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Muskens JB, Ester WA, Klip H, Zinkstok J, van Dongen-Boomsma M, Staal WG. Novel Insights into Somatic Comorbidities in Children and Adolescents Across Psychiatric Diagnoses: An Explorative Study. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01587-w. [PMID: 37656290 DOI: 10.1007/s10578-023-01587-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/02/2023]
Abstract
Many children with psychiatric disorders display somatic symptoms, although these are frequently overlooked. As somatic morbidity early in life negatively influences long-term outcomes, it is relevant to assess comorbidity. However, studies of simultaneous psychiatric and somatic assessment in children are lacking. The aim of this study was to assess the prevalence of somatic comorbidities in a clinical sample of children and adolescents with psychiatric disorders in a naturalistic design. Data were assessed from 276 children with various psychiatric disorders (neurodevelopmental disorders, affective disorders, eating disorders and psychosis) aged 6-18 years. These data were collected as part of routine clinical assessment, including physical examination and retrospectively analyzed. For a subsample (n = 97), blood testing on vitamin D3, lipid spectrum, glucose and prolactin was available. Results of this cross-sectional study revealed that food intake problems (43%) and insomnia (66%) were common. On physical examination, 20% of the children were overweight, 12% displayed obesity and 38% had minor physical anomalies. Blood testing (n = 97) highlighted vitamin D3 deficiency (< 50 nmol/L) in 73% of the children. None of the predefined variables (gender, age, medication and socioeconomic factors) contributed significantly to the prevalence of somatic comorbidities. The main somatic comorbidities in this broad child- and adolescent psychiatric population consisted of (1) problems associated with food intake, including obesity and vitamin D3 deficiency and (2) sleeping problems, mainly insomnia. Child and adolescent psychiatrists need to be aware of potential somatic comorbidities and may promote a healthy lifestyle.
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Affiliation(s)
- Jet B Muskens
- Karakter Child and Adolescent Psychiatry University Centre Nijmegen, Nijmegen, The Netherlands.
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands.
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands.
| | - Wietske A Ester
- Sarr Autism Rotterdam, Youz Child and Adolescence Psychiatry, Dynamostraat 18, Rotterdam, 3083 AK, The Netherlands
- Parnassia Psychiatric Institute, Kiwistraat 30, The Hague, 2552 DH, The Netherlands
- Department of Child and Adolescent Psychiatry, Curium-LUMC, Leiden University Medical Center, Endegeesterstraatweg 27, Oegstgeest, 2342 AK, The Netherlands
| | - Helen Klip
- Karakter Child and Adolescent Psychiatry University Centre Nijmegen, Nijmegen, The Netherlands
| | - Janneke Zinkstok
- Karakter Child and Adolescent Psychiatry University Centre Nijmegen, Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martine van Dongen-Boomsma
- Karakter Child and Adolescent Psychiatry University Centre Nijmegen, Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Wouter G Staal
- Karakter Child and Adolescent Psychiatry University Centre Nijmegen, Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
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Leuning EM, van den Berk-Smeekens I, van Dongen-Boomsma M, Staal WG. Eye Movement Desensitization and Reprocessing in adolescents with autism; Efficacy on ASD symptoms and stress. Front Psychiatry 2023; 14:981975. [PMID: 36873194 PMCID: PMC9975260 DOI: 10.3389/fpsyt.2023.981975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 01/16/2023] [Indexed: 02/17/2023] Open
Abstract
INTRODUCTION Eye Movement Desensitization and Reprocessing (EMDR) is a well-established and thoroughly researched treatment method for posttraumatic stress symptoms. When patients with an autism spectrum disorder (ASD) are treated with EMDR for their Posttraumatic Stress Disorder (PTSD), they sometimes report a decrease in the core symptoms of ASD. This explorative pre-post-follow up design study is designed to investigate whether EMDR with a focus on daily experienced stress, is effective in reducing ASD symptoms and stress in adolescents with ASD. METHODS Twenty-one adolescents with ASD (age 12 to 19) were treated with ten sessions EMDR, focusing on events of daily experienced stress. RESULTS No significant decrease of ASD symptoms was found on the total score of the Social Responsiveness Scale (SRS) as reported by caregivers from baseline to end measurement. However, there was a significant decrease on total caregivers SRS score comparing the baseline to the follow-up measurement. On two subscales, Social Awareness and Social Communication, a significant decrease was found from baseline to follow-up. On the subscales Social Motivation and Restricted Interests and Repetitive Behavior, no significant effects were found. On pre- and posttest scores of total ASD symptoms measured by the Autism Diagnostic Observation Schedule (ADOS-2), no significant effects were found. On the contrary, scores on self-reported Perceived Stress Scale (PSS) showed a significant decrease from baseline to follow-up. Also, 52% of adolescents showed a significant improvement of global clinical functioning at endpoint measurement on the Clinical Global Impression Improvement, rated by an independent child psychiatrist. DISCUSSION In sum, these results of this uncontrolled study suggest a partial effect of EMDR in adolescents with ASD on ASD symptoms, rated by their caregivers. In addition, the results of this study show that EMDR treatment on daily experienced stress significantly reduce perceived stress as reported by the participants, and improves global clinical functioning. The results also suggest a 'sleeper effect', since no significant effects were found between baseline- and post- treatment measurements, but only between baseline- and follow up three months after the treatment. This finding is in line with other studies investigating psychotherapeutic effects in ASD. Implications for clinical practice and suggestions for future research are discussed.
