Cortical structure reorganization and correlation with attention deficit in subcortical stroke: An underlying pattern analysis

BACKGROUND

Subcortical stroke may significantly alter the cerebral cortical structure and affect attention function, but the details of this process remain unclear. The study aimed to investigate the neural substrates underlying attention impairment in patients with subcortical stroke.

MATERIALS AND METHODS

In this prospective observational study, two distinct datasets were acquired to identify imaging biomarkers underlying attention deficit. The first dataset consisted of 86 patients with subcortical stroke, providing a cross-sectional perspective, whereas the second comprised 108 patients with stroke, offering longitudinal insights. All statistical analyses were subjected to false discovery rate correction upon P < 0.05.

RESULTS

In the chronic-stage data, the stroke group exhibited significantly poorer attention function compared with that of the control group. The cortical structure analysis showed that patients with stroke exhibited decreased cortical thickness of the precentral gyrus and surface area of the cuneus, along with an increase in various frontal, occipital, and parietal cortices regions. The declined attention function positively correlated with the superior frontal gyrus cortical thickness and supramarginal gyrus surface area. In the longitudinal dataset, patients with stroke showed gradually increasing cortical thickness and surface area within regions of obvious structural reorganization. Furthermore, deficient attention positively correlated with supramarginal gyrus surface area both at the subacute and chronic stages post-stroke.

CONCLUSIONS

Subcortical stroke can elicit dynamic reorganization of cortical areas associated with attention impairment. Moreover, the altered surface area of the supramarginal gyrus is a potential neuroimaging biomarker for attention deficits.

[Effect of Emotion Regulation on Anxiety/Depression Symptoms in Children With Attention-Deficit/Hyperactivity Disorder: The Mediating Role of Social Problems and the Moderating Role of Family Functioning]

Objective

To investigate the mediating effect of social problems in the effect pathway of emotional dysregulation influencing anxiety/depression emotions in children with attention-deficit/hyperactivity disorder (ADHD) and to explore the potential moderating effect of family functionality.

Methods

A total of 235 children diagnosed with ADHD were enrolled in the study. The paticipants' age ranged from 6 to 12. Emotion Regulation Checklist, Achenbach's Child Behavior Checklist (CBCL) Social Problems Subscale, CBCL Anxious/Depressed Subscale, and Family Assessment Device were used to evaluate the emotional regulation, social problems, anxiety/depression emotions, and family functionality of the participants. A moderated mediation model was employed to analyze whether social problems and family functionality mediate and moderate the relationship between emotional regulation and anxiety/depression emotions.

Results

Social problems partially mediated the impact of emotional dysregulation on anxiety/depression emotions in ADHD children, with the direct effect being 0.26 (95% confidence interval [CI]: [0.17, 0.36], P<0.001), the indirect effect being 0.13 (95% CI: [0.07, 0.19], P<0.001), and the mediating effect accounting for 33% of the total effect. Family functionality exhibited a positive moderating effect on the relationship between social problems and anxiety/depression emotions.

Conclusion

This study contributes to the understanding of complex factors influencing anxiety/depression in children with ADHD, providing reference for the further development of targeted interventions for children with ADHD and the improvement of prognosis.

The effects of working memory training on attention deficit, adaptive and non-adaptive cognitive emotion regulation of Chinese children with Attention Deficit/Hyperactivity Disorder (ADHD)

BACKGROUND

Attention Deficit/Hyperactivity Disorder (ADHD) poses cognitive and emotional challenges for Chinese children. This study addresses the potential benefits of Working Memory Training for ADHD-affected children. Understanding its impact on Attention, cognitive regulation, and emotional responses is crucial for tailored interventions in the Chinese context. The Trial Registration Number (TRN) for this study is [TRN-2023-123,456], and it was officially registered on July 15, 2023, by Changchun Normal University.

OBJECTIVES

This study investigated how Working Memory training influences Attention, adaptive cognitive regulation, and non-adaptive cognitive emotion regulation in Chinese children with ADHD. It also assessed changes in attentional focus, improvements in adaptive cognitive regulation, and alterations in non-adaptive cognitive emotion regulation strategies.

METHODOLOGY

This quasi-experimental study aimed to assess the impact of working memory training on Chinese children with ADHD. Using pretest-posttest measures, 120 female students underwent Cogmed software training, targeting attention deficits and cognitive emotion regulation. Three reliable instruments measured outcomes. The procedure involved informed consent, questionnaires, 25 training sessions, and a two-month follow-up. Statistical analyses, including repeated measures ANOVA, assessed training effects.

RESULTS

ANOVA revealed a significant impact of Working memory training on attention deficit. Repeated measures ANOVA for cognitive emotion regulation indicated positive changes in adaptive and non-adaptive strategies over time, with sustained improvements in self-blame, rumination, catastrophizing, and blaming others. Bonferroni follow-up tests showed significant differences between pre-test, post-test, and follow-up, favoring the post-test and follow-up tests.

CONCLUSIONS

In summary, this research sheds light on the positive impact of memory training on Attention and cognitive emotion regulation in children with ADHD. The study underscores the potential of working memory interventions, particularly software-focused approaches, in enhancing attention levels and improving cognitive emotion regulation. The findings align with existing literature emphasizing the role of working memory deficits in ADHD.

IMPLICATIONS

Practically, incorporating memory training interventions into educational settings emerges as a viable strategy to support children with ADHD. This includes integrating memory training programs into both classroom activities and home-based interventions. Additionally, sustained implementation and long-term follow-up assessments are crucial for maximizing the effectiveness of memory training interventions. Tailoring interventions to specific ADHD subtypes and seamlessly integrating memory training activities into daily routines offer practical and personalized solutions for managing ADHD symptoms in diverse settings.

Clinical and cognitive characteristics of subjects with schizophrenia and childhood attention-deficit/hyperactivity disorder: Results from the multicentric FACE-SZ cross-sectional dataset

BACKGROUND

Childhood Attention-deficit/hyperactivity disorder (C-ADHD) is a neurodevelopmental disorder, associated with an increased risk of subsequent schizophrenia. The objective of the present study was to determine the prevalence of C-ADHD in schizophrenia and the clinical and cognitive characteristics associated with C-ADHD history in schizophrenia.

METHODS

569 subjects with schizophrenia (74 % men, mean age 30.8) were included in ten expert centers at a national level and tested with a comprehensive battery of clinician-rated, patient-reported scales and cognitive tests. C-ADHD was assessed with the WURS (Wender Utah Rating Scale) self-report questionnaire. Multivariate, correlation, and principal component analyses (PCA) were conducted.

RESULTS

Thirty-nine subjects (N = 39, 6.9 %) were classified in the C-ADHD group. Compared to those without C-ADHD, subjects with C-ADHD were more frequently male, had lower education levels, more severe positive clinical symptoms, more subjective cognitive deficits complaints, and lower medication adherence with small to medium effect sizes. Two cognitive components emerged from the PCA, one component including perceptual reasoning and working memory, and another component including visuospatial search and graphomotor speed, cognitive inhibition/flexibility and central executive functioning. Both components were associated with lower performances in the C-ADHD group.

CONCLUSIONS

C-ADHD is frequent in schizophrenia and associated with more severe positive symptoms and impaired cognitive performances compared to those without C-ADHD. This suggests that the pathophysiological mechanisms contributing to these disorders may lead to the worsening of the cognitive functioning in patients with both disorders. C-ADHD is a relevant clinical marker to discriminate subgroups of schizophrenia with different profiles for a precision-psychiatry approach.

The relationship between problematic internet use and attention deficit, hyperactivity and impulsivity: A meta-analysis

OBJECTIVE

This study aimed to investigate the relationship between problematic internet use (PIU) and ADHD-related symptoms of attention deficit, impulsivity and hyperactivity.

METHODS

We chose a meta-analytical approach and searched for relevant studies in different databases (Pubmed, PsycInfo, Google scholar). We identified 24 studies with 18 859 participants (mean age = 18.40 (SD = 5.51)) published between 2004 and 2021 which were applicable for our research. We calculated 21, 7, and 9 effect sizes for attention deficit, hyperactivity and impulsivity, respectively.

RESULTS

We found significant associations between PIU and attention deficit (r = 0.36, 95% confidence interval = [0.28 to 0.43]), hyperactivity (r = 0.44, 95% confidence interval = [0.33 to 0.53]), and impulsivity (r = 0.41, 95% confidence interval = [0.30 to 0.51]), p < .001 for all three. The effect sizes of attention deficit and hyperactivity were significantly higher in male compared to female participants. Additionally, higher attention deficit effects were found in adults compared to children/adolescents.

CONCLUSIONS

Our meta-analysis indicates that ADHD-related symptoms are associated with PIU. Although cross-sectional analyses cannot explain cause-and-effect relationships, we hypothesize that attention deficit, hyperactivity and impulsivity constitute a vulnerability towards PIU.

Associations between maternal metabolic conditions and neurodevelopmental conditions in offspring: the mediating effects of obstetric and neonatal complications

BACKGROUND

Maternal pre-gestational diabetes (PGDM), gestational diabetes mellitus (GDM), and overweight/obesity have been associated with increased risks of offspring neurodevelopmental conditions (NDCs) including autism, intellectual disability (ID), and attention deficit/hyperactivity disorder (ADHD). Less is known about whether and how obstetric and neonatal complications (e.g., preterm birth, neonatal asphyxia) could mediate these associations.

METHODS

In this Swedish register-based cohort study, we examined complications during pregnancy, delivery, and the neonatal period as potential mediators of the relationships between maternal metabolic conditions and offspring NDCs. We quantified the extent to which these obstetric and neonatal factors could mediate the associations of maternal metabolic conditions with offspring NDCs by applying parametric regression models for single mediation analyses and weighting-based methods for multiple mediation analyses under counterfactual frameworks.

RESULTS

The study sample included 2,352,969 singleton children born to 1,299,692 mothers from 1987-2010 who were followed up until December 31, 2016, of whom 135,832 children (5.8%) were diagnosed with at least one NDC. A substantial portion of the association between maternal PGDM and children's odds of NDCs could be explained by the combined group of obstetric and neonatal complications in the multiple mediation analysis. For instance, these complications explained 44.4% of the relationship between maternal PGDM and offspring ID risk. The proportion of the relationship between maternal overweight/obesity and children's risk of NDCs that could be explained by obstetric and neonatal complications was considerably smaller, ranging from 1.5 to 8.1%. Some complications considered on their own, including pregnancy hypertensive diseases, preterm birth, neonatal asphyxia, and hematological comorbidities, could explain at least 10% of the associations between maternal PGDM and offspring NDCs. Complications during the neonatal period showed a stronger joint mediating effect for the relationship between PGDM and offspring NDCs than those during pregnancy or delivery.

CONCLUSIONS

Obstetric and neonatal complications could explain nearly half of the association between maternal PGDM and offspring risk of NDCs. The mediating effects were more pronounced for complications during the neonatal period and for specific complications such as pregnancy hypertensive diseases, preterm birth, neonatal asphyxia, and hematological comorbidities. Effective preventive strategies for offspring NDCs should holistically address both the primary metabolic issues related to PGDM and the wide array of potential complications, especially those in the neonatal period.

MiR-130/SNAP-25 axis regulate presynaptic alteration in anterior cingulate cortex involved in lead induced attention deficits

Brain volume decrease in the anterior cingulate cortex (ACC) after lead (Pb) exposure has been linked to persistent impairment of attention behavior. However, the precise structural change and molecular mechanism for the Pb-induced ACC alteration and its contribution to inattention have yet to be fully characterized. The present study determined the role of miRNA regulated synaptic structural and functional impairment in the ACC and its relationship to attention deficit disorder in Pb exposed mice. Results showed that Pb exposure induced presynaptic impairment and structural alterations in the ACC. Furthermore, we screened for critical miRNA targets responsible for the synaptic alteration. We found that miR-130, which regulates presynaptic vesicle releasing protein SNAP-25, was responsible for the presynaptic impairment in the ACC and attention deficits in mice. Blocking miR-130 function reversed the Pb-induced decrease in the expression of its presynaptic target SNAP-25, leading to the redistribution of presynaptic vesicles, as well as improved presynaptic function and attention in Pb exposed mice. We report, for the first time, that miR-130 regulating SNAP-25 mediates Pb-induced presynaptic structural and functional impairment in the ACC along with attention deficit disorder in mice.

Animal Models of Childhood Exposure to Lead or Manganese: Evidence for Impaired Attention, Impulse Control, and Affect Regulation and Assessment of Potential Therapies

Behavioral disorders involving attention and impulse control dysfunction, such as ADHD, are among the most prevalent disorders in children and adolescents, with significant impact on their lives. The etiology of these disorders is not well understood, but is recognized to be multifactorial, with studies reporting associations with polygenic and environmental risk factors, including toxicant exposure. Environmental epidemiological studies, while good at establishing associations with a variety of environmental and genetic risk factors, cannot establish causality. Animal models of behavioral disorders, when properly designed, can play an essential role in establishing causal relationships between environmental risk factors and a disorder, as well as provide model systems for elucidating underlying neural mechanisms and testing therapies. Here, we review how animal model studies of developmental lead or manganese exposure have been pivotal in (1) establishing a causal relationship between developmental exposure and lasting dysfunction in the domains of attention, impulse control, and affect regulation, and (2) testing the efficacy of specific therapeutic approaches for alleviating the lasting deficits. The lead and manganese case studies illustrate how animal models can advance knowledge in ways that are not possible in human studies. For example, in contrast to the Treatment of Lead Poisoned Children (TLC) human clinical trial evaluating succimer chelation efficacy to improve cognitive functioning in lead-exposed children, our developmental lead exposure animal model showed that succimer chelation can produce lasting cognitive benefits if chelation sufficiently reduces brain lead levels. In addition, this study revealed that succimer treatment in the absence of lead exposure produces lasting cognitive dysfunction, highlighting potential risks of chelation in off-label uses, such as the treatment of autistic children without a history of lead exposure. Our animal model of developmental manganese exposure has demonstrated that manganese can cause lasting attentional and sensorimotor deficits, akin to an ADHD-inattentive behavioral phenotype, thereby providing insights into the role of environmental exposures as contributors to ADHD. These studies have also shown that oral methylphenidate (Ritalin) can fully alleviate the deficits produced by early developmental Mn exposure. Future work should continue to focus on the development and use of animal models that appropriately recapitulate the complex behavioral phenotypes of behavioral disorders, in order to determine the mechanistic basis for the behavioral deficits caused by developmental exposure to environmental toxicants, and the efficacy of existing and emerging therapies.

Autistic traits as predictors of persistent depression

Persistent depression has been suggested to be associated with autistic traits in people of working age. This study aimed to clarify which autistic characteristics at the initial visit were associated with persistent depression at the 12 week follow-up in a primary care setting. Newly depressed outpatients aged 24-59 years with no history of autism were asked to complete the 50-item autism spectrum quotient (AQ) and the Beck depression inventory (BDI) at baseline and 12 week follow-up (N = 123, males: 48%, age: 37.7 ± 9.15 years). Nearly 40% of participants had an AQ score ≥ 26. Significant differences were observed between the group with remitted depression (N = 43) and those with persistent depression (N = 80) in educational years and AQ "attention switching" and "attention to detail" subscale scores. In addition, a statistically significant decrease in the total AQ and the "communication" and "imagination" scores were observed in the remitted group, while no such change was observed in the group with persistent depression. It remains unclear whether the self-perceived severity of communication and imagination traits in persistent depression was due to the state of persistent depression or a kind of premorbid autistic trait. The results suggest that high levels of autistic traits are frequently present in adults with depression. High "attention switching" and "attention to detail" scores in AQ screening at the first visit might predict the persistence of depressive symptoms after 12 weeks in adults with depression, while total AQ scores, especially for "communication" and "imagination" items, might be state-dependent.

Symptomatology of attention deficit, hyperactivity and defiant behavior as predictors of academic achievement

BACKGROUND

It is essential to understand the factors that affect the academic achievement of schoolchildren, both in general and in terms of the major subsectors of each grade. Although symptoms of Attention Deficit Hyperactivity Disorder (ADHD) and Negative Defiant Disorder (NDD-which are commonly recognized as externalizing problems in childhood and adolescence-have been associated with lower academic achievement in the international literature, few studies have addressed this problem in Latin America. This study aimed to analyze the possible predictive relationship of attention problems, hyperactivity, and defiant behavior on academic achievement.

METHODS

We recruited a sample of 4580 schoolchildren (50.9% female, 1754 belonging to primary school, and 2826 to secondary school, ranging from 9 to 18 years old). This cross-sectional study used the scales pertaining to attention problems, hyperactivity, and challenging behavior from the Child and Adolescent Evaluation System.

RESULTS

The analysis showed that attention problems significantly affected all academic achievement areas, while hyperactivity and challenging behavior affected only some of them. The regression models explained 24% of the variability in overall academic achievement in primary school and 17% in secondary school. Other predictors included sex, age, socioeconomic level, and school attendance.

CONCLUSIONS

It is important to consider this symptomatology in the design of educational interventions.

Auditory event-related electroencephalographic potentials in borderline personality disorder

BACKGROUND

Borderline Personality Disorder (BPD) is characterized by mood dysregulation, impulsivity, identity disturbances, and a higher risk for suicide. Currently, the diagnosis is solely based on clinical observation of overt symptoms, and this can delay the detection of the disease and the timely start of appropriate treatment. Several candidate clinical tools have been studied to better characterize BPD, including event-related potentials (ERP). This review aimed at summarizing the results of the available ERP studies on BPD to clarify the possible application of this technique in the early diagnosis of BPD.

METHODS

A bibliographic search on PubMed and PsycInfo was performed in order to identify studies comprising individuals with BPD diagnosis and a control group that evaluated the ERP elicited by auditory stimuli.

RESULTS

Ten studies that explored various ERP components associated with auditory stimuli in BPD were included. Overall, the results showed that positive ERP (P50, P100, and P300) amplitude and latencies as well as loudness dependance were altered in BPD patients compared to controls, possibly reflecting deficits involving attention, mainly at its early stage, and executive functions.

LIMITATIONS

The reviewed studies used different ERP approaches and non-homogeneous BPD diagnostic criteria.

CONCLUSIONS

Auditory ERP appear to be a promising tool for the assessment of BPD patients, especially for early diagnosis and evaluation of cognitive symptoms.

Is common carotid artery intima-media thickness (cIMT) a risk assessment marker in children with attention deficit/hyperactivity disorder?

OBJECTIVE

Attention deficit/hyperactivity disorder (ADHD) is associated with impairment in social, academic and job-related functioning in both children and adults. The purpose of this study is to investigate the susceptibility to cardiovascular risk factors in children with ADHD diagnosis through common carotid artery intima-media thickness (cIMT) measurement, to compare cIMT in ADHD and control groups and to evaluate the association between cIMT and ADHD symptom severity.

METHODS

The mean cIMT of 42 children with ADHD, ADHD symptom scales and a semi-structured psychiatric interview, and 42 age and sex matched healthy controls were measured with B-mode Doppler neck ultrasonography.

RESULTS

The median cIMT was significantly higher for the ADHD group compared to the healthy controls. There was a statistically significant, negative, moderate correlation between cIMT and Conners ADHD index score, hyperactivity score, oppositional score and the presence of ODD comorbidity.

CONCLUSIONS

In this study, we found significantly higher cIMT in children with ADHD when compared to healthy controls. Considering that increased cIMT is a sign of atherosclerosis and it can be used as a marker of cardiovascular risk factors, our finding may indicate that children with ADHD are at increased risk for cardiovascular diseases.KeypointscIMT was significantly higher in children with ADHD when compared to healthy controls.Higher cIMT in children with ADHD may indicate that children with ADHD are at increased risk for cardiovascular diseases.cIMT measurement may be studied as a potential tool for risk assessment before a child with ADHD is started on psychostimulant medications.

Interaction between spatial neglect and attention deficit in patients with right hemisphere damage

Unilateral spatial neglect (USN) was originally regarded as a parietal syndrome, but it has become evident that USN is a disturbance in the widespread attention network. Here, we focused on an interaction between spatial neglect and non-spatial aspect of attention deficit, and aimed to establish a novel evaluation approach based on the characteristics of the spatial distribution of reaction times. We tested 174 patients with right hemisphere damage and divided them based on their prescreening scores on the Behavioral Inattention Test (BIT): (1) USN++ (n = 79: BIT<131), (2) USN+ (n = 47: BIT≥131 with history of USN), and (3) RHD (n = 48: without neglect symptom). The patients were asked to conduct a touch panel-based pointing task toward 2D-arranged (seven columns × five rows) circular targets on a PC monitor, and the reaction time to each object was recorded. To evaluate aspects of attention deficit and neglect symptoms, we calculated the total average of the reaction time for all objects (RT_mean) and the ratios of the right and left space (L/R_ratio), respectively. The results revealed that RT_mean and L/R_ratio can be regarded as independent evaluation parameters for attention deficit and neglect symptoms, respectively. Voxel-based lesion-symptom mapping based on RT_mean and L/R_ratio values revealed relevant lesions with attention-related brain areas (middle temporal gyrus, angular gyrus, and inferior frontal gyrus), and neglect-related brain areas (superior temporal gyrus and superior longitudinal fascicules). A cluster analysis with Gaussian mixture model detected six different states of USN with an interaction between neglect symptoms and attention deficit. Interestingly, the recovery process after USN can be properly explained by the transition pattern from one cluster to another. Our results suggest that a novel evaluation approach to distinguish between neglect symptoms and attention deficit, namely the characterization of the interaction between RT_mean and L/R_ratio, provides useful information for understanding pathological features of USN.

Mobile app-based chatbot to deliver cognitive behavioral therapy and psychoeducation for adults with attention deficit: A development and feasibility/usability study

BACKGROUND

Attention deficit is a growing problem in adults, and early diagnosis and treatment are needed. Previous studies have shown that cognitive behavioral therapy (CBT) is effective in improving attention deficit symptoms. However, many patients are not receiving adequate treatment due to time, space, and cost constraints. Recently, in other mental illnesses, mobile-based chatbots delivering CBT and psychoeducation have been used for symptom mitigation and treatment.

OBJECTIVE

This study aimed to investigate the feasibility and usability of a short-term intervention, specifically a mobile-based interactive chatbot application, in alleviating attention deficit symptoms.

METHODS

This was a randomized, non-blind parallel-group pilot study conducted from September 2019 to March 2020. Forty-six individuals with attention deficit aged 19-60 were randomly allocated to the chatbot (n = 23) and information-only control groups (n = 23) for 4 weeks. The former group was instructed to use the chatbot application "Todaki," while the latter group was provided with a book on managing attention deficit symptoms. Participants were administered questionnaires to assess their symptoms of attention deficit, depression, and anxiety and evaluated at baseline and 4 weeks after the intervention. The post-intervention survey assessed the chatbot's usability, acceptability, and side effects.

RESULTS

The average age of the participants was 25.1 years (standard deviation [SD] 7.5 years), and 56.5 % (26/46) participants were female. Intention-to-treat analysis (chatbot, n = 23; control, n = 23) revealed a significant reduction of attention deficit symptoms only in the chatbot group, which is represented by group-by-time interaction in Conner's Adult ADHD Rating Scale subscales of Diagnostic and Statistical Manual-IV Attention-Deficit/Hyperactivity Disorder (ADHD) Hyperactive-Impulsive symptoms (F = 4.39; p = .04) and ADHD symptoms total (F = 6.74, p = .01). Further, the results of the paired t-test were significant only in the chatbot group. The average number of times the chatbots were used in 4 weeks was 20.32 (SD 12.89). The total average usage time was 1 h 15 min (SD 1 h 20 min). The degree of improvement in the ADHD symptoms total score was correlated with the number of times the psychoeducation program was used. According to the participants, the empathic/friendly character and unnatural flow of conversation were the best and worst features of the chatbot, respectively.

CONCLUSIONS

This study identified the feasibility and usability of using the mobile-based chatbot to improve attention deficit and its associated psychiatric symptoms. Using this novel intervention to conduct CBT would provide a useful digital therapeutic tool that allows easy accessibility and self-guided management for people with attention deficit, which should be verified through the large scale randomized controlled trial.

Time knowledge impairments in children with ADHD

BACKGROUND

A large number of studies have shown time perception impairment and reaction time (RT) variability in children with attention deficit hyperactivity disorder (ADHD), and have discussed the causes of such difficulties. However, very few studies have investigated time knowledge (i.e., the correct representation and use of time units) in children with ADHD.

METHODS

We evaluated time knowledge in 33 children with ADHD, aged 8-12 years, who had consulted a reference center for learning disabilities in Paris, matched for age and gender with 33 typically developing (TD) children. We used a simple questionnaire-based survey and neuropsychological tests for cognitive and attentional skills.

RESULTS

The acquisition of time knowledge was delayed in children with ADHD compared with TD children (P<0.01). At the end of primary school, children with ADHD obtained time knowledge scores that were close to those of TD children at the beginning of primary school. In children with ADHD, time knowledge was significantly related to the working memory index (P<0.05), but not to ADHD presentation (with or without hyperactivity).

CONCLUSION

This study shows time knowledge impairment in children with ADHD, and paves the way for new screening tests and rehabilitation focused on time knowledge and time-related skills, in order to improve patient care and autonomy.

Psychomotor development and attention problems caused by a splicing variant of CNKSR2

Background

Mutations in CNKSR2 have been described in patients with neurodevelopmental disorders characterized by childhood epilepsy, language deficits, and attention problems. The encoded protein plays an important role in synaptic function.

Case presentation

Whole-exome sequencing was applied to detect pathogenic variants in a patient with clinical symptoms of psychomotor development, attention deficit, poor logical thinking ability, and an introverted personality, but without epilepsy or any significant electroencephalogram changes. Genetic study revealed a splicing mutation (c.1904 + 1G > A) and RT-PCR revealed aberrant splicing of exon 16, leading to a reading-frame shift and a truncated protein in the PH domain.

Conclusions

This is the first report of a splicing variant of CNKSR2, and the unique clinical features of this pedigree will help extend our understanding of the genetic and phenotypic spectra of CNKSR2-related disorders.

Effect of L-Carnosine as adjunctive therapy in the management of children with autism spectrum disorder: a randomized controlled study

L-Carnosine is an amino acid that acts as an anti-oxidant, anti-toxic and neuroprotective agent. There is a paucity of data about the effectiveness of L-Carnosine in the management of autism spectrum disorder (ASD) in children. This study aimed at investigating the effectiveness of L-Carnosine as adjunctive therapy in the management of ASD. This was a randomized controlled trial. Children aged 3-6 years with a diagnosis of mild to moderate ASD were assigned to standard care arm (occupational and speech therapy) and intervention care arm (L-Carnosine, 10-15 mg/kg in 2 divided doses) plus standard care treatment. The children were assessed at the baseline and the end of 2 months for the scores of Childhood Autism Rating Scale, Second Edition-Standard Version (CARS2-ST), Autism Treatment Evaluation Checklist (ATEC), BEARS sleep screening tool and 6-item Gastrointestinal Severity Index (6-GSI). Of the sixty-seven children enrolled, sixty-three children had completed the study. No statistically significant difference (p > 0.05) was observed for any of the outcome measures assessed. Supplementation of L-Carnosine did not improve the total score of CARS2-ST, ATEC, BEARS sleep screening tool and 6-GSI scores of children with ASD. Further investigations are needed with more objective assessments to critically validate the effectiveness of L-Carnosine on ASD children for more decisive results.

Attention deficits in adults with Major depressive disorder: A systematic review and meta-analysis

Attention deficits have been proven in patients with major depressive disorder (MDD). However, a detailed characterization of attention deficits in MDD was unclear. The aim of current study was to explore the specific deficits of attention in different sub-domains of attention so as to produce an overall picture of contemporary research on this field. We performed a systematic review and meta-analysis of published researches. PubMed, EMBASE, Cochrane Library and review of references were searched up to October 2019. Studies using at least one objective measurement to assess attention performances of MDD patients were included. Effect sizes were calculated using random-effects models for attention outcomes. Publication bias was evaluated using Egger's test. Twenty-three eligible studies including 1371 MDD patients were enrolled in this meta-analysis. Significant deficit of global attention was observed. For the specific outcomes, MDD patients showed significant deficits in psychomotor speed/attention, auditory attention, visuo-spatial attention, sustained visual attention, ranging from small to moderate, but not in selective attention. Larger sample sizes and more detailed subgroup analyses based on features of patients should be conducted to produce a more accurate conclusion.

Associations of attention distractibility with attention deficit and with variation in the KTN1 gene

Attention distractibility in a low load visual search experiment with a rare irrelevant distractor could be an objective continuous measure in adulthood that correlates well with the symptoms of attention deficit throughout lifespan. This was studied using a birth cohort representative sample in a longitudinal study. The expected correlations were not found between the distractor cost measured in the experiment in adulthood and the inattention questionnaire scores from ages 15-33. However, the coefficient of variability for RT (CVRT) correlated negatively with self-reported motor restlessness (age 15) and attention deficit (age 25). We suggest that hyperactivity in childhood improved motor control at age 33. Associations with the gene KTN1 rs945270 (found to affect putamen size) were explored. CVRT, motor restlessness at age 15 and attention deficit scores at age 25 were especially low for male C-allele carriers. A possible association with the volume of putamen of individual participants is considered.

Osmotic Release Oral System-Methylphenidate Hydrochloride (OROS-MPH) versus atomoxetine on executive function improvement and clinical effectiveness in ADHD: A randomized controlled trial

OBJECTIVES

The aim of this study to compare the clinic efficacy and effects of osmotic release oral system-methylphenidate and atomoxetine on executive function in children and adolescents with attention deficit hyperactivity disorder by a open-label, prospective, randomized controlled trial.

METHODS

The study was performed by 95 cases between ages 6 and 12 years who were diagnosed as attention-deficit/hyperactivity disorder (ADHD) and also 40 control individuals. In this study, Conners' Teacher Rating Scale (CTRS) was used in order to evaluate the efficacy of the treatment. Executive functions were assessed by the performance-based neuropsychological tests and ecological behavioral rating scales. Stroop test, cancellation test, and serial digit learning test were applied to performance based neuropsychological tests. Behavior Rating Inventory of Executive Function tests (BRIEFs) were used as behavioral assessment scales.

RESULTS

Among the ADHD groups, a reduction of over 40% in the CTRS subtest scores used to evaluate the efficacy of the treatment was considered to be an improvement, and no significant difference was found for both drugs. Both Osmotic Release Oral System-Methylphenidate Hydrochloride (OROS-MPH) and atomoxetine (ATX) significantly improved scores in neuropsychological tests.

CONCLUSION

Atomoxetine and OROS-MPH treatments have shown similar efficacy in clinical recovery and improvement on executive functions. However, disturbances in executive functions observed in children with ADHD are persistent despite treatment, when compared with the control group.

Evaluation of symptoms of preopoperative and postoperative psychosomatic screening in children with adenoidectomy and adenotonsillectomy

INTRODUCTION

Adenoidectomy and adenotonsillectomy are very common operations in childhood. It is important to clarify their effects on this age group; in this study, we aimed to investigate the effects of the causative agent on children's mental health by using scales that help to screen for indications of mental disorders in children, who have had adenoidectomy or adenotonsillectomy, both before and after surgery. In this way, we aimed to investigate the effects of this factor on children's mental health.

MATERIALS AND METHODS

The study included 82 children aged 6-12 years with signs of upper respiratory tract obstruction or recurrent adenotonsilitis. Adenotonsillectomy was performed in 41 patients included in the study and adenoidectomy was performed in 41 patients included in the study. 40 healthy children matched with the patient groups in terms of age and gender were included in the control group. Patients, were divided into three groups, those who underwent adenoidectomy, patients undergoing adenotonsillectomy and those in the control group Preoperative and postoperative questionnaires were used to investigate the effect of tonsillectomy or adenoidectomy on the mental health of children. The Parents' Form for the Strengths and Difficulties Questionnaire, the Parental Form for the Children's Anxiety Screening Scale, the Sleeping Scale for Children and the Quality of Life Scale for Children were used in the screening.

RESULTS

In children, who underwent adenoidectomy/adenotonsillectomy due to recurrent infection and adeno/adenotonsillar hypertrophy; it was seen that there was a significant decrease in the scores for the Strengths and Difficulties Questionnaire, the Anxiety Screening Scale in Children, and the Sleep Scale in Children, and a significant increase in Quality of Life Scale for Children scores.

OUTCOME

In conclusion, adenoidectomy/adenotonsillectomy in children with sleep apnea due to recurrent episodes of infection and adeno/adenotonsillar hypertrophy was thought to prevent further neurobehavioral problems, likely to become more complex in the future, and to improve quality of life.

Psychological evaluation of children victims of sexual abuse: development of a protocol

Sexual abuse (SA) is associated with significant psychological problems in childhood, making it increasingly important to develop evaluation protocols. This study examined clinical aspects and cognitive measures of 49 children (24 with SA history and 25 controls). It employed a SA assessment questionnaire, clinical evaluations of posttraumatic stress disorder, risk indicators and neuropsychological tests in order to elaborate a specific forensic psychological evaluation protocol for this population. Conflicting couples (80%), separated parents (68%) and parents' alcohol/drug abuse (76%) were revealed as major risk factors. Fathers represented the primary perpetrator (24%). The main cognitive complaint was difficulty concentrating. Regarding the association between clinical and cognitive variables, it was observed that children who were anxious or referred to having fear, difficulties with operational memory and difficulty sleeping, had more trouble performing tasks that required attention and memory (operational, immediate and late). Children with SA history demonstrated inferior performance in visual attention/task switching and memory; with an emphasis in the loss of set in the Wisconsin test. The findings suggest the possibility of a primary attention deficit in children with SA history, possibly influencing the performance of other cognitive functions.

Genetics of ADHD: What Should the Clinician Know?

PURPOSE OF REVIEW

Attention deficit hyperactivity disorder (ADHD) shows high heritability in formal genetic studies. In our review article, we provide an overview on common and rare genetic risk variants for ADHD and their link to clinical practice.

RECENT FINDINGS

The formal heritability of ADHD is about 80% and therefore higher than most other psychiatric diseases. However, recent studies estimate the proportion of heritability based on singlenucleotide variants (SNPs) at 22%. It is a matter of debate which genetic mechanisms explain this huge difference. While frequent variants in first mega-analyses of genome-wideassociation study data containing several thousand patients give the first genome-wide results, explaining only little variance, the methodologically more difficult analyses of rare variants are still in their infancy. Some rare genetic syndromes show higher prevalence for ADHD indicating a potential role for a small number of patients. In contrast, polygenic risk scores (PRS) could potentially be applied to every patient. We give an overview how PRS explain different behavioral phenotypes in ADHD and how they could be used for diagnosis and therapy prediction. Knowledge about a patient's genetic makeup is not yet mandatory for ADHD therapy or diagnosis. PRS however have been introduced successfully in other areas of clinical medicine, and their application in psychiatry will begin within the next years. In order to ensure competent advice for patients, knowledge of the current state of research is useful forpsychiatrists.

Frequency coupling of low and high frequencies in the EEG of ADHD children and adolescents in closed and open eyes conditions

The present report examines the possible differences in absolute Power Spectral Density (PSD), the topography of brain rhythms, and low frequency (delta and theta) vs. beta PSD when attention deficit disorder (ADHD) children and controls are compared. These results would potentially be useful to test the validity of the developmental lag and differential developmental models for ADHD. The EEG resting state under the experimental conditions of open and closed eyes were recorded in samples of control subjects and children with ADHD (6-17 years old). The PSD from 0 to 46 Hz was calculated and ANOVAs were performed to compare the groups of subjects in the two experimental conditions. To observe differences in the co-maturation of the brain rhythms between the groups of subjects, correlations of the PSD of all frequency ranges were computed. These results showed an increase in delta power in children with ADHD compared to control subjects. The topographies of the different brain rhythms were similar in children with ADHD and controls. The maturational power-to-power frequency-coupling between low frequencies and beta rhythms was lower in children with ADHD. The increased delta PSD in ADHD and the similar brain rhythms topographies in children with ADHD and controls support the developmental lag model, whereas the decreased co-maturation of low frequencies vs. beta PSD in children with ADHD suggests a differential maturation rate for low and beta frequencies in children with ADHD compared to controls.

Sleep Evaluation in the Assessment of Pediatric Attention Deficit Disorders

INTRODUCTION

Examining the impact of appropriate sleep evaluation on diagnosis of attention deficit disorders can improve the standard of care in pediatrics. This quality improvement project examined current practice and subsequent implementation of a validated standardized sleep evaluation tool in the assessment of children with symptoms of attention deficit.

METHODS

Retrospective chart review and implementation of the Children's Sleep Habits Questionnaire (CSHQ) for children 6 to 14years old with attention deficit symptoms.

MEASURES

Rates of sleep screening, sleep referrals, diagnosis of sleep and attention deficit disorders, Vanderbilt scores, CSHQ scores.

RESULTS

In the retrospective group (n = 41), 76% of patients had attention deficit disorder/attention deficit hyperactivity disorder, 19.5% had sleeping disorders. There were significant provider differences in diagnosing sleep problems (p = .007). In the intervention group (n = 5), 60% had abnormal CSHQ scores.

DISCUSSION

There was considerable incidence of sleeping problems in children with symptoms of attention deficit and provider variation in sleep evaluation and diagnosis, with minimal referral to specialist care. Our findings support a more comprehensive and standardized evaluation of sleep when assessing for attention deficit disorders to improve appropriate referrals, diagnosis, and treatment in pediatrics.

Computer-assisted rehabilitation of attention in pediatric multiple sclerosis and ADHD patients: a pilot trial

BACKGROUND

The treatment of cognitive deficits is challenging in pediatric onset multiple sclerosis (POMS) and in patients with attention deficit hyperactivity disorder (ADHD). We performed a pilot double-blind RCT to evaluate the efficacy of a home-based computerized-program for retraining attention in two cohorts of POMS and ADHD patients.

METHODS

POMS and ADHD patients failing in at least 2/4 attention tests on a neuropsychological battery were randomized to specific or nonspecific computerized training (ST, nST), performed in one-hour sessions, twice/week for 3 months. The primary outcome was the effect of the training on global neuropsychological performances measured by the cognitive impairment index (CII). The efficacy of the intervention was evaluated in each disease group by using repeated measures ANOVA.

RESULTS

Sixteen POMS (9 females, age 15.75 ± 1.74 years) and 20 ADHD (2 females, age 11.19 ± 2.49 years) patients were enrolled. In POMS patients the ST exposure was associated to a significantly more pronounced improvement of the CII (p < 0.0001) and on cognitive test exploring attention, concentration, planning strategies and visuo-spatial memory performances in comparison to nST exposure. In ADHD patients the difference between the ST and nST on the CII was not statistical significant (p = 0.06), but a greater effect of the ST was found only on cognitive test exploring attention and delayed recall of visuo-spatial memory performances.

CONCLUSIONS

Our data suggest that a cognitive rehabilitation program that targets attention is a suitable tool for improving global cognitive functioning in POMS patients, whereas it has a less pronounced transfer effect in ADHD patients.

TRIAL REGISTRATION

ClinicalTrials.gov; NCT03190902 ; registration date: June 15, 2017; retrospectively registered.

Acute and chronic effect of physical activity on cognition and behaviour in young people with ADHD: A systematic review of intervention studies

BACKGROUND

Young people with attention deficit hyperactivity disorder (ADHD) often have learning and behavioral control difficulties.

AIM

The aim of this review is analyse the acute and chronic effect of physical activity (PA) on the cognition and behaviour of children and adolescents with ADHD.

METHODS

Studies were identified in five databases (PubMed, SPORTDiscus, ProQuest, Web of Science, and SCOPUS), from January 2000 through to January 2017. A total of 16 interventional studies met the inclusion criteria.

RESULTS/CONCLUSIONS

PA practice of 20-30 min (intensity 40-75%) produces a positive acute effect on processing speed, working memory, planning and problem solving in young people with ADHD. However, these effects on behaviour are contradictory and vary depending on age. Chronic PA practice (≥30 min per day, ≥40% intensity, ≥three days per week, ≥five weeks) further improves attention, inhibition, emotional control, behaviour and motor control. The results must be treated with caution, because only 25% of the studies used confounders.

IMPLICATION

More research is needed to justify the causes of these effects. It is necessary to establish programs with regard to the duration, intensity, kind of exercise, and time of PA to improve cognition and behaviour in young people with ADHD taking into account potential confounders.

Evaluation of artifact-corrected electroencephalographic (EEG) training: a pilot study

This double-blind study examined the effect of electromyographical (EMG) artifacts, which contaminate electroencephalographical (EEG) signals, by comparing artifact-corrected (AC) and non-artifact-corrected (NAC) neurofeedback (NF) training procedures. 14 unmedicated college students were randomly assigned to two groups: AC (n = 7) or NAC (n = 7). Both groups received 12 sessions of NF and were trained using identical NF treatment protocols to reduce their theta/beta power ratios (TBPR). Outcomes on a continuous performance test revealed that the AC group had statistically significant increases across measures of auditory and visual attention. The NAC group showed smaller gains that only reached statistical significance on measures of visual attention. Only the AC group reduced their TBPR, the NAC group did not. AC NF appears to play an important role during training that leads to improvements in both auditory and visual attention. Additional research is required to confirm the results of this study.

The influence of EEG-detected nocturnal centrotemporal discharges on the expression of core symptoms of ADHD in children with benign childhood epilepsy with centrotemporal spikes (BCECTS): A prospective study in a tertiary referral center

Benign childhood epilepsy with centrotemporal spikes (BCECTS) is the most frequent benign focal epilepsy in childhood. Although it is described as a benign epilepsy syndrome, many studies have revealed that a significant number of patients have some degree of neuropsychological impairment. Thirty-two patients with BCECTS aged 6-11years were included in the study. All patients (without any antiepileptic or psychiatric medication) underwent all-night EEG monitoring and complex neuropsychological testing to diagnose the presence of core symptoms of attention-deficit/hyperactivity disorder (ADHD). The spike index (number of spikes per minute) on awake and asleep EEG, age at seizure onset, family history of epilepsy, and perinatal risks were correlated with the results of neuropsychological testing. Of the 32 patients, 21 patients (65.6%) fulfilled the criteria for ADHD diagnosis. Children who were younger at epilepsy onset demonstrated lower IQ and higher attention deficit (P=0.004) and higher impulsivity (P=0.016). The occurence of epileptiform discharges on nocturnal EEG was positively related to higher attention deficit and higher impulsivity. The findings are discussed in terms of how interictal discharges in the centrotemporal region during sleep affect the development of cognitive functions in children during critical epochs of neuropsychological development.

Motor dysfunction in NF1: Mediated by attention deficit or inherent to the disorder?

AIM

Attention deficit and compromised motor skills are both prevalent in Neurofibromatosis type 1 (NF1), but the relationship is unclear. We investigated motor function in children with NF1 and in children with Attention Deficit/Hyperactivity Disorder (ADHD), and explored if, in patients with NF1, attention deficit influences motor performance.

METHODS

Motor performance was measured using the Movement Assessment Battery for Children (M-ABC) in 71 children (26 with NF1 plus ADHD, 14 with NF1 without ADHD, and 31 with ADHD without NF1) aged 6-12 years.

RESULTS

There was a significant effect of group on motor performance. Both NF1 groups scored below children with ADHD without NF1. Attention performance mediated motor performance in children with ADHD without NF1, but not in children with NF1.

CONCLUSIONS

Motor function is not mediated by attention performance in children with NF1. While in ADHD, attention deficit influences motor performance, motor problems in NF1 seem to be independent from attention deficit. This argues for different pathomechanisms in these two groups of developmental disorders.

[A twin study of genetic and environmental influences on relationship between attention deficit and anxiety/depression in children and adolescents]

Objective: To understand the genetic and environmental influences on the relationship between attention deficit and anxiety/depression in children and adolescents. Methods: A total of 1 062 same-sex twins aged 6-18 years were included in this study. A parent-rated child behavior checklist (CBCL) was used in the assessment. Software Mx was used to fit the univariate model of structural equation. The relationship between attention deficit and anxiety/depression was analyzed through bivariate genetic modeling. Results: The genetic factor had influence on the relationship between attention deficit and anxiety/depression (r(g)=0.48). Shared and non-shared environmental correlation scores of attention deficit and anxiety/depression were 0.86 and 0.14 respectively. Conclusion: Common genetic and shared environmental influences can explain the relationship between attention deficit and anxiety/depression in children and adolescents.

The effects of video game therapy on balance and attention in chronic ambulatory traumatic brain injury: an exploratory study

Background

Patients with traumatic brain injury often have balance and attentive disorders. Video game therapy (VGT) has been proposed as a new intervention to improve mobility and attention through a reward-learning approach. In this pilot randomized, controlled trial, we tested the effects of VGT, compared with a balance platform therapy (BPT), on balance, mobility and selective attention in chronic traumatic brain injury patients.

Methods

We enrolled chronic traumatic brain injury patients (n = 21) that randomly received VGT or BPT for 3 sessions per week for 6 weeks. The clinical outcome measures included: i) the Community Balance & Mobility Scale (CB&M); ii) the Unified Balance Scale (UBS); iii) the Timed Up and Go test (TUG); iv) static balance and v) selective visual attention evaluation (Go/Nogo task).

Results

Both groups improved in CB&M scores, but only the VGT group increased on the UBS and TUG with a between-group significance (p < 0.05). Selective attention improved significantly in the VGT group (p < 0.01).

Conclusions

Video game therapy is an option for the management of chronic traumatic brain injury patients to ameliorate balance and attention deficits.

Trial registration

NCT01883830, April 5 2013.

A connective tissue disorder may underlie ESSENCE problems in childhood

BACKGROUND

Ehlers-Danlos syndrome hypermobility type, also known as Joint Hypermobility Syndrome (EDS-HT/JHS), is the most common hereditary disorder of the connective tissue (HDCT). It is characterized by tissue fragility, joint hypermobility and a wide range of articular and non-articular manifestations, which often appear in infancy. The clinical picture of EDS-HT/JHS is poorly known by the medical community, as is the presence of "ESSENCE" (Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations) problems in affected children.

AIM

The present work reviews the clinical and empirical evidence for ESSENCE difficulties in children with EDS-HT/JHS.

METHOD

A narrative review of the literature was undertaken following a comprehensive search of scientific online databases and reference lists. This included publications of quantitative and qualitative research.

RESULTS

Motor abnormality, hyperactivity/hypoactivity, inattention, speech/language, social interaction, behavioral, sleep, feeding and emotional problems are ESSENCE difficulties for which there is some evidence of an association with EDS-HT/JHS.

CONCLUSION

Children with EDS-HT/JHS present ESSENCE problems that often coexist and tend to be recognized before the HDCT. Clinicians encountering children with ESSENCE problems should consider the possibility of an underlying HDCT such as EDS-HT/JHS, probably influencing neurodevelopmental attributes in a subgroup of children. Awareness of these interconnected clinical problems might help improve early referral, diagnosis and treatment of EDS-HT/JHS.

The Effect of Neurofeedback Therapy on Reducing Symptoms Associated with Attention Deficit Hyperactivity Disorder: A Case Series Study

Introduction:

This study aimed to evaluate the effectiveness of neurofeedback on attention deficit hyperactivity disorder.

Methods:

This is a quasi-experimental study without a control group. The study population included all children aged 5 to 12 years old affected with attention deficit hyperactivity disorders in Tehran, Iran who were referred to psychiatric clinics and given the diagnosis. The sample included 12 children with attention deficit hyperactivity disorder who were selected based on their availability (non-random sampling). They received 30 sessions of neurofeedback treatment, 2 times per week. Before and after neurofeedback training, the children were evaluated and compared with the use of cognitive assessment system test. Data were analyzed using dependent T-test.

Results:

The total mean score for pretest was 88.81 while the total mean score for the post test was 82.23. The mean in pretest for attention hyperactivity disorder was higher than the mean in the post test. Moreover, The difference of pretest and post test scores of children affected with learning disorder associated with ADHD was calculated that showed significant (P=0.003).

Conclusion:

Neurofeedback is effective in the improvement of attention deficit hyperactivity disorder.

Functional connectivity change of brain default mode network in breast cancer patients after chemotherapy

INTRODUCTION

Complaint about attention disorders is common among breast cancer patients who have undergone chemotherapy, which may be associated with the default mode network (DMN). To validate this hypothesis, we investigated the DMN functional connectivity (FC) change and its relationship with the attention function in breast cancer patients (BC) using resting-state functional magnetic resonance imaging (rs-fMRI).

METHODS

Twenty-two BC treated with chemotherapy and 22 healthy controls (HC) were recruited into this study. The FC between the DMN's hubs and regions of the dorsal medial prefrontal cortex (dMPFC) and medial temporal lobe (MTL) subsystems was respectively calculated for each participant.

RESULTS

The statistical result showed significantly lower connectivity in dMPFC and MTL subsystems in the BC group. In addition, the partial correlation analysis result indicated that the low connectivity of some brain regions in MTL subsystem was correlated with attention dysfunction following BC chemotherapy.

CONCLUSION

These results suggest that the functional disconnection in MTL subsystem of the DMN may have association with attention function of BC after chemotherapy.

Association of screen time with self-perceived attention problems and hyperactivity levels in French students: a cross-sectional study

OBJECTIVE

To investigate whether high levels of screen time exposure are associated with self-perceived levels of attention problems and hyperactivity in higher education students.

DESIGN

Cross-sectional study among participants of the i-Share cohort.

SETTING

French-speaking students of universities and higher education institutions.

PARTICIPANTS

4816 graduate students who were at least 18 years old.

EXPOSURE

Screen time was assessed by self-report of the average time spent on five different screen activities on smartphone, television, computer and tablet and categorised into quartiles.

MAIN OUTCOME MEASURE

We used the Attention Deficit Hyperactivity Disorder Self-Report Scale (ASRS-v1.1) concerning students' behaviour over the past 6 months to measure self-perceived levels of attention problems and hyperactivity. Responses were summarised into a global score as well as scores for attention problems and hyperactivity.

RESULTS

The 4816 participants of this study had a mean age of 20.8 years and 75.5% were female. Multivariable ordinary regression models showed significant associations of screen time exposure with quintiles of the total score of self-perceived attention problems and hyperactivity levels as well as the individual domains. Compared to the lowest screen time exposure category, the ORs (95% CI) were 1.58 (1.37 to 1.82) for each increasing level of quintiles of the global score, 1.57 (1.36 to 1.81) for increasing quintiles of attention levels and 1.25 (1.09 to 1.44) for increasing quartiles of hyperactivity.

CONCLUSIONS

Results of this large cross-sectional study among French university and higher education students show dose-dependent associations between screen time and self-perceived levels of attention problems and hyperactivity. Further studies are warranted to evaluate whether interventions could positively influence these associations.

Visual attention: Linking prefrontal sources to neuronal and behavioral correlates

Attention is a means of flexibly selecting and enhancing a subset of sensory input based on the current behavioral goals. Numerous signatures of attention have been identified throughout the brain, and now experimenters are seeking to determine which of these signatures are causally related to the behavioral benefits of attention, and the source of these modulations within the brain. Here, we review the neural signatures of attention throughout the brain, their theoretical benefits for visual processing, and their experimental correlations with behavioral performance. We discuss the importance of measuring cue benefits as a way to distinguish between impairments on an attention task, which may instead be visual or motor impairments, and true attentional deficits. We examine evidence for various areas proposed as sources of attentional modulation within the brain, with a focus on the prefrontal cortex. Lastly, we look at studies that aim to link sources of attention to its neuronal signatures elsewhere in the brain.

Effects of adenoidectomy/adenotonsillectomy on ADHD symptoms and behavioral problems in children

OBJECTIVES

In children, the most common reason of upper airway obstruction (UAO) is adenotonsillar hypertrophy. In literature, the adverse effects of UAO and obstructive sleep apnea syndrome on behavior and attention in children have been reported in several articles. However, the methods used for the evaluation of behavioral disorders have not been standardized in those studies. The aim of this study was to investigate the behavioral and attention characteristics of children before and after adenoidectomy/adenotonsillectomy using an internationally valid method.

METHODS

A total of 41 patients, between 6 and 11 years of age and having a medical history of UAO for at least one year for which adenotonsillectomy procedure was indicated, were enrolled in the study. The patients were evaluated for signs of attention/behavioral disorders by a child-adolescent psychiatrist and Kiddie-Schedule for Affective Disorders and Schizophrenia for School-Age Children: Present and Lifetime Version (K-SADS-PL) and The Turgay DSM-IV-Based Child and Adolescent Disruptive Behavioral Disorders Screening and Rating Scale (T-DSM-IV-S), before and at the 6th month following the operation.

RESULTS

In the preoperative period, a psychiatric disorder was identified by K-SADS-PL in 41.4% (n =1 7) of patients. Of these, 11 patients had attention deficit hyperactivity disorder (ADHD), 6 had enuresis nocturna, and 2 had separation anxiety disorder. Pre- and postoperative mean scores in T-DSM-IV-S parent scale were 31.3 ± 8.5 and 20.2 ± 10.3, respectively, and this difference was statistically significant (p < 0.001).

CONCLUSION

The relationship of UAO and attention/behavioral disorders should be taken into consideration by child-adolescent psychiatrists together with ENT specialists and a multidisciplinary approach is important for the treatment team.

Evaluation of adult attention deficit hyperactivity disorder in smokers and Maras powder users

BACKGROUND

The aim of this study was to evaluate adult attention deficit and hyperactivity disorder (ADHD) in smokers, Maras powder users and non-users of tobacco products by using the Adult Attention Deficit and Hyperactivity Disorder Self-report Scale (ASRS).

METHODS

The study was performed on 446 males presenting to family health centers in Kahramanmara, Turkey. Of 446 participants, 104 were Maras powder users, 133 were smokers and 209 were volunteers not using any tobacco products. Data were collected with a questionnaire composed of questions about socio-demographic features and features of smoking and Maras powder use, and the Fagerström Nicotine Dependence Scale and the ASRS. P < 0.05 was considered significant.

RESULTS

The mean age of the participants was 33.94 ± 10.68 years (min = 18, max = 64). There was no significant difference in age between the study groups (P = 0.089). Thirty-one participants (7.0%) received scores higher than the cut-off value (≥ 14 points) for the short form of the ASRS. Twenty-one participants (4.7%) achieverd scores higher than the cut-off value (≥ 44 points) for the ASRS. The smokers received the highest scores of 8.42 ± 3.79 for all the subscales of the short version of the ASRS, 26.87 ± 10.46 for the ASRS, 12.57 ± 6.47 for the attention deficit subscale and 14.30 ± 5.35 for the hyperactivity and impulsivity subscale.

CONCLUSION

Higher rates of the smokers and the Maras powder users had symptoms of ADHD. Considering nicotine may decrease symptoms of ADHD, it can be assumed that the rates of the smokers and Maras powder users with ADHD are higher.

The prevalence and factors affecting attention deficit hyperactivity disorder among school children in Khartoum State

Attention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in children, characterized by age-inappropriate features of inattention, hyperactivity and impulsivity or both. The aim of this study is to determine the prevalence and socio demographic correlates of ADHD symptoms in general basic schoolchildren. A cross-sectional study conducted in Khartoum North. A random sample of 190 general basic schools was chosen, from which sample of 1000 students from both boys and girls were selected by systematic random sampling, their age ranges between 7 and 14 years. They were screened for different subtypes of ADHD symptoms using the SNAP-IV-C teacher and parent rating scale, which is a revision of the Swanson Nalon and Pelham (SNAP) questionnaire. The overall prevalence of ADHD was 9.4%. The prevalence of children with ADHD/inattentive sub type, ADHD/ hyperactive-impulsive sub type, ADHD/ combined subtype were 3.5%, 6.9 % and 1.0 %, respectively. The prevalence rate increased significantly with the increase in age. The study showed that the prevalence of ADHD symptoms among school children in Sudan was high as rated by both teacher and parents rather than what has been reported in other studies. ADHD symptoms are more common among boys than girls and more prevalent in late childhood and in those who lived in rural area.

Dysfunctional cortical inhibition in adult ADHD: neural correlates in auditory event-related potentials

In recent times, the relevance of an accurate diagnosis of attention-deficit/hyperactivity disorder (ADHD) in adults has been the focus of several studies. No longer considered a pathology exclusive to children and adolescents, and taking into account its social implications, developing enhanced support tools for the current diagnostic procedure becomes a priority. Here we present a method for the objective assessment of ADHD in adults using chirp-evoked, paired auditory late responses (ALRs) combined with a two-dimensional ALR denoising scheme to extract correlates of intracortical inhibition. Our method allows for an effective single-sweep denoising, thus requiring less trials to obtain recognizable physiological features, useful as pointers of cortical impairment. Results allow an optimized diagnosis, reduction of data loss and acquisition time; moreover, they do not account exclusively for critical elements within clinical evaluations, but also allow studying the pathophysiology of the condition by providing objective information regarding impaired cortical functions.

Non-negative matrix factorization of multimodal MRI, fMRI and phenotypic data reveals differential changes in default mode subnetworks in ADHD

In the multimodal neuroimaging framework, data on a single subject are collected from inherently different sources such as functional MRI, structural MRI, behavioral and/or phenotypic information. The information each source provides is not independent; a subset of features from each modality maps to one or more common latent dimensions, which can be interpreted using generative models. These latent dimensions, or "topics," provide a sparse summary of the generative process behind the features for each individual. Topic modeling, an unsupervised generative model, has been used to map seemingly disparate features to a common domain. We use Non-Negative Matrix Factorization (NMF) to infer the latent structure of multimodal ADHD data containing fMRI, MRI, phenotypic and behavioral measurements. We compare four different NMF algorithms and find that the sparsest decomposition is also the most differentiating between ADHD and healthy patients. We identify dimensions that map to interpretable, recognizable dimensions such as motion, default mode network activity, and other such features of the input data. For example, structural and functional graph theory features related to default mode subnetworks clustered with the ADHD-Inattentive diagnosis. Structural measurements of the default mode network (DMN) regions such as the posterior cingulate, precuneus, and parahippocampal regions were all related to the ADHD-Inattentive diagnosis. Ventral DMN subnetworks may have more functional connections in ADHD-I, while dorsal DMN may have less. ADHD topics are dependent upon diagnostic site, suggesting diagnostic differences across geographic locations. We assess our findings in light of the ADHD-200 classification competition, and contrast our unsupervised, nominated topics with previously published supervised learning methods. Finally, we demonstrate the validity of these latent variables as biomarkers by using them for classification of ADHD in 730 patients. Cumulatively, this manuscript addresses how multimodal data in ADHD can be interpreted by latent dimensions.

Different characteristics of cognitive impairment in elderly schizophrenia and Alzheimer's disease in the mild cognitive impairment stage

We compared indices of the revised version of the Wechsler Memory Scale (WMS-R) and scaled scores of the five subtests of the revised version of the Wechsler Adult Intelligence Scale (WAIS-R) in 30 elderly schizophrenia (ES) patients and 25 Alzheimer's disease (AD) patients in the amnestic mild cognitive impairment (aMCI) stage (AD-aMCI). In the WMS-R, attention/concentration was rated lower and delayed recall was rated higher in ES than in AD-aMCI, although general memory was comparable in the two groups. In WAIS-R, digit symbol substitution, similarity, picture completion, and block design scores were significantly lower in ES than in AD-aMCI, but the information scores were comparable between the two groups. Delayed recall and forgetfulness were less impaired, and attention, working memory and executive function were more impaired in ES than in AD-aMCI. These results should help clinicians to distinguish ES combined with AD-aMCI from ES alone.