Validation of the Mind Excessively Wandering Scale and the Relationship of Mind Wandering to Impairment in Adult ADHD

Where Is My Mind? The Daydreaming Characteristics Questionnaire, a New Tool to Differentiate Absorptive Daydreaming From Mind-Wandering

OBJECTIVE

Maladaptive daydreaming (MD) is an impairing condition characterized by addiction to narrative, emotional fantasizing, involving dissociative absorption. By compulsively withdrawing toward vivid imaginative scenarios, MD hinders attentional functioning and replaces social interactions. Previous Interview-based research showed clinical importance in differentiating MD from ADHD and the associated construct of mind-wandering. We aimed to create a self-report tool asking directly about the content and structure of distracting thoughts.

METHOD

Two samples, namely, 346 undergraduate students and 381 adults from the general community, completed a novel measure, the Daydreaming Characteristics Questionnaire (DCQ), along with validated measures for ADHD, mind-wandering, MD, dissociation, and general distress.

RESULTS

Exploratory Factor Analyses on the DCQ, replicated across both samples, yielded two distinct factors (immersive daydreaming and daydream functionality) uniquely associated with MD.

CONCLUSION

The DCQ represents characteristics of immersive daydreaming much more than general attentional deficiency and is thus useful in differentiating MD from ADHD/mind-wandering distractions.

An item-level systematic review of the presentation of ADHD in females

Previous studies examining sex differences in attention deficit hyperactivity disorder (ADHD) have primarily examined total or subscale scores. This systematic review aimed to examine which symptoms contribute to the female presentation of ADHD at an item-level. Six research literature databases were searched for studies comparing ADHD symptoms and their impact at an item-level in females with ADHD compared with: 1) males with ADHD and 2) females without ADHD. Thirteen studies were included. In childhood, females were more likely to display the symptoms 'fails to sustain attention in tasks' and 'often easily distracted', whereas males were more likely to display the symptoms 'often fidgets', 'difficulty remaining seated when required', 'runs/climbs in situations when inappropriate', 'always on the go', 'often noisy in playing', 'difficulty waiting turn', 'often blurts out answers' and 'often interrupts others'. In adulthood, females were more likely to endorse the symptoms 'easily distracted', 'difficulty organising tasks', 'blurts out answers' and 'talks excessively', as well as to report mind wandering and adverse home impacts. Females with ADHD differ in their symptom profile to males with ADHD, highlighting the need for future research to identify and characterise symptoms typical of female ADHD.

Does Mind-Wandering Explain ADHD-Related Impairment in Adolescents?

Currently, diagnostic criteria for ADHD mainly reflect behavioral symptoms, neglecting internal phenomena like mind-wandering. Recent studies found that mind-wandering explains impairment beyond ADHD symptoms in adults. To better capture ADHD-related impairment in adolescents, we aimed to elucidate whether mind-wandering is associated with impairments that are prevalent in adolescents (i.e., risk-taking behavior, homework problems, emotional dysregulation, and general impairment) beyond ADHD symptoms. Furthermore, we sought to validate the Dutch translation of the Mind Excessively Wandering Scale (MEWS). We assessed a community sample of 626 adolescents on ADHD symptoms, mind-wandering, and the impairment domains. The Dutch MEWS had good psychometric properties. Mind-wandering was linked to general impairment and emotional dysregulation beyond ADHD symptoms, but was not linked to risk-taking behavior and homework problems beyond ADHD symptoms. Internal psychological phenomena such as mind-wandering may add to the behavioral symptoms of ADHD in explaining part of the impairment that adolescents with ADHD characteristics experience.

