility. Their caregivers were interviewed regarding their hyperactive-impulsive symptoms. 25.9% of the main sample met diagnostic criteria for ADHD. Multiple linear regression analysis was used to determine whether specific aspects of motor control were associated with specific aspects of cognitive control, and whether any associations were moderated by hyperactive-impulsive symptoms. Additionally, cognitive modeling (the drift diffusion model approximated with EZ-DM) was used to understand performance on a cognitive inhibition task. Visuomotor fluency was significantly associated with cognitive inhibition. Visuomotor flexibility was significantly associated with cognitive flexibility. There were no significant moderation effects. Cognitive modeling was inconclusive. In conclusion, the ability to fluently perform visually guided continuous movement is linked with the ability to inhibit the effects of distracting information. The ability to spontaneously use visual information to flexibly alter motor responses is related to the ability to cognitively shift from one frame of mind to another. These relationships appear to be quantitatively and qualitatively similar across the childhood hyperactive-impulsive continuum as rated by parents.

Associations Between Coordination and Wearable Sensor Variables Vary by Recording Context but Not Assessment Type

Motor coordination is an important driver of development and improved coordination assessments could facilitate better screening, diagnosis, and intervention for children at risk of developmental disorders. Wearable sensors could provide data that enhance the characterization of coordination and the clinical utility of that data may vary depending on how sensor variables from different recording contexts relate to coordination. We used wearable sensors at the wrists to capture upper-limb movement in 85 children aged 6-12. Sensor variables were extracted from two recording contexts. Structured recordings occurred in the lab during a unilateral throwing task. Unstructured recordings occurred during free-living activity. The objective was to determine the influence of recording context (unstructured versus structured) and assessment type (direct vs. indirect) on the association between sensor variables and coordination. The greatest associations were between six sensor variables from the structured context and the direct measure of coordination. Worse coordination scores were associated with upper-limb movements that had higher peak magnitudes, greater variance, and less smoothness. The associations were consistent across both arms, even though the structured task was unilateral. This finding suggests that wearable sensors could be paired with a simple, structured task to yield clinically informative variables that relate to motor coordination.

Atypical Functional Network Properties and Associated Dimensions of Child Psychopathology During Rest and Task Performance

Background

When brain networks deviate from typical development, this is thought to contribute to varying forms of psychopathology. However, research has been limited by the reliance on discrete diagnostic categories that overlook the potential for psychological comorbidity and the dimensional nature of symptoms.

Methods

This study examined the topology of functional networks in association with 4 bifactor-defined psychopathology dimensions-general psychopathology, internalizing symptoms, conduct problems, and attention-deficit/hyperactivity disorder symptoms-via the Child Behavior Checklist in a sample of 3568 children from the ABCD (Adolescent Brain Cognitive Development) Study. Local and global graph theory metrics were calculated at rest and during tasks of reward processing, inhibition, and working memory.

Results

Greater attention-deficit/hyperactivity disorder symptoms were associated with reduced modularity across rest and tasks as well as reduced local efficiency in motor networks at rest. Results survived sensitivity analyses for medication and socioeconomic status. Greater conduct problem symptoms were associated with reduced modularity on working memory and reward processing tasks; however, these results did not persist after sensitivity analyses. General psychopathology and internalizing symptoms showed no significant network associations.

Conclusions

Our findings suggest reduced efficiency in topology in those with greater attention-deficit/hyperactivity disorder symptoms across 4 critical cognitive states, with conduct problems also showing network deficits, although less consistently. This may suggest that modularity deficits are a neurobiological marker of externalizing behavior in children. Such specificity has not been demonstrated before using graph theory metrics and has the potential to redefine our understanding of network deficits in children with psychopathology symptoms.

Fracture rates by medication type in attention-deficit/hyperactive disorder

Background

ADHD is a condition with extensively researched increased risks of psychiatric disorders, traumatic injury, impulsivity, and delayed response times.

Objectives

To analyze the incidences of fractures in patients with ADHD on various medication regimens.

Methods

Using the TriNetX database, we created seven patient cohorts, all of age under 25, based on medication types commonly used for ADHD. The cohorts we created were: no medication use, exclusive use of a -phenidate class stimulant, exclusive use of an amphetamine class stimulant, nonexclusive use of formations of either stimulant, exclusive use of non-stimulant medications approved for ADHD, nonexclusive use, and no medications. We then examined rates while controlling for age, sex, race, and ethnicity.