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Affiliation(s)
| | - Iris van den Berk-Smeekens
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, Netherlands.,Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Martine van Dongen-Boomsma
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, Netherlands.,Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Wouter G Staal
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, Netherlands.,Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands.,Leiden Institute for Brain and Cognition, Leiden University, Leiden, Netherlands
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de Korte MWP, van Dongen-Boomsma M, Oosterling IJ, Buitelaar JK, Staal WG. Pivotal Response Treatment (PRT) parent group training for young children with autism spectrum disorder: a pilot study. Sci Rep 2022; 12:7691. [PMID: 35546154 PMCID: PMC9095862 DOI: 10.1038/s41598-022-10604-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/15/2022] [Indexed: 11/23/2022] Open
Abstract
Pivotal Response Treatment (PRT) is a promising intervention addressing core symptoms of autism spectrum disorder (ASD), with parent involvement as key component. Parent group-delivered PRT may be an effective treatment model, but currently the evidence is limited. Also, little attention has been paid to therapeutic involvement of multiple important contexts (e.g. home, school, community) of the young child. The current study explores a 14-week protocol of PRT parent group training (PRT-PG), complemented with individual parent–child sessions and involvement of teachers and other childcare providers. Children aged 2–6 years old with ASD and their parents (n = 20) were included. Preliminary results showed a significant increase in spontaneous initiations during a semi-structured therapist-child interaction together with widespread gains in clinical global functioning. No significant improvement on parent-rated general social-communication skills was observed. These findings justify further research on parent group delivered PRT models.
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Affiliation(s)
- Manon W P de Korte
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands. .,Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | | | - Iris J Oosterling
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
| | - Jan K Buitelaar
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands.,Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Wouter G Staal
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands.,Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, Nijmegen, The Netherlands.,Leiden University, Leiden, The Netherlands
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Muskens J, Klip H, Zinkstok JR, van Dongen-Boomsma M, Staal WG. Vitamin D status in children with a psychiatric diagnosis, autism spectrum disorders, or internalizing disorders. Front Psychiatry 2022; 13:958556. [PMID: 36186854 PMCID: PMC9515420 DOI: 10.3389/fpsyt.2022.958556] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/26/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Multiple studies suggest that children with Autism Spectrum Disorders (ASD) have significantly lower vitamin D3 levels than typically developing children. However, whether vitamin D3 deficiency is more common in children with ASD than in children with other psychiatric disorders remains unclear. This study was conducted to explore the prevalence of vitamin D3 in children with a psychiatric diagnosis including children with ASD or with internalizing disorders (mood and anxiety disorders). In addition, this study investigated the potential associations between vitamin D3 and Body Mass Index (BMI). MATERIALS AND METHODS Clinical data, including BMI and vitamin D3 levels, of 93 children (6-18 years; n = 47; 51% female) with ASD (n = 58) and internalizing disorders (n = 37) were retrospectively analyzed. RESULTS In the overall sample, the prevalence of vitamin D3 deficiency (<50 nmol/L) was 77.4%. Additionally, 75.9% of the children with ASD and 79.5% with internalizing disorders had vitamin D3 deficiency. BMI was inversely related to vitamin D3 in the total group (p = 0.016). The multiple regression model for the total group significantly predicted vitamin D3 (p = 0.022). Age contributed significantly to the prediction. Stratified for sex and primary diagnosis, multiple regression models showed that for boys with ASD, higher BMI levels were associated with lower vitamin D3 levels (p = 0.031); in boys with internalizing disorders and in girls, no relation was found between BMI and vitamin D3 levels. CONCLUSION In this this cross-sectional, explorative study high rates of vitamin D3 deficiency in children with different psychiatric disorders were found. The results showed an inverse relation between BMI and vitamin D3 levels in the total group. Vitamin D3 deficiency was particularly common in boys with ASD and obesity. Lifestyle factors may contribute to the association between high BMI and low vitamin D3 levels in boys with ASD. Vitamin D3 deficiency is common in patients with psychiatric disorders and it is highly recommended to increase clinicians' awareness of this common and remediable risk factor.