Examination of Excessive Mind-Wandering Following Attention-Deficit and Hyperactivity Disorder Treatment in Adults

Although mind-wandering (MW) is a part of attention deficit and hyperactivity disorder (ADHD), the impact of psychostimulants on excessive MW remains unclear. We aimed to elucidate how psychostimulants impact the MW of adult ADHD patients post treatment. This cross-sectional cohort study consisted of 54 randomly selected ADHD patients who applied to our psychiatry outpatient clinic and 40 healthy controls. The ADHD patients were administered methylphenidate or atomoxetine. A Semi-Structured Sociodemographic and Clinical Data Form, the Adult ADHD Self-Report Scale (ASRS), and the Mind Excessively Wandering Scale (MEWS) were applied. Routine psychiatric assessments in the 1st, 2nd, and 3rd months of pharmacological treatment were carried out by a psychiatrist. The pre-treatment MEWS score of the ADHD patients was 26.09 ± 1.92, which significantly decreased to 12.78 ± 2.54 post-treatment (F = 715.250, p < .001). A statistically significant difference was identified between the mean pre-treatment ASRS total score (44.07 ± 10.09) and post-treatment score (27.34 ± 11.22; F = 50.364, p < .001). A lifetime history of alcohol/substance use was positively associated with the MEWS score. ADHD pharmacotherapy led to significant reductions in MW. Recognizing the interaction between MW and ADHD could help in the design of more specific and comprehensive interventions.

Hyperactive ADHD symptoms are associated with increased variability in thought content in less constrained contexts

The current study used two complementary methods to examine whether hyperactive and inattentive ADHD symptoms are differentially linked to thought dynamics under contexts that differ in the extent to which constraints are placed on ongoing thoughts. First, participants voiced aloud their thoughts in real-time (i.e., Think Aloud task), under two conditions varying in the levels of constraints exerted on their thoughts. Individuals with more hyperactive symptoms displayed heightened variability in thought content only in the less constrained condition. Second, participants completed seven days of ecological momentary assessment during which they received six thought probes daily asking the extent to which their thoughts were freely moving (as a proxy for thought content variability) and a question that captured different levels of constraints. Hyperactive symptoms were positively associated with freely moving thoughts only during responses that corresponded with lower levels of constraints. Across two approaches, we provide converging evidence that hyperactive, but not inattentive, ADHD symptoms are associated with increased thought content variability during lower levels of deliberate constraints on thoughts. Together, these results support the Dynamic Framework of Spontaneous Thought and highlight the importance of considering context in the study of thought dynamics in ADHD.

Could Maladaptive Daydreaming Delay ADHD Diagnosis Until Adulthood? Clinical Characteristics of Adults With ADHD Based on Diagnosis Age

INTRODUCTION

Our study aimed to compare the sociodemographic, diagnostic, clinical, and self-report scale data of adults diagnosed with ADHD in childhood/adolescence versus adulthood and to identify risk factors associated with delayed/missed diagnosis for ADHD.

METHOD

Sociodemographic, clinical, and diagnostic data of 214 adults with ADHD, followed at the Adult Neurodevelopmental Disorders Clinic, Selçuk University, between January 2022 and January 2024, were analyzed. The diagnostic evaluations were made using the Structured Clinical Interview for DSM-5 Clinician Version. Clinical data included age, gender, years of education, alcohol/substance use, diagnosis age, and current medication use for ADHD. Data collected from self-report scales included both ADHD-related measurements and comorbidity-related measurements.

RESULTS

The findings revealed that only 34.4% (n = 74) of sample received a formal ADHD diagnosis during childhood/adolescence. Adults diagnosed with ADHD in adulthood were older and had higher education levels, more severe ADHD symptoms, and increased maladaptive daydreaming (MD) scores, compared to those diagnosed in childhood or adolescence. Logistic regression analysis indicated that the severity of MD was associated with being in the group diagnosed with ADHD in adulthood while controlling for other significant parameters from bivariate analyses, such as age, years of education, and current medication use for ADHD. Finally, analyses conducted separately in both groups showed that: (1) increased MD severity was a predictor of higher ADHD symptoms in those diagnosed in adulthood, but not in those diagnosed in childhood/adolescence, and (2) MD severity had a stronger correlation with ADHD symptoms, the number of comorbid psychiatric disorders, and symptoms of excessive mind wandering, depression, and anxiety in those diagnosed in adulthood compared to those diagnosed in childhood/adolescence.

CONCLUSION

MD may delay ADHD diagnosis until adulthood by masking and compensating ADHD symptoms and delay in referral to mental health professionals, and it might also be a predictive symptom for recognizing ADHD in adults who have never been diagnosed; however, longitudinal studies are needed to confirm this.