Results

The comparison of ADHD to neurotypical individuals revealed an increased risk for all fracture types. For the controlled analysis, all but one cohort had significant differences in each fracture type compared to the baseline cohort of ADHD patients without any medication use. Patients in the "phenidate" cohort had an insignificant difference in risk of lower limb fractures. Patients in the "any medication," "-etamine," "stimulant," and "not ADHD" groups all had significant decreased risks for all fracture types, with confidence intervals often overlapping between treatment modalities.

Conclusions

As patients experiment with different medication regimens, providers should be aware of the difference in risk of fracture by medication type. Our results highlight the need for continued research to better discern appropriate medication regimens with the goal of improving overall risk reduction and producing better outcomes for individuals with ADHD.

A Randomized Trial of a Swimming-Based Alternative Treatment for Children with Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) is considered a highly prevalent neurodevelopmental childhood disorder extending from ages 1−2 to 12−13, associated with impairment across multiple domains, including social, emotional, and cognitive functioning. Little is known about alternative treatments for this disorder. Interest has grown in physical activity as a potential intervention for rehabilitating children with ADHD. This study aimed to investigate the impact of adapted swimming activity on cognitive functions, academic performance, and related behavior of Tunisian children with ADHD. The study was conducted on school children aged 9 to 12 years (n = 40, 5 female and 35 male) diagnosed with ADHD. They were randomly assigned to an experimental group (exercise intervention) or the control group. The Hayling test was used to assess cognitive performance, the Children Behavior Check List (CBCL) was used to assess ADHD-related behavior, and the change in reading and numeracy proficiency was assessed pre- and post-intervention. After 12 weeks of the intervention, the results revealed that there were significant improvements in behavior (p < 0.001), inhibition process (p < 0.001), and academic performance (p < 0.001) in the experimental group compared with the control group. These findings suggest that adapted swimming activity may have positive implications for cognitive function, behavior, and academic performance. This research may provide preliminary support for alternative therapeutic interventions that could be used by practitioners. Moreover, the results support active practice of recreational physical activities as a strategy to support children in overcoming ADHD deficiencies.

Retained Primitive Reflexes and Potential for Intervention in Autistic Spectrum Disorders

We provide evidence to support the contention that many aspects of Autistic Spectrum Disorder (ASD) are related to interregional brain functional disconnectivity associated with maturational delays in the development of brain networks. We think a delay in brain maturation in some networks may result in an increase in cortical maturation and development in other networks, leading to a developmental asynchrony and an unevenness of functional skills and symptoms. The paper supports the close relationship between retained primitive reflexes and cognitive and motor function in general and in ASD in particular provided to indicate that the inhibition of RPRs can effect positive change in ASD.

Relationship between Emotional Intelligence, Victimization, and Academic Achievement in High School Students

The study of bullying implies analyzing the emotional competences of students, and it has been demonstrated that this phenomenon is due to the poor management of emotions. This study explores whether high scores in Emotional Intelligence (EI) are positively related to academic performance and negatively to bullying. The sample composition focused on students of Compulsory Secondary Education, formed by 3451 subjects aged between 11 and 18 years (50.88% women and 49.12% men). The selection of the high schools was made for non-random convenience, administering Peer Bullying Questionnaire (CAI), TMM-24 and school grades. To analyze the results, a model of structural equations was used by estimating the maximum likelihood together with the bootstrapping procedure. We concluded that EI stands as a protector against bullying and has a positive impact on academic performance. This infers that having greater clarity, repair and emotional attention correlates with a lower possibility of being bullied, at the same time, a school climate without aggressiveness generates positive links towards the school and towards optimal learning environments.