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Affiliation(s)
- Jet Muskens
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, Netherlands.,Department of Psychiatry, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Helen Klip
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, Netherlands
| | - Janneke R Zinkstok
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, Netherlands.,Department of Psychiatry, Radboud University Medical Centre, Nijmegen, Netherlands.,Department of Psychiatry, University Medical Centre, Utrecht, Netherlands
| | - Martine van Dongen-Boomsma
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, Netherlands.,Department of Psychiatry, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Wouter G Staal
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, Netherlands.,Department of Psychiatry, Radboud University Medical Centre, Nijmegen, Netherlands.,Leiden Institute for Brain and Cognition, Leiden, Netherlands
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De Korte MW, van den Berk-Smeekens I, van Dongen-Boomsma M, Oosterling IJ, Den Boer JC, Barakova EI, Lourens T, Buitelaar JK, Glennon JC, Staal WG. Self-initiations in young children with autism during Pivotal Response Treatment with and without robot assistance. Autism 2020; 24:2117-2128. [PMID: 32730096 DOI: 10.1177/1362361320935006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT The initiation of social interaction is often defined as a core deficit of autism spectrum disorder. Optimizing these self-initiations is therefore a key component of Pivotal Response Treatment, an established intervention for children with autism spectrum disorder. However, little is known about the development of self-initiations during intervention and whether this development can be facilitated by robot assistance within Pivotal Response Treatment. The aim of this study was to (1) investigate the effect of Pivotal Response Treatment and robot-assisted Pivotal Response Treatment on self-initiations (functional and social) of young children with autism spectrum disorder over the course of intervention and (2) explore the relation between development in self-initiations and additional gains in general social-communicative skills. Forty-four children with autism spectrum disorder (aged 3-8 years) were included in this study. Self-initiations were assessed during parent-child interaction videos of therapy sessions and coded by raters who did not know which treatment (Pivotal Response Treatment or robot-assisted Pivotal Response Treatment) the child received. General social-communicative skills were assessed before start of the treatment, after 10 and 20 weeks of intervention and 3 months after the treatment was finalized. Results showed that self-initiations increased in both treatment groups, with the largest improvements in functional self-initiations in the group that received robot-assisted Pivotal Response Treatment. Increased self-initiations were related to higher parent-rated social awareness 3 months after finalizing the treatment.
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Affiliation(s)
- Manon Wp De Korte
- Karakter Child and Adolescent Psychiatry University Centre, The Netherlands.,Radboud University Nijmegen Medical Centre, The Netherlands
| | - Iris van den Berk-Smeekens
- Karakter Child and Adolescent Psychiatry University Centre, The Netherlands.,Radboud University Nijmegen Medical Centre, The Netherlands
| | | | - Iris J Oosterling
- Karakter Child and Adolescent Psychiatry University Centre, The Netherlands
| | | | | | | | - Jan K Buitelaar
- Karakter Child and Adolescent Psychiatry University Centre, The Netherlands.,Radboud University Nijmegen Medical Centre, The Netherlands
| | | | - Wouter G Staal
- Karakter Child and Adolescent Psychiatry University Centre, The Netherlands.,Radboud University Nijmegen Medical Centre, The Netherlands.,Leiden University, The Netherlands
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van den Berk-Smeekens I, van Dongen-Boomsma M, De Korte MWP, Den Boer JC, Oosterling IJ, Peters-Scheffer NC, Buitelaar JK, Barakova EI, Lourens T, Staal WG, Glennon JC. Adherence and acceptability of a robot-assisted Pivotal Response Treatment protocol for children with autism spectrum disorder. Sci Rep 2020; 10:8110. [PMID: 32415231 PMCID: PMC7229010 DOI: 10.1038/s41598-020-65048-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 04/20/2020] [Indexed: 12/16/2022] Open
Abstract
The aim of this study is to present a robot-assisted therapy protocol for children with ASD based on the current state-of-the-art in both ASD intervention research and robotics research, and critically evaluate its adherence and acceptability based on child as well as parent ratings. The robot-assisted therapy was designed based on motivational components of Pivotal Response Treatment (PRT), a highly promising and feasible intervention focused at training “pivotal” (key) areas such as motivation for social interaction and self-initiations, with the goal of establishing collateral gains in untargeted areas of functioning and development, affected by autism spectrum disorders. Overall, children (3–8 y) could adhere to the robot-assisted therapy protocol (Mean percentage of treatment adherence 85.5%), showed positive affect ratings after therapy sessions (positive in 86.6% of sessions) and high robot likability scores (high in 79.4% of sessions). Positive likability ratings were mainly given by school-aged children (H(1) = 7.91, p = .005) and related to the movements, speech and game scenarios of the robot. Parent ratings on the added value of the robot were mainly positive (Mean of 84.8 on 0–100 scale), while lower parent ratings were related to inflexibility of robot behaviour.
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Affiliation(s)
- Iris van den Berk-Smeekens
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, P.O. Box 9104, 6500 HB, Nijmegen, The Netherlands. .,Karakter Child and Adolescent Psychiatry University Centre, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands.
| | - Martine van Dongen-Boomsma
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, P.O. Box 9104, 6500 HB, Nijmegen, The Netherlands.,Karakter Child and Adolescent Psychiatry University Centre, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
| | - Manon W P De Korte
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, P.O. Box 9104, 6500 HB, Nijmegen, The Netherlands.,Karakter Child and Adolescent Psychiatry University Centre, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
| | - Jenny C Den Boer
- Karakter Child and Adolescent Psychiatry, Postbus 68, 6710 BB, Ede, The Netherlands
| | - Iris J Oosterling
- Karakter Child and Adolescent Psychiatry University Centre, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
| | - Nienke C Peters-Scheffer
- Behavioural Science Institute, Radboud University Nijmegen, PO Box 9104, 6500 HE, Nijmegen, The Netherlands.,Driestroom, PO box 139, 6660 AC, Elst, The Netherlands
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, P.O. Box 9104, 6500 HB, Nijmegen, The Netherlands.,Karakter Child and Adolescent Psychiatry University Centre, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
| | - Emilia I Barakova
- Faculty of Industrial Design, University of Technology, Eindhoven, P.O. Box 513 5600 MB, Eindhoven, The Netherlands
| | - Tino Lourens
- TiViPE, Kanaaldijk ZW 11, 5706 LD, Helmond, The Netherlands
| | - Wouter G Staal
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, P.O. Box 9104, 6500 HB, Nijmegen, The Netherlands.,Karakter Child and Adolescent Psychiatry University Centre, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands.,Institute for Brian and Cognition, Leiden University, P.O. Box 9600 (C2-S), 2300 RC, Leiden, Netherlands
| | - Jeffrey C Glennon
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, P.O. Box 9104, 6500 HB, Nijmegen, The Netherlands
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van den Berk-Smeekens I, Oosterling IJ, den Boer JC, Buitelaar JK, Staal WG, van Dongen-Boomsma M. Pivotal Response Treatment for autism spectrum disorder (ASD). Hippokratia 2017. [DOI: 10.1002/14651858.cd012887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Iris van den Berk-Smeekens
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour; Radboud University Nijmegen Medical Centre; Nijmegen Netherlands
- Karakter Child and Adolescent Psychiatry University Centre; Nijmegen Netherlands
| | - Iris J Oosterling
- Karakter Child and Adolescent Psychiatry University Centre; Nijmegen Netherlands
| | - Jenny C den Boer
- Karakter Child and Adolescent Psychiatry Centre; Ede Netherlands
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour; Radboud University Nijmegen Medical Centre; Nijmegen Netherlands
- Karakter Child and Adolescent Psychiatry University Centre; Nijmegen Netherlands
| | - Wouter G Staal
