Effect of short-term methylphenidate on social impairment in children with attention deficit/hyperactivity disorder: systematic review

Attention Deficit/Hyperactivity disorder (ADHD) is one of the most common disorders in school-age children. In addition to learning difficulties associated with the disorder's core symptoms of inattention and hyperactivity, children with ADHD display substantial social impairments. Methylphenidate (MPH) in formulations such as Ritalin or Concerta mitigates inattention and hyperactivity, but the effects of the therapy on social behavior in children with ADHD are not clear. This review aims to determine the effectiveness of short term (up to 6 months) MPH treatment on three domains of social skills in children aged 6-14 with ADHD: (i) Recognition of nonverbal emotional expressions, which are a marker of inherent (unlearned) social understanding, (ii) theory of mind (ToM) components that relate to learned cognition and social communication, and (iii) social competence in everyday environments. 15 relevant studies were identified based on inclusion/exclusion criteria. The results show mixed effects: the overall social performance as evaluated by parents, teachers or peers, and some components of ToM, were found to improve following a weeks-long course of MPH treatment. However, the effects of the medication are less clear when evaluating momentary/nonverbal social responses such as reactions to emotional facial expressions. While the findings of this review indicate that an MPH medication regime of order weeks to months could improve, to a degree, social impairment in children with ADHD, more studies are required to identify the medications' mechanism and confirm such a conclusion.

The effects of sleep deprivation on the processing of emotional facial expressions in young adults with and without ADHD

The ability to recognize emotions from facial expressions is essential to the development of complex social cognition behaviors, and impairments in this ability are associated with poor social competence. This study aimed to examine the effects of sleep deprivation on the processing of emotional facial expressions and nonfacial stimuli in young adults with and without attention-deficit/hyperactivity disorder (ADHD). Thirty-five men (mean age 25.4) with (n = 19) and without (n = 16) ADHD participated in the study. During the five days preceding the experimental session, the participants were required to sleep at least seven hours per night (23:00/24:00–7:00/9:00) and their sleep was monitored via actigraphy. On the morning of the experimental session, the participants completed a 4-stimulus visual oddball task combining facial and nonfacial stimuli, and repeated it after 25 h of sustained wakefulness. At baseline, both study groups had poorer performance in response to facial rather than non-facial target stimuli on all indices of the oddball task, with no differences between the groups. Following sleep deprivation, rates of omission errors, commission errors and reaction time variability increased significantly in the ADHD group but not in the control group. Time and target type (face/non-face) did not have an interactive effect on any indices of the oddball task. Young adults with ADHD are more sensitive to the negative effects of sleep deprivation on attentional processes, including those related to the processing of emotional facial expressions. As poor sleep and excessive daytime sleepiness are common in individuals with ADHD, it is feasible that poor sleep quality and quantity play an important role in cognitive functioning deficits, including the processing of emotional facial expressions that are associated with ADHD.

The Impact of Sleep Deprivation on Continuous Performance Task Among Young Men With ADHD

Objective: To identify the impact of sleep deprivation on functioning of young adults with or without ADHD on a continuous performance attention task. Method: Thirty-four men (M age = 25.38) with (n = 16) or without (n = 18) ADHD completed a continuous performance task before and after 25 hr of sustained wakefulness in a controlled environment. Results: In both groups, sleep deprivation caused a decline in performance on all variables: omission errors, commission errors, reaction time, and reaction time variability. In addition, the ADHD group made more omission and commission errors, and had greater reaction time variability. Conclusion: Sleep deprivation has a detrimental effect on attention functioning among young adults. In addition, although young adults with ADHD generally perform worse on continuous performance tasks than young adults without ADHD, the groups are similarly affected by sleep deprivation.

The Effect of Sleep Deprivation on Recognition of Ambiguous Emotional Facial Expressions in Individuals With ADHD