Effect of Yoga on the Motor Proficiency of Children with Autism Spectrum Disorder and the Feasibility of its Inclusion in Special School Environments

Yoga as a movement-based intervention is increasingly considered to improve the motor skills of children with autism spectrum disorder (ASD). However, there is little evidence of the effect of yoga on their motor skills. The current study aims to explore the effect of group yoga program on motor proficiency of children with ASD and feasibility of its inclusion in special schools. Forty-three children with ASD from four special schools were randomized into yoga (n = 23) and control (n = 20) group. A structured yoga program of 45 min for 12 weeks was delivered by trained yoga teachers who also tracked their daily responses. The Bruininks-Oseretsky Test of Motor Proficiency. Second Edition was used to assess both the groups pre- and postintervention. In conclusion, the study highlighted that yoga appears to have a positive impact on the gross motor rather than fine motor proficiency of children with ASD and is feasible to be delivered as group intervention in special schools.

Attention and Motor Learning in Adult Patients with Neurofibromatosis Type 1

OBJECTIVE

Neurofibromatosis type 1 (NF1) is an autosomal dominant genetic disorder that is associated with cognitive disabilities, including attention and motor learning problems. These disabilities have been extensively studied in children with NF1 but limited studies have been performed in adults.

METHOD

Attention, motor learning and intellectual performance were studied with neuropsychological tasks in 32 adults with NF1 and 32 controls.

RESULTS

The NF1 and control group performed similarly on attention and motor learning tasks, although controls had shorter reaction times than adults with NF1 during the motor learning task (t[60] = -2.20, p = .03). Measures of attention or motor learning were not significantly associated with reduced intellectual performance in NF1.

CONCLUSION

In contrast to many studies in children with NF1, our findings did not provide evidence for presence of attention or motor learning problems in adults with NF1 in neuropsychological tasks. Our observations may be of clinical importance to determine treatment focus in adults with NF1.

Obesity and Attention-Deficit Hyperactivity Disorder

An association between ADHD and obesity has been established throughout the past 20 years via animal model experiments and both correlational and longitudinal studies in humans. However, much remains to be determined regarding causality, developmental course, and effective treatments targeting both conditions. This chapter provides an overview and update on the current state of the science on the relationship between obesity and ADHD; expands the scope of the connection between obesity and ADHD to include behavioral components important to weight regulation - i.e., physical activity, eating behaviors, and sleep; and presents applications of these findings to treatment approaches and future directions.

Individual differences in white matter of the uncinate fasciculus and inferior fronto-occipital fasciculus: possible early biomarkers for callous-unemotional behaviors in young children with disruptive behavior problems

BACKGROUND

Callous-unemotional (CU) behaviors are important for identifying severe patterns of conduct problems (CP). One major fiber tract implicated in the development of CP is the uncinate fasciculus (UF), which connects amygdala and orbitofrontal cortex (OFC). The goals of the current study were to (a) explore differences in the white matter microstructure in the UF and other major fiber tracks between young typically developing (TD) children and those with a disruptive behavior disorder (DBD) and (b) explore, within the DBD group, whether individual differences in these white matter tracts relate to co-occurring CP and CU behaviors.

METHODS

Participants included 198 young children (69% boys, M_age  = 5.66 years; 80% Latinx; 48.5% TD). CU behaviors and CP were measured via a combination of teacher/parent ratings. Non-invasive diffusion-weighted imaging (DWI) was used to measure fractional anisotropy (FA), an indirect indicator of white matter properties.

RESULTS

Relative to TD children, children in the DBD group had reduced FA on four out of the five fiber tracks we examined (except for cingulum and right ILF), even after accounting for whole brain FA, sex, movement, parental income, and IQ. Within the DBD group, no associations were found between CP and reduced white matter integrity across any of the fiber tracks examined. However, we found that even after accounting for CP, ADHD symptomology, and a host of covariates (whole brain FA, sex, movement, parental income, and IQ), CU behaviors were independently related to reduced FA in bilateral UF and left inferior fronto-occipital fasciculus (IFOF) in the DBD group, but this was not the case for TD children.

CONCLUSIONS

Alterations in the white matter microstructure within bilateral UF and left IFOF may be biomarkers of CU behaviors, even in very young children.

Effects of Neurofeedback in Children with Attention-Deficit/Hyperactivity Disorder: A Systematic Review

Attention deficit/hyperactivity disorder (ADHD) is one of the most frequent neurodevelopmental disorders in childhood and adolescence. Choosing the right treatment is critical to controlling and improving symptoms. An innovative ADHD treatment is neurofeedback (NF) that trains participants to self-regulate brain activity. The aim of the study was to analyze the effects of NF interventions in children with ADHD. A systematic review was carried out in the CINAHL, Medline (PubMed), Proquest, and Scopus databases, following the PRISMA recommendations. Nine articles were found. The NF improved behavior, allowed greater control of impulsivity, and increased sustained attention. In addition, it improved motor control, bimanual coordination and was associated with a reduction in theta waves. NF combined with other interventions such as medication, physical activity, behavioral therapy training, or attention training with brain-computer interaction, reduced primary ADHD symptoms. Furthermore, more randomized controlled trials would be necessary to determine the significant effects.

Effectiveness of structured exercises on motor skills, physical fitness and attention in children with ADHD compared to typically developing children-A pilot study

Purpose: Children with ADHD exhibit decrements in fitness levels, motor skill ability and attention. The purpose was to evaluate the benefits of a structured, school-based exercise program on motor skill, physical fitness and attention in children with ADHD. Method: Ten 8–12 year old school boys with ADHD and ten typically developing (TD) were recruited. They underwent a six week structured exercise program which included aerobics, resistance exercises, motor skills and attention training. Results: Following the 6 week, school -based exercise program significant improvements in physical fitness, motor skills and attention were observed in ADHD children compared to the TD children. Additionally, the exercise sessions were acceptable and enjoyable to all children. Conclusion: It is proposed that an exercise program be incorporated in school physical education curriculum. Exercises should be considered, in addition to other forms of intervention, as an essential treatment for improving problems associated with ADHD in school children.

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The structured exercise program was administrated for 45 min per session, over a period of six weeks for a total of eighteen sessions.

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All children improved in motor skill, physical fitness and attention.

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This program can be incorporated within the physical education curriculum as all children found the exercise sessions to be acceptable and more importantly, enjoyable.

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Exercise helped ADHD children to manage their deficits, & also to integrate with their peers within school & community.

Motor Abnormalities in Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder Are Associated With Regional Grey Matter Volumes

Attention-Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) are associated with motor impairments, with some children holding a comorbid diagnosis of Developmental Coordination Disorder (DCD). However, DCD is underdiagnosed in these populations and the volume abnormalities that contribute to explaining these motor impairments are poorly understood. In this study, motor abilities as measured by the Developmental Coordination Disorder Questionnaire (DCDQ) were compared between children with ADHD, children with ASD and typically developing (TD) children, aged 8–12 years old. Additionally, the association between the DCDQ scores (general coordination, fine motor/handwriting, control during movement, total) and regional volume abnormalities were explored in 6 regions of interest (pre-central gyrus, post-central gyrus, inferior parietal cortex, superior frontal gyrus, middle frontal gyrus, medial frontal gyrus), within each group and across all participants. Children with ASD and children with ADHD showed impaired motor abilities in all the DCDQ-derived scores compared to TD children. Additionally, most children with ASD or ADHD had an indication or suspicion of DCD. Within the ASD group, coordination abilities were associated with the volume of the right medial frontal gyrus, and within the ADHD group, the total DCDQ score was associated with the volume of the right superior frontal gyrus. This study underlines the importance of routinely checking motor abilities in populations with ASD or ADHD in clinical practise and contributes to the understanding of structural abnormalities subtending motor impairments in these disorders.

Behavioral rhythm and EEG rhythm to determine timing deficits in attention deficit hyperactivity disorder symptoms

One characteristic of attention deficit hyperactivity disorder (ADHD) is a timing deficit, i.e. difficulty tapping a self-selected pace and keeping the pace. The timing disorder is reported to relate to the frontal brain area. However, optimal means for evaluating this timing deficit and the corresponding neural mechanisms that accompany ADHD symptoms have not been identified. To address the issue, we required participants to tap one key of a keyboard sequentially and to maintain arbitrary tempos of their tapping intervals. We assessed ADHD symptoms using the Adult ADHD Self-Report Scale (ASRS) and evaluated brain activity via electroencephalography (EEG). Behavioral results indicated that the high ASRS group displayed a large inter-tap-interval gap (defined as the distribution of the time difference between the current tapping interval and the last one). Moreover, EEG results indicated that the work-load related brain activity (i.e. frontal beta activity) was higher in the high ASRS group. These results suggest that our tasks and analyses are useful for the evaluation of ADHD symptoms, although it was preliminary due to the small sample size and the non-patient data.