Short-term and long-term effect of non-pharmacotherapy for adults with ADHD: a systematic review and network meta-analysis

Background

Attention-Deficit/Hyperactivity Disorder (ADHD) is a lifelong neurodevelopmental condition with a global prevalence of 2.5% to 6.7% among adults. Non-pharmacological interventions have demonstrated effectiveness both as standalone treatments and adjuncts to pharmacotherapy in managing adult ADHD. Nevertheless, the comparative efficacy of these interventions, particularly with respect to diverse ADHD-related outcomes and their long-term impacts, remains insufficiently investigated.

Objective

This study aims to evaluate and compare the short-term and long-term effects of various non-pharmacological therapies on core ADHD symptoms (inattention, hyperactivity, and impulsivity) and emotional disorders (depression and anxiety) in adults with ADHD and to rank these therapies accordingly.

Methods

A systematic search was conducted for relevant randomized controlled trials (RCTs) in the Web of Science, PubMed, Cochrane Library, and EMBASE databases from inception to Sep 2024. Researchers independently screened and extracted data, and the analysis was performed using R version 4.3.2. Cochrane Risk of Bias tool version 2 (ROB2) and Confidence in Network Meta-Analysis (CINeMA) were used to assess the risk of bias and the certainty of the evidence. Standardized mean differences were estimated using network meta-analyses with random effects.

Results

A total of 37 RCTs involving 2,289 participants and 10 non-pharmacological therapies were included. The risk of bias was classified as low in 24.3%, unclear in 27%, and high in 48.6%, while the CINeMA assessment indicated that confidence in the evidence was "very low" or "low" for most of the remaining treatments. Cognitive behavioral therapy (CBT) showed significantly greater effectiveness than the control group/condition in both the short-term (SMD: -4.43, 95%CI: -5.50 to -3.37) and long-term (SMD: -3.61, 95%CI: -4.66 to -2.56) core symptoms. Additionally, CBT shows both short-term and long-term efficacy for depression (SMD: -4.16, 95%CI: -5.51 to -2.81; SMD: -3.89, 95%CI: -5.95 to -1.83) and anxiety (SMD: -2.12, 95%CI: -3.18 to -1.07; SMD: -7.25, 95%CI: -10.57 to -3.94).

Conclusion

CBT may be the most effective intervention for adults with ADHD and associated emotional disorders, while Mindfulness-based Cognitive Therapy (MC) is recommended as a preferable option for those without comorbidities. Caution is needed in interpreting our results, and high-quality RCTs are urgently required for more reliable insights.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?, identifier CRD42024432912.

The role of self-rumination and self-reflection in depressive symptoms among individuals with attention-deficit/hyperactivity disorder traits

While some types of rumination have been reported as exacerbating factors in depressive symptoms related to attention-deficit/hyperactivity disorder (ADHD) traits, the role of self-rumination remains underexplored. Additionally, self-reflection-a similar form of private self-consciousness which may have protective effects-has been even less examined. This study of 3,000 Japanese adults (aged 18-50 years) investigates self-rumination and self-reflection in depressive symptoms related to ADHD, using the Adult ADHD Self-Report Scale, Rumination-Reflection Questionnaire, and Beck Depression Inventory-II. Statistical analyses included Pearson's correlation and linear regression for mediation/moderation. ADHD traits were correlated with depressive symptoms (r = 0.413, p < 0.001), mediated by self-rumination (indirect effect = 0.21, 95% confidence interval [0.17, 0.26]). Self-reflection was positively correlated with depressive symptoms (r = 0.193, p < 0.001) but had a protective effect when controlling for self-rumination (β = -0.75, p < 0.001). Moderated mediation analysis showed self-reflection reduced depressive symptoms related to ADHD traits by moderating both the impact of ADHD traits on self-rumination and the influence of self-rumination on depressive symptoms. These effects were particularly significant for inattention traits. Our findings suggest that self-reflection, by mitigating self-rumination, may serve as a therapeutic target for depressive symptoms in adults with ADHD traits.