Objective: The present study sought to investigate whether young adults with ADHD have more difficulty recognizing emotional facial expressions compared with young adults without ADHD, and whether such a difference worsens following sleep deprivation. Method: Thirty-one young men (M = 25.6) with (n = 15) or without (n = 16) a diagnosis of ADHD were included in this study. The participants were instructed to sleep 7 hr or more each night for one week, and their sleep quality was monitored via actigraph. Subsequently, the participants were kept awake in a controlled environment for 30 hr. The participants completed a visual emotional morph task twice-at the beginning and at the end of this period. The task included presentation of interpolated face stimuli ranging from neutral facial expressions to fully emotional facial expressions of anger, sadness, or happiness, allowing for assessment of the intensity threshold for recognizing these facial emotional expressions. Results: Actigraphy data demonstrated that while the nightly sleep duration of the participants with ADHD was similar to that of participants without ADHD, their sleep efficiency was poorer. At the onset of the experiment, there were no differences in recognition thresholds between the participants with ADHD and those without ADHD. Following sleep deprivation, however, the ADHD group required clearer facial expressions to recognize the presence of angry, sad, and, to a lesser extent, happy faces. Conclusion: Among young adults with ADHD, sleep deprivation may hinder the processing of emotional facial stimuli.

The relationship between individuals with fearful-avoidant adult attachment orientation and early neural responses to emotional content: An event-related potentials (ERPs) study

OBJECTIVE

Adult attachment orientation affects the interactions of individuals with others. Fearful-avoidant individuals are characterized by both high anxiety and high avoidance. This study examines the response of individuals with fearful-avoidant attachment orientation to neutral, emotionally positive, or emotionally negative visual stimuli.

METHOD

Participants included 119 undergraduate students (91 female), mean age 23.5 ± 3.6 years: 30 fearful-avoidant, 32 secure, 28 anxious-preoccupied, and 29 dismissive-avoidant. The response of individuals with fearful-avoidant attachment orientation to IAPS emotional and neutral pictures was measured using Event-Related Potential (ERP), and compared to individuals with dismissive-avoidance or anxious-preoccupied attachment orientations (with a secure attachment group as control). The study focused on early time reaction, as defined by the P1, N1, and P2 components (110-165, 165-215, and 215-280 ms poststimulus, respectively).

RESULTS

We find that individuals with fearful-avoidant attachment orientation display a reaction to emotional (positive or negative) cues, at the P1 and P2 components, that is significantly different than that of individuals with anxious-preoccupied attachment, but is similar to that of individuals with dismissive-avoidant attachment.

CONCLUSIONS

Our results suggest that the initial response to emotional stimuli of individuals with fearful-avoidant attachment is dominated by avoidance, rather than anxiety. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Response Patterns to Emotional Faces Among Adolescents Diagnosed With ADHD

OBJECTIVE

The present study investigated differences in emotional face processing between adolescents (age 15-18) with ADHD-Combined type (ADHD-CT) and typically developing controls.

METHOD

Participants completed a visual emotional task in which they were asked to rate the degree of negativity/positivity of four facial expressions (taken from the NimStim face stimulus set).

RESULTS

Participants' ratings, ratings' variability, response times (RTs), and RTs' variability were analyzed. Results showed a significant interaction between group and the type of presented stimuli. Adolescents with ADHD-CT discriminated less between positive and negative emotional expressions compared with those without ADHD. In addition, adolescents with ADHD-CT exhibited greater variability in their RTs and in their ratings of facial expressions when compared with controls.

CONCLUSION

The present results lend further support to the existence of a specific deficit or alteration in the processing of emotional face stimuli among adolescents with ADHD-CT.

Cognitive functions in adults with β-thalassemia major: before and after blood transfusion and comparison with healthy controls

While β-thalassemia major (β-TM)-related physiological complications have been well established, less is known about implications for neuropsychological and cognitive function. The few existing studies have focused almost exclusively on children. We evaluated cognitive function in adult β-TM patients compared to healthy controls (study 1) and in β-TM patients before and after blood transfusion (study 2). Performance intelligence quotient (IQ) was evaluated with four subtests from the Wechsler Adult Intelligence Scale (WAIS-III). Attention functions were evaluated using the online continuous performance test (OCPT). The results of study 1 revealed poorer performance of β-TM patients on three of the four intelligence subtests, with significantly lower total performance IQ scores compared with controls. The percentage of participants with abnormal performance IQ (<85) was almost five times higher in the β-TM group (58%) than in the control group (12%). In study 2, significant differences were found in OCPT performance as a function of blood transfusion. Before transfusion, patients had higher rates of omission and commission errors, slower response times (RTs), and lower RT consistency than after transfusion. As β-TM patients' life expectancy is increasing, assessment and treatment of neurocognitive functions should become an integral part of appropriate follow-up to improve patients' quality of life.

Executive function and neural activation in adults with β-thalassemia major: an event-related potentials study

In recent years, there has been growing interest in understanding the involvement of the nervous system and neurological complications in β-thalassemia major (β-TM). Several reports have demonstrated β-TM-related neurological abnormalities, and these have been postulated to be responsible for impaired cognitive and neuropsychological functioning. We investigated neural correlates of cognitive function in adults with β-TM and healthy controls using scalp-recorded event-related potentials (ERPs). To date, there have been no ERP studies in β-TM adult patients. We identified ERP correlates of executive function by using a complex task-switching paradigm in which participants have to quickly and effectively switch between two different task sets. The results indicated poorer cognitive performance of β-TM patients, resulting in overall higher error rates, longer response times, and increased switch costs compared with controls. Hemoglobin levels were negatively correlated with error rates and response times. Electrophysiological results indicated significant alterations in peak amplitudes of the ERP components P1, N1, and P2 in β-TM patients relative to controls. P2 amplitude correlated with hemoglobin levels. This novel investigation of executive function and related brain mechanisms and dynamics in adults with β-TM underscores the usefulness of ERP methodology as a sensitive measure for the study of neurocognitive processes in β-TM.

Unpackaging Cross-Cultural Differences in Initiation Between Israeli Subgroups

This study was designed to gain a better understanding of cross-cultural differences in initiation behavior within the relatively Westernized Israeli society. It has been suggested that traditional subgroups in Israel exhibit lower initiation behavior than the majority group and that control orientations mediate this difference based on their high relevance to initiation and their previously established difference in modern versus traditional cultures. A sample of 178 students comprised of members of the majority group and of two traditional subgroups (Israeli Arabs and Israelis of Ethiopian origin) was investigated. The modern and traditional groups were compared on two measures of initiation: a behavioral measure that required minimal initiation and a self-reported measure of initiation behavior. Models showed that the expected cross-cultural differences in initiation were unpackaged by tradition and control orientations, with tradition, secondary control, and relinquished control serving as meaningful mediators. Primary control was a less proximal predictor.

Gastric bypass surgery is protective from high-fat diet-induced non-alcoholic fatty liver disease and hepatic endoplasmic reticulum stress

AIM

High-fat diets are known to contribute to the development of obesity and related co-morbidities including non-alcoholic fatty liver disease (NAFLD). The accumulation of hepatic lipid may increase endoplasmic reticulum (ER) stress and contribute to non-alcoholic steatohepatitis and metabolic disease. We hypothesized that bariatric surgery would counter the effects of a high-fat diet (HFD) on obesity-associated NAFLD.

METHODS

Sixteen of 24 male Sprague Dawley rats were randomized to Sham (N = 8) or Roux-en-Y gastric bypass (RYGB) surgery (N = 8) and compared to Lean controls (N = 8). Obese rats were maintained on a HFD throughout the study. Insulin resistance (HOMA-IR), and hepatic steatosis, triglyceride accumulation, ER stress and apoptosis were assessed at 90 days post-surgery.

RESULTS

Despite eating a HFD for 90 days post-surgery, the RYGB group lost weight (-20.7 ± 6%, P < 0.01) and improved insulin sensitivity (P < 0.05) compared to Sham. These results occurred with no change in food intake between groups. Hepatic steatosis and ER stress, specifically glucose-regulated protein-78 (Grp78, P < 0.001), X-box binding protein-1 (XBP-1) and spliced XBP-1 (P < 0.01), and fibroblast growth factor 21 (FGF21) gene expression, were normalized in the RYGB group compared to both Sham and Lean controls. Significant TUNEL staining in liver sections from the Obese Sham group, indicative of accelerated cell death, was absent in the RYGB and Lean control groups. Additionally, fasting plasma glucagon like peptide-1 was increased in RYGB compared to Sham (P < 0.02).

CONCLUSION

These data suggest that in obese rats, RYGB surgery protects the liver against HFD-induced fatty liver disease by attenuating ER stress and excess apoptosis.

The relationships among ADHD, self-esteem, and test anxiety in young adults

OBJECTIVE

The comorbidity of adult ADHD with test anxiety (TA) has not been previously reported. This comorbidity can potentially affect clinical and academic interventions among individuals with ADHD. The present study investigated the relationships among ADHD, self-esteem, and three subscales of TA among young adults: Cognitive Obstruction, Social Derogation, and Tenseness.

METHOD

A total of 25 female participants diagnosed with ADHD and 30 female controls without ADHD of comparable age and education completed an Online Continuous Performance Test, an ADHD questionnaire, a self-esteem inventory, and a TA questionnaire.

RESULTS

Participants with ADHD exhibited significantly higher levels of TA on all three subscales and lower levels of self-esteem compared with controls. Self-esteem served as a partial mediator between ADHD and cognitive obstruction TA and as a full mediator between ADHD and social derogation TA, but had no mediation effect in the relationships between ADHD and tenseness TA.

CONCLUSION

The findings of this study suggest that TA, well known to affect success on tests, is correlated with ADHD. Therefore, interventions for ADHD should include components aimed at reducing TA.

Reliability, validity and sensitivity of a computerized visual analog scale measuring state anxiety

BACKGROUND AND OBJECTIVES

Assessment of state anxiety is frequently required in clinical and research settings, but its measurement using standard multi-item inventories entails practical challenges. Such inventories are increasingly complemented by paper-and-pencil, single-item visual analog scales measuring state anxiety (VAS-A), which allow rapid assessment of current anxiety states. Computerized versions of VAS-A offer additional advantages, including facilitated and accurate data collection and analysis, and applicability to computer-based protocols. Here, we establish the psychometric properties of a computerized VAS-A.

METHODS

Experiment 1 assessed the reliability, convergent validity, and discriminant validity of the computerized VAS-A in a non-selected sample. Experiment 2 assessed its sensitivity to increase in state anxiety following social stress induction, in participants with high levels of social anxiety.

RESULTS

Experiment 1 demonstrated the computerized VAS-A's test-retest reliability (r = .44, p < .001); convergent validity with the State-Trait Anxiety Inventory's state subscale (STAI-State; r = .60, p < .001); and discriminant validity as indicated by significantly lower correlations between VAS-A and different psychological measures relative to the correlation between VAS-A and STAI-State. Experiment 2 demonstrated the VAS-A's sensitivity to changes in state anxiety via a significant pre- to during-stressor rise in VAS-A scores (F(1,48) = 25.13, p < .001).

LIMITATIONS

Set-order administration of measures, absence of clinically-anxious population, and gender-unbalanced samples.

CONCLUSIONS

The adequate psychometric characteristics, combined with simple and rapid administration, make the computerized VAS-A a valuable self-rating tool for state anxiety. It may prove particularly useful for clinical and research settings where multi-item inventories are less applicable, including computer-based treatment and assessment protocols. The VAS-A is freely available: http://people.socsci.tau.ac.il/mu/anxietytrauma/visual-analog-scale/.

Neural correlates of emotional intelligence in a visual emotional oddball task: an ERP study

The present study was aimed at identifying potential behavioral and neural correlates of Emotional Intelligence (EI) by using scalp-recorded Event-Related Potentials (ERPs). EI levels were defined according to both self-report questionnaire and a performance-based ability test. We identified ERP correlates of emotional processing by using a visual-emotional oddball paradigm, in which subjects were confronted with one frequent standard stimulus (a neutral face) and two deviant stimuli (a happy and an angry face). The effects of these faces were then compared across groups with low and high EI levels. The ERP results indicate that participants with high EI exhibited significantly greater mean amplitudes of the P1, P2, N2, and P3 ERP components in response to emotional and neutral faces, at frontal, posterior-parietal and occipital scalp locations. P1, P2 and N2 are considered indexes of attention-related processes and have been associated with early attention to emotional stimuli. The later P3 component has been thought to reflect more elaborative, top-down, emotional information processing including emotional evaluation and memory encoding and formation. These results may suggest greater recruitment of resources to process all emotional and non-emotional faces at early and late processing stages among individuals with higher EI. The present study underscores the usefulness of ERP methodology as a sensitive measure for the study of emotional stimuli processing in the research field of EI.

Reliability and validity of the Online Continuous Performance Test among children

OBJECTIVE

The study assesses the reliability and validity of a new Online Continuous Performance Test (OCPT) for measuring sustained attention, response inhibition, and response time consistency among children.

METHOD

The study sample comprised 73 children (6-13 years), 47 children with attention deficit hyperactivity disorder and 24 in the control group. The Diagnostic Interview Schedule for Children was administered to participants' parents to confirm group allocation. Children completed the OCPT in a laboratory setting, and a week later completed the OCPT at home.

RESULTS

Split-half correlation coefficients reflected high levels of reliability in the laboratory and at home. Significant correlations were found between the laboratory- and home-based OCPT scores. Significant differences in OCPT performance were found between children with and without attention deficit hyperactivity disorder on the OCPT in the two settings.

CONCLUSIONS

These results support the reliability and validity of the OCPT and suggest that it may serve as an effective tool for the assessment of children's attention function in naturalistic settings.

Behavioral and neural correlates of emotional intelligence: an event-related potentials (ERP) study

The present study was aimed at identifying potential behavioral and neural correlates of emotional intelligence (EI) by using scalp-recorded Event-Related Potentials (ERPs). EI levels were defined according to both self-report questionnaire and a performance-based test. We identified ERP correlates of emotional processing by comparing ERPs elicited in trials using pleasant, neutral and unpleasant pictures. The effects of these emotion-inducing pictures were then compared across groups with low and high EI levels. Behavioral results revealed a significant valence×EI group interaction effect since valence ratings were lower for unpleasant pictures and higher for pleasant pictures in the high EI group compared with the low EI group. The groups did not differ with respect to neutral picture ratings. The ERP results indicate that participants with high EI exhibited significantly greater mean amplitudes of the P2 (200-300ms post-stimulus) and P3 (310-450ms post-stimulus) ERP components in response to emotional and neutral pictures, at posterior-parietal as well as at frontal scalp locations. This may suggest greater recruitment of resources to process all emotional and non-emotional stimuli at early and late processing stages among individuals with higher EI. The present study also underscores the usefulness of ERP methodology as a sensitive measure for the study of emotional stimuli processing in the research field of EI.

Influence of methylphenidate on motor performance and attention in children with developmental coordination disorder and attention deficit hyperactive disorder

Individuals with attention deficit hyperactive disorder (ADHD) often have coexisting developmental coordination disorder (DCD). The positive therapeutic effect of methylphenidate on ADHD symptoms is well documented, but its effects on motor coordination are less studied. We assessed the influence of methylphenidate on motor performance in children with comorbid DCD and ADHD. Participants were 30 children (24 boys) aged 5.10-12.7 years diagnosed with both DCD and ADHD. Conners' Parent Rating Scale was used to reaffirm ADHD diagnosis and the Developmental Coordination Disorder Questionnaire was used to diagnose DCD. The Movement Assessment Battery for Children-2 and the online continuous performance test were administrated to all participants twice, with and without methylphenidate. The tests were administered on two separate days in a blind design. Motor performance and attention scores were significantly better with methylphenidate than without it (p<0.001 for improvement in the Movement Assessment Battery for Children-2 and p<0.006 for the online continuous performance test scores). The findings suggest that methylphenidate improves both attention and motor coordination in children with coexisting DCD and ADHD. More research is needed to disentangle the causality of the improvement effect and whether improvement in motor coordination is directly affected by methylphenidate or mediated by improvement in attention.

Reliability and validity of the online continuous performance test among young adults

Continuous Performance Tests (CPTs) are used in research and clinical contexts to measure sustained attention and response inhibition. Reliability and validity of a new Online Continuous Performance Test (OCPT) was assessed. The OCPT is designed for delivery over the Internet, thereby opening new opportunities for research and clinical application in naturalistic settings. In Study 1, participants completed the OCPT twice over a 1-week period. One test was taken at home and one in the laboratory. Construct validity was assessed against a gold standard CPT measure. Results indicate acceptable reliability between the home- and laboratory-administered tests. Modest to high correlations were observed between the OCPT scales and the corresponding scales of the gold standard CPT. Study 2 examined whether the OCPT may discriminate participants with attention deficit hyperactivity disorder from healthy controls. Results revealed significantly higher rates of omission and commission errors and greater response time variability in participants with attention deficit hyperactivity disorder relative to healthy controls. These results support the reliability and validity of the OCPT and suggest that it may serve as an effective tool for the assessment of attention function in naturalistic settings.

Effects of early relationships on children’s perceived control: A longitudinal study

People’s response to stress depends to a large extent on their sense of perceived control over the situations they encounter. This longitudinal study of 136 children (70 girls) examined associations between attachment patterns and maternal sensitivity at 12 months of age, and perceived primary and secondary control at 11 years of age. Compared with children who were ambivalently attached in infancy, children who were securely attached reported a greater perceived primary control in general, and more primary control in interaction with their parents at 11 years of age. No such between-group difference in primary control tendencies was found in the context of reported interaction with peers. Higher maternal sensitivity in infancy was associated with higher perceived general primary control at 11 years of age. Lower maternal sensitivity was associated with higher perceived secondary control in children who were ambivalently attached to their mothers in infancy. The results are discussed within a theoretical framework linking early infant experience and the evolving personality characteristics of primary and secondary perceived control in older children and adolescents.

Changing the World Through Changing the Self

This study proposes a new control strategy, control via self-improvement, in addition to primary and secondary control. This strategy is aimed at an actual external change (primary target), whereas the means to reach the goal is self-improvement (secondary target—the self). A study conducted in Israel and in Hong Kong indicated that the strategy of control via self-improvement exists in the achievement domain and is more prevalent in Hong Kong than in Israel.

Predicting children's anxiety from early attachment relationships

This study assessed whether infants with anxious-ambivalent attachment develop higher levels of anxiety later in childhood than do infants with secure attachment. Infants (N=136) participated in Ainsworth's Strange Situation Procedure at 12 months of age. The Screen for Child Anxiety Related Emotional Disorders (SCARED) was completed by children and their mothers at 11 years of age. Results show that compared with children who were securely attached in infancy, children who were ambivalently attached had higher levels of school phobia, and, that compared with boys who were securely attached boys who were ambivalently attached had higher levels of social phobia at 11 years. However, in this normative sample, anxious-ambivalent attachment was not related to anxiety levels that approach pathological significance. These findings are discussed within the context of previous research on associations between attachment and anxiety disorders.

Attachment Style and Individual Differences in Leadership Perceptions and Emergence

The authors examined whether individuals' approaches to relationships, expressed in terms of attachment styles, was related to how they viewed ideal leadership and to their degree of tendency to emerge as team leaders. Specifically, the authors hypothesized that attachment styles, or cognitive representations of orientation to others, would explain individual differences in leadership perceptions and emergence. Participants were 127 American students in college teams. The authors found that securely attached individuals (n = 81) perceived themselves as more effective team members than did insecurely attached individuals (n = 46) and that fellow team members saw securely attached team members as emerging team leaders significantly more often than they did insecurely attached team members.

Effect of in vitro irradiation of donor larynges on cyclosporine requirements and rejection rates in rat laryngeal transplantation

Total lymphoid irradiation is an acknowledged adjunctive immunosuppressant in whole organ transplantation in humans and animals. Local irradiation administered for a similar purpose is at best controversial. We evaluated in vitro donor larynx irradiation immediately preceding laryngeal transplantation as an immunomodulator. Each donor larynx was pretreated with 7.34 Gy of radiation in vitro. After transplantation, cyclosporine was administered in doses of 5 mg/kg per day, 2.5 mg/kg per day, and 1 mg/kg per day for trial lengths of 15 days and 30 days. Each of these 6 groups consisted of 10 rats per group. Earlier data have shown cyclosporine dosed at 5 mg/kg per day, without irradiation, administered for 1 month to have varied efficacy. Established histologic criteria were used to determine rejection patterns. All recipient rats survived the 15-day and 30-day trials. In all 10 rats receiving 5 mg/kg per day of cyclosporine for 15 days, the harvested transplanted larynges were viable without evidence of meaningful rejection (mild rejection). In 9 of the 10 rats receiving 5 mg/kg per day of cyclosporine for 30 days, the transplanted larynges displayed no meaningful rejection (mild rejection). In 9 of the 10 rats receiving 2.5 mg/kg per day of cyclosporine for 15 days, the transplanted larynges displayed no meaningful rejection (mild rejection). One rat receiving 2.5 mg/kg per day of cyclosporine for 15 days had a transplanted larynx that displayed moderate rejection. In all 10 rats receiving 2.5 mg/kg per day of cyclosporine for 30 days, the transplanted larynges displayed no meaningful rejection (mild rejection). At 15 days, 5 rats treated with 1 mg/kg per day of cyclosporine displayed mild rejection, 2 displayed moderate rejection, 2 displayed advanced to moderate rejection, and 1 displayed severe rejection. At 30 days, 4 rats treated with 1 mg/kg per day of cyclosporine displayed moderate rejection, 2 displayed advanced to moderate rejection, and 4 displayed severe rejection. We conclude that pretransplantation in vitro irradiation of donor larynges has immunomodulatory effects, allowing reduced cyclosporine immunosuppression with less rejection.