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour; Radboud University Nijmegen Medical Centre; Nijmegen Netherlands
- Karakter Child and Adolescent Psychiatry University Centre; Nijmegen Netherlands
| | - Martine van Dongen-Boomsma
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour; Radboud University Nijmegen Medical Centre; Nijmegen Netherlands
- Karakter Child and Adolescent Psychiatry University Centre; Nijmegen Netherlands
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Vollebregt MA, van Dongen-Boomsma M, Slaats-Willemse D, Buitelaar JK, Oostenveld R. How the Individual Alpha Peak Frequency Helps Unravel the Neurophysiologic Underpinnings of Behavioral Functioning in Children With Attention-Deficit/Hyperactivity Disorder. Clin EEG Neurosci 2015; 46:285-91. [PMID: 25392007 DOI: 10.1177/1550059414537257] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 04/30/2014] [Indexed: 11/16/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) has been associated with an elevated resting-state theta/beta power ratio and elevated theta power. However, the potential confounding effect of a low individual alpha peak frequency (IAPF) on the theta-power estimate has often been disregarded when studying the relationship between ADHD and the theta/beta power ratio or theta power alone. The aim of the present study was to assess whether the theta/beta power ratio and relative theta power are correlated with behavioral functioning in children with ADHD, as expected from previous studies. Subsequently, the influence of IAPF and the amount of supposed overlap between the individually determined alpha-band and the fixed theta-band were studied. For 38 children (aged 8-15 years), electroencephalographic (EEG) and investigator-scored ADHD Rating Scale IV data were available. Additional neurocognitive data were available for 32 children. As expected, the theta/beta power ratio and theta were positively related to the ADHD core symptoms. This relationship strengthened when controlling for IAPF, although correlations did not significantly differ from one another. Eight of 38 children (21%) showed a supposed overlap between their individually determined alpha band and the theta band. Neurocognitive performance did not show any relationship with the theta/beta power ratio or theta. The results of this study confirm that the theta/beta power ratio and theta power are indeed correlated with behavioral symptoms in children with ADHD and underscore the relevance of taking the IAPF into account.
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Affiliation(s)
- Madelon A Vollebregt
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, Netherlands Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, Nijmegen, Netherlands Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, Netherlands
| | - Martine van Dongen-Boomsma
- Radboud University Medical Centre, Department of Psychiatry, Nijmegen, Netherlands Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, Netherlands Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, Nijmegen, Netherlands
| | - Dorine Slaats-Willemse
- Radboud University Medical Centre, Department of Psychiatry, Nijmegen, Netherlands Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, Netherlands Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, Nijmegen, Netherlands
| | - Jan K Buitelaar
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, Netherlands Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, Nijmegen, Netherlands Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, Netherlands
| | - Robert Oostenveld
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, Netherlands
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van Dongen-Boomsma M, Vollebregt MA, Buitelaar JK, Slaats-Willemse D. Working memory training in young children with ADHD: a randomized placebo-controlled trial. J Child Psychol Psychiatry 2014; 55:886-96. [PMID: 24628438 DOI: 10.1111/jcpp.12218] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND Until now, working memory training has not reached sufficient evidence as effective treatment for ADHD core symptoms in children with ADHD; for young children with ADHD, no studies are available. To this end, a triple-blind, randomized, placebo-controlled study was designed to assess the efficacy of Cogmed Working Memory Training (CWMT) in young children with ADHD. METHODS Fifty-one children (5-7 years) with a DSM-IV-TR diagnosis of ADHD (without current psychotropic medication) were randomly assigned to the active (adaptive) or placebo (nonadaptive) training condition for 25 sessions during 5 weeks. The compliance criterion (>20 sessions) was met for 47 children. The primary outcome measure concerned the core behavioural symptoms of ADHD, measured with the ADHD Rating Scale IV (ADHD-RS). Secondary outcome measures were neurocognitive functioning, daily executive functioning, and global clinical functioning. The influence of the increase in difficulty level (Index-Improvement) for the treatment group was also analysed. Clinical trial registration information - 'Working Memory Training in Young ADHD Children'; www.clinicaltrials.gov; NCT00819611. RESULTS A significant improvement in favour of the active condition was found on a verbal working memory task (p = .041; adapted Digit Span WISC-III, backward condition). However, it did not survive correction for multiple testing. No significant treatment effect on any of the primary or other secondary outcome measurements was found. The Index-Improvement significantly contributed to ADHD-RS and the Behavior Rating Inventory of Executive Function, both rated by the teacher, but revealed no significant group difference. CONCLUSIONS This study failed to find robust evidence for benefits of CMWT over the placebo training on behavioural symptoms, neurocognitive, daily executive, and global clinical functioning in young children with ADHD.
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Affiliation(s)
- Martine van Dongen-Boomsma
- Department of Psychiatry, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands; Department of Cognitive Neuroscience, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
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Vollebregt MA, van Dongen-Boomsma M, Slaats-Willemse D, Buitelaar JK. What future research should bring to help resolving the debate about the efficacy of EEG-neurofeedback in children with ADHD. Front Hum Neurosci 2014; 8:321. [PMID: 24860487 PMCID: PMC4030169 DOI: 10.3389/fnhum.2014.00321] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 04/29/2014] [Indexed: 11/13/2022] Open
Abstract
In recent years a rising amount of randomized controlled trials, reviews, and meta-analyses relating to the efficacy of electroencephalographic-neurofeedback (EEG-NF) in children with attention-deficit/hyperactivity disorder (ADHD) have been published. Although clinical reports and open treatment studies suggest EEG-NF to be effective, double blind placebo-controlled studies as well as a rigorous meta-analysis failed to find support for the efficacy of EEG-NF. Since absence of evidence does not equate with evidence of absence, we will outline how future research might overcome the present methodological limitations. To provide conclusive evidence for the presence or absence of the efficacy of EEG-NF in the treatment of ADHD, there is a need to set up a well-designed study that ensures optimal implementation and embedding of the training, and possibly incorporates different forms of neurofeedback.
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Affiliation(s)
- Madelon A Vollebregt
- Karakter University Centre for Child and Adolescent Psychiatry Nijmegen, Netherlands ; Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre Nijmegen, Netherlands ; Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre Nijmegen, Netherlands
| | - Martine van Dongen-Boomsma
- Karakter University Centre for Child and Adolescent Psychiatry Nijmegen, Netherlands ; Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre Nijmegen, Netherlands ; Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre Nijmegen, Netherlands
| | - Dorine Slaats-Willemse
- Karakter University Centre for Child and Adolescent Psychiatry Nijmegen, Netherlands ; Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre Nijmegen, Netherlands ; Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre Nijmegen, Netherlands
| | - Jan K Buitelaar
- Karakter University Centre for Child and Adolescent Psychiatry Nijmegen, Netherlands ; Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre Nijmegen, Netherlands ; Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre Nijmegen, Netherlands ; Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre Nijmegen, Netherlands
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Vollebregt MA, van Dongen-Boomsma M, Buitelaar JK, Slaats-Willemse D. Does EEG-neurofeedback improve neurocognitive functioning in children with attention-deficit/hyperactivity disorder? A systematic review and a double-blind placebo-controlled study. J Child Psychol Psychiatry 2014; 55:460-72. [PMID: 24168522 DOI: 10.1111/jcpp.12143] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND The number of placebo-controlled randomized studies relating to EEG-neurofeedback and its effect on neurocognition in attention-deficient/hyperactivity disorder (ADHD) is limited. For this reason, a double blind, randomized, placebo-controlled study was designed to assess the effects of EEG-neurofeedback on neurocognitive functioning in children with ADHD, and a systematic review on this topic was performed. METHODS Forty-one children (8-15 years) with a DSM-IV-TR diagnosis of ADHD were randomly allocated to EEG-neurofeedback or placebo-neurofeedback treatment for 30 sessions, twice a week. Children were stratified by age, electrophysiological state of arousal, and medication use. Neurocognitive tests of attention, executive functioning, working memory, and time processing were administered before and after treatment. Researchers, teachers, children and their parents, with the exception of the neurofeedback-therapist, were all blind to treatment assignment. Outcome measures were the changes in neurocognitive performance before and after treatment. CLINICAL TRIAL REGISTRATION www.clinicaltrials.gov: NCT00723684. RESULTS No significant treatment effect on any of the neurocognitive variables was found. A systematic review of the current literature also did not find any systematic beneficial effect of EEG-neurofeedback on neurocognitive functioning. CONCLUSION Overall, the existing literature and this study fail to support any benefit of neurofeedback on neurocognitive functioning in ADHD, possibly due to small sample sizes and other study limitations.
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Affiliation(s)
- Madelon A Vollebregt
- Karakter University Centre for Child and Adolescent Psychiatry, Nijmegen, the Netherlands; Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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van Dongen-Boomsma M, Vollebregt MA, Slaats-Willemse D, Buitelaar JK. A randomized placebo-controlled trial of electroencephalographic (EEG) neurofeedback in children with attention-deficit/hyperactivity disorder. J Clin Psychiatry 2013; 74:821-7. [PMID: 24021501 DOI: 10.4088/jcp.12m08321] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 03/29/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE A double-blind, randomized, placebo-controlled study was designed to assess the efficacy and safety of electroencephalographic (EEG) neurofeedback in children with attention-deficit/hyperactivity disorder (ADHD). The study started in August 2008 and ended in July 2012 and was conducted at Karakter Child and Adolescent Psychiatry University Centre in Nijmegen, The Netherlands. METHOD Forty-one children (aged 8-15 years) with a DSM-IV-TR diagnosis of ADHD were randomly assigned to treatment with either EEG neurofeedback (n = 22) or placebo neurofeedback (n = 19) for 30 sessions, given as 2 sessions per week. The children were stratified by age, electrophysiologic state of arousal, and medication use. Everyone involved in the study, except the neurofeedback therapist and the principal investigator, was blinded to treatment assignment. The primary outcome was severity of ADHD symptoms on the ADHD Rating Scale IV, scored at baseline, during treatment, and at study end. Clinical improvement as measured by the Clinical Global Impressions-Improvement scale (CGI-I) was a secondary outcome. RESULTS While total ADHD symptoms improved over time in both groups (F1,39 = 26.56, P < .001), there was no significant treatment effect, ie, group × time interaction (F1,39 = 0.36, P = .554); the same was true for clinical improvement as measured by the CGI-I (P = .092). No clinically relevant side effects were observed. Among the children and their parents, guessing treatment assignment was not better than chance level (P = .224 for children, P = .643 for parents). CONCLUSION EEG neurofeedback was not superior to placebo neurofeedback in improving ADHD symptoms in children with ADHD. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00723684.
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Lansbergen MM, Arns M, van Dongen-Boomsma M, Spronk D, Buitelaar JK. The increase in theta/beta ratio on resting-state EEG in boys with attention-deficit/hyperactivity disorder is mediated by slow alpha peak frequency. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:47-52. [PMID: 20713113 DOI: 10.1016/j.pnpbp.2010.08.004] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 07/21/2010] [Accepted: 08/05/2010] [Indexed: 10/19/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) was found to be characterized by a deviant pattern of electrocortical activity during resting state, particularly increased theta and decreased beta activity. The first objective of the present study is to confirm whether individuals with slow alpha peak frequency contribute to the finding of increased theta activity in ADHD. The second objective is to explore the relation between resting-state brain oscillations and specific cognitive functions. From 49 boys with ADHD and 49 healthy control boys, resting-state EEG during eyes open and eyes closed was recorded, and a variety of cognitive tasks were administered. Theta and beta power and theta/beta ratio were calculated using both fixed frequency bands and individualized frequency bands. As expected, theta/beta ratio, calculated using fixed frequency bands, was significantly higher in ADHD children than control children. However, this group effect was not significant when theta/beta ratio was assessed using individualized frequency bands. No consistent relation was found between resting-state brain oscillations and cognition. The present results suggest that previous findings of increased theta/beta ratio in ADHD may reflect individuals with slow alpha peak frequencies in addition to individuals with true increased theta activity. Therefore, the often reported theta/beta ratio in ADHD can be considered a non-specific measure combining several distinct neurophysiological subgroups such as frontal theta and slowed alpha peak frequencies. Future research should elucidate the functional role of resting-state brain oscillations by investigating neurophysiological subgroups, which may have a clearer relation to cognitive functions than single frequency bands.
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Affiliation(s)
- Marieke M Lansbergen
- Department of Psychiatry, Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.
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van Dongen-Boomsma M, Lansbergen MM, Bekker EM, Sandra Kooij J, van der Molen M, Kenemans JL, Buitelaar JK. Relation between resting EEG to cognitive performance and clinical symptoms in adults with attention-deficit/hyperactivity disorder. Neurosci Lett 2010; 469:102-6. [DOI: 10.1016/j.neulet.2009.11.053] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Revised: 11/17/2009] [Accepted: 11/21/2009] [Indexed: 10/20/2022]
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