Unraveling the relationship between executive function and mind wandering in childhood ADHD

Attention Deficit/Hyperactivity Disorder (ADHD) is one of the most prevalent neurodevelopmental disorders in children. According to developmental literature findings, there is a link between executive function (EF) and ADHD. Although EF deficits vary across ADHD presentations in children, working memory capacity is commonly associated with attention impairments. Notably, deficits in working memory capacity are also observed in frequent mind wandering reports for typically developing children. Mind wandering is shifting attention away from a current task to an unrelated thought. To explore the relationship between EF and mind wandering in children with ADHD (n = 47) and further compare our current sample to a typically developing (control) group from a previous study (n = 47), all participants completed three EF-related tasks. They concurrently reported if they were on task or mind wandering. Our results indicate better short-term memory capacity predicted lower mind wandering frequency in children who reported high levels of ADHD symptoms. Similar trends were observed for working memory capacity and ADHD symptomatology. Children with ADHD also reported more overall and unintentional mind wandering on questionnaires compared to children without ADHD. However, the relationship between EF and mind wandering did not differ between these groups. The current study suggests memory-related cognitive abilities may inform our understanding and management of mind wandering in children, driving the development of interventions targeting attention regulation.

The brief mind wandering three-factor scale (BMW-3)

In recent years, researchers from different fields have become increasingly interested in measuring individual differences in mind wandering as a psychological trait. Although there are several questionnaires that allow for an assessment of people's perceptions of their mind wandering experiences, they either define mind wandering in a very broad sense or do not sufficiently separate different aspects of mind wandering. Here, we introduce the Brief Mind Wandering Three-Factor Scale (BMW-3), a 12-item questionnaire available in German and English. The BMW-3 conceptualizes mind wandering as task-unrelated thought and measures three dimensions of mind wandering: unintentional mind wandering, intentional mind wandering, and meta-awareness of mind wandering. Based on results from 1038 participants (823 German speakers, 215 English speakers), we found support for the proposed three-factorial structure of mind wandering and for scalar measurement invariance of the German and English versions. All subscales showed good internal consistencies and moderate to high test-retest correlations and thus provide an effective assessment of individual differences in mind wandering. Moreover, the BMW-3 showed good convergent validity when compared to existing retrospective measures of mind wandering and mindfulness and was related to conscientiousness, emotional stability, and openness as well as self-reported attentional control. Lastly, it predicted the propensity for mind wandering inside and outside the lab (as assessed by in-the-moment experience sampling), the frequency of experiencing depressive symptoms, and the use of functional and dysfunctional emotion regulation strategies. All in all, the BMW-3 provides a brief, reliable, and valid assessment of mind wandering for basic and clinical research.

Psychotic-like Experiences and Underlying Mechanisms: An Integrative Model of ADHD Symptoms, Rumination, Negative Affect, and Trauma Experience

Background: Psychotic-like experiences (PLEs) are low-intensity subclinical phenomena, often transient in nature. The etiology of PLEs primarily involves neurodevelopmental changes, trauma exposure, and maladaptive coping styles. Attention-Deficit/Hyperactivity Disorder (ADHD) is considered to be one of the factors that increase the risk of future psychosis. Furthermore, ADHD symptoms predict a heightened incidence of traumatic experiences, ruminative thoughts, and negative affect (NA). This present study examines whether rumination and NA mediate the relationship between ADHD symptoms and PLEs and whether trauma experiences moderate these pathways. Methods: A total of 188 participants (72% female) aged 18-35 completed questionnaires assessing ADHD symptoms and traumatic experiences and took part in a seven-day experience sampling method (ESM) procedure, completing ratings of PLEs experiences, the intensity of ruminations, and NA. Results: Correlation analysis showed significant relationships between all tested variables. Serial mediation analysis revealed a significant indirect effect of rumination and NA in the link between ADHD symptoms and PLEs. There was no significant impact of trauma experience in this relationship. Conclusions: Our study underscores the important role of rumination and NA in the co-development of ADHD symptoms and PLEs. Future research should consider investigating the intra-individual dynamics of ADHD and trauma using ecologically valid research methods in the context of PLEs to better understand these complex relationships.

Measuring mind wandering with experience sampling during task performance: An item response theory investigation

The tendency for individuals to mind wander is often measured using experience sampling methods in which probe questions embedded within computerized cognitive tasks attempt to catch episodes of off-task thought at random intervals during task performance. However, mind-wandering probe questions and response options are often chosen ad hoc and vary between studies with extant little guidance as to the psychometric consequences of these methodological decisions. In the present study, we examined the psychometric properties of several common approaches for assessing mind wandering using methods from item response theory (IRT). IRT latent modeling demonstrated that measurement information was generally distributed across the range of trait estimates according to when probes were presented in time. Probes presented earlier in time provided more information about individuals with greater tendency to mind wandering than probes presented later. Furthermore, mind-wandering ratings made on a continuous scale or using multiple categorical rating options provided more information about individuals' latent mind-wandering tendency - across a broader range of the trait continuum - than ratings dichotomized into on-task and off-task categories. In addition, IRT provided evidence that reports of "task-related thoughts" contribute to the task-focused dimension of the construct continuum, providing justification for studies conceptualizing these responses as a kind of task-related focus. Together, we hope these findings will help guide researchers hoping to maximize the measurement precision of their mind wandering assessment procedures.

Dynamics of spontaneous thoughts: Exploration, attentional profile and the segmentation of the stream of thoughts

For a long time, clinical knowledge and first-person reports have pointed to individual differences in the dynamics of spontaneous thoughts, in particular in the extreme case of psychiatric conditions (e.g. racing thoughts in Attention Deficit / Hyperactivity Disorder, ADHD; rumination in depression). We used a novel procedure to investigate this individual variability by combining verbal fluency tasks and introspective reports of thought content. Our goal was twofold. First, we tested the hypothesis that a greater segmentation of the stream of thoughts would be associated with trait inattention, in line with subjective reports of ADHD patients. Second, we tested whether the segmentation of the stream of thoughts increased with an increased tendency for exploratory behavior, following recent theoretical claims on the mechanisms underpinning the generation of spontaneous thoughts. Our results support both hypotheses, shedding light on the factors contributing to the individual variability in the dynamics of the stream of thought.

Validation of the dispositional adult hyperfocus questionnaire (AHQ-D)

Hyperfocus (HF), or intense, deep concentration on a task, has gained significant research attention in recent years, particularly in regard to clinical populations such as Attention-Deficit/Hyperactivity Disorder (ADHD). The present work aims to provide validation of the 12-item dispositional adult hyperfocus questionnaire (AHQ-D) as a quantitative metric of HF in adults. We preregistered the study design and hypotheses. We administered the AHQ-D and several additional questionnaires to 347 adults (mean ± SD age: 33 ± 11 years; 47% female). Exploratory factor analysis revealed high factor loadings (0.57-0.81) on a single HF factor; item response theory analysis suggested that the questionnaire items had high discrimination and covered a wide range of responses; and we report strong internal consistency metrics (Cronbach's alpha 0.93, mean split-half reliability 0.93). Replicating our previous work, HF was positively correlated with Conners' Adult ADHD Rating Scale (CAARS) scores (r(345) = 0.53), suggesting that HF may be related to ADHD traits (though in this sample we did not specifically recruit individuals with ADHD). The AHQ-D demonstrated the hypothesized convergent validity; HF on the AHQ-D was positively correlated with HF measured using a different HF scale (r(344) = 0.69), as well as flow (r(345) = 0.12) and mind wandering (r(345) = 0.39) scores. AHQ-D HF scores showed a weak negative correlation with grit (r(345) = - 0.29). Though there was a weak negative correlation between HF and social desirability response tendency (r(345) = - 0.24), suggesting that those who care more about what others think may report less HF, there was no relationship between HF and extrasensory perception beliefs (r(345) = 0.01), suggesting that participants were not simply biased in their response tendencies. Taken together, we demonstrate strong scale metrics for the AHQ-D, the expected convergent validity, and a general lack of response bias, in addition to replicating our previous association of HF with ADHD traits. We suggest that the AHQ-D can be confidently used in future work as a valid way to measure HF in adults.

The efficacy of real versus sham external Trigeminal Nerve Stimulation (eTNS) in youth with Attention-Deficit/Hyperactivity Disorder (ADHD) over 4 weeks: a protocol for a multi-centre, double-blind, randomized, parallel-group, phase IIb study (ATTENS)

BACKGROUND

Attention Deficit/Hyperactivity Disorder (ADHD), if severe, is usually treated with stimulant or non-stimulant medication. However, users prefer non-drug treatments due to side effects. Alternative non-medication treatments have so far only shown modest effects. External trigeminal nerve stimulation (eTNS) is a minimal risk, non-invasive neuromodulation device, targeting the trigeminal system. It was approved for ADHD in 2019 by the USA Food and Drug administration (FDA) based on a small proof of concept randomised controlled trial (RCT) in 62 children with ADHD showing improvement of ADHD symptoms after 4 weeks of nightly real versus sham eTNS with minimal side effects. We present here the protocol of a larger confirmatory phase IIb study testing efficacy, longer-term persistency of effects and underlying mechanisms of action.

METHODS

A confirmatory, sham-controlled, double-blind, parallel-arm, multi-centre phase IIb RCT of 4 weeks of eTNS in 150 youth with ADHD, recruited in London, Portsmouth, and Southampton, UK. Youth with ADHD will be randomized to either real or sham eTNS, applied nightly for 4 weeks. Primary outcome is the change in the investigator-administered parent rated ADHD rating scale. Secondary outcomes are other clinical and cognitive measures, objective hyperactivity and pupillometry measures, side effects, and maintenance of effects over 6 months. The mechanisms of action will be tested in a subgroup of 56 participants using magnetic resonance imaging (MRI) before and after the 4-week treatment.

DISCUSSION

This multi-centre phase IIb RCT will confirm whether eTNS is effective in a larger age range of children and adolescents with ADHD, whether it improves cognition and other clinical measures, whether efficacy persists at 6 months and it will test underlying brain mechanisms. The results will establish whether eTNS is effective and safe as a novel non-pharmacological treatment for ADHD.

TRIAL REGISTRATION

ISRCTN82129325 on 02/08/2021, https://doi.org/10.1186/ISRCTN82129325 .

Self-compassion and grit mediated the relation between mindfulness and mind wandering based on cross-sectional survey data

Previous research suggests that mindfulness and mind wandering are opposing constructs. However, little is known about why and how they are negatively related. Through a process-oriented approach, this cross-sectional study tested self-compassion and grit as mediators for the relation between mindfulness and mind wandering. A total of 487 self-identified meditators were recruited from the UK (241 female, 49.49%). Participants reported a mean age of 38.98 years (SD = 10.03), with an average of 2.26 h of meditation practice per week (SD = 4.47). Upon informed consent, the participants completed a self-report questionnaire that assessed the core variables under study. Path analysis indicated that mindfulness was related to self-compassion. Greater self-compassion was, in turn, related to greater grit, which was then related to lower mind wandering. Bootstrapping analysis further indicated that self-compassion and grit as mediators between mindfulness and mind wandering, above and beyond age, gender, hours of meditation, income, and education as covariates. The cross-sectional findings provided initial evidence of mediation by showing that mindfulness and mind wandering were related through self-compassion and grit.

Side effects of monaural beat stimulation during sustained mental work on mind wandering and performance measures

Excessive mind wandering (MW) contributes to the development and maintenance of psychiatric disorders. Previous studies have suggested that auditory beat stimulation may represent a method enabling a reduction of MW. However, little is known about how different auditory stimulation conditions are subjectively perceived and whether this perception is in turn related to changes in subjective states, behavioral measures of attention and MW. In the present study, we therefore investigated MW under auditory beat stimulation and control conditions using experience sampling during a sustained attention to response task (SART). The subjective perception of the stimulation conditions, as well as changes in anxiety, stress and negative mood after versus before stimulation were assessed via visual-analog scales. Results showed that any auditory stimulation applied during the SART was perceived as more distracting, disturbing, uncomfortable and tiring than silence and was related to more pronounced increases of stress and negative mood. Importantly, the perception of the auditory conditions as disturbing was directly correlated with MW propensity. Additionally, distracting, disturbing and uncomfortable perceptions predicted negative mood. In turn, negative mood was inversely correlated with response accuracy for target stimuli, a behavioral indicator of MW. In summary, our data show that MW and attentional performance are affected by the adverse perception of auditory stimulation, and that this influence may be mediated by changes in mood.

Unique Patterns of Eye Movements Characterizing Inattentive Reading in ADHD

OBJECTIVE

We aimed to identify unique patterns of eye-movements measures reflecting inattentive reading among adults with and without ADHD.

METHOD & RESULTS

We recorded eye-movements during uninterrupted text reading of typically developed (TD) and ADHD adults. First, we found significantly longer reading time for the ADHD group than the TD group. Further, we detected cases in which words were reread more than twice and found that such occasions were much more frequent in participants with ADHD than in TD participants. Moreover, we discovered that the first reading pass of these words was less sensitive to the length of the word than the first pass of words read only once, indicating a less meaningful reading.

CONCLUSION

We propose that high rate of words that were reread is a correlate of inattentive reading which is more pronounced among ADHD readers. Implications of the findings in the context of reading comprehension are discussed.

Preliminary examination of ADHD inattentive and cognitive disengagement syndrome symptoms in relation to probe-caught mind-wandering during a sustained attention to response task

OBJECTIVE

The role of mind-wandering- periods of internally-directed distractibility - among patients with attention-deficit/hyperactivity disorder (ADHD) has recently garnered attention, though few studies have assessed mind-wandering using thought probes during a sustained attention to response task (SART) or examined the possible role of cognitive disengagement syndrome (CDS) symptoms. We examined whether parent- and/or teacher-reported ADHD-inattentive (ADHD-IN) or CDS symptoms were independently associated with probe-caught mind-wandering.

METHODS

Fifty-four children (ages 9-12; 35.2% female) completed a SART with thought probes inquiring about various on- and off-task thoughts, including mind-wandering and distraction. Questionnaires provided information on demographics, medication treatment, and parent- and teacher-reported ADHD-IN and CDS symptoms. Regression models were estimated separately by informant to examine whether ADHD-IN or CDS symptoms were uniquely associated with mind-wandering or distraction frequency during the SART.

RESULTS

Higher teacher-reported CDS ratings, but not ADHD-IN ratings, were uniquely associated with more probe-caught mind-wandering. No significant findings related to parent-reported symptoms or probe-caught distraction were observed.

CONCLUSIONS

These preliminary findings add to an emerging body of work pointing to CDS as more consistently or strongly associated than ADHD-IN with mind-wandering. Theoretical and clinical implications are discussed.

Breathing Right… or Left! The Effects of Unilateral Nostril Breathing on Psychological and Cognitive Wellbeing: A Pilot Study

The impact of controlled breathing on cognitive and affective processing has been recognized since ancient times, giving rise to multiple practices aimed at achieving different psychophysical states, mostly related to mental clarity and focus, stress reduction, and relaxation. Previous scientific research explored the effects of forced unilateral nostril breathing (UNB) on brain activity and emotional and cognitive functions. Some evidence concluded that it had a contralateral effect, while other studies presented controversial results, making it difficult to come to an unambiguous interpretation. Also, a few studies specifically addressed wellbeing. In the present study, we invited a pilot sample of 20 participants to take part in an 8-day training program for breathing, and each person was assigned to either a unilateral right nostril (URNB) or left nostril breathing condition (ULNB). Then, each day, we assessed the participants' wellbeing indices using their moods and mind wandering scales. The results revealed that, after the daily practice, both groups reported improved wellbeing perception. However, the effect was specifically related to the nostril involved. URNB produced more benefits in terms of stress reduction and relaxation, while ULNB significantly and increasingly reduced mind-wandering occurrences over time. Our results suggest that UNB can be effectively used to increase wellbeing in the general population. Additionally, they support the idea that understanding the effects of unilateral breathing on wellbeing and cognition requires a complex interpretive model with multiple brain networks to address bottom-up and top-down processes.

Excessive mind wandering, rumination, and mindfulness mediate the relationship between ADHD symptoms and anxiety and depression in adults with ADHD

BACKGROUND

Persistent mind-wandering processes are associated with negative emotions; however, mindful states exhibit an anticorrelation with mind-wandering patterns. The aim of this study is to investigate the mediating role of excessive mind wandering (EMW), rumination, and trait mindfulness between attention-deficit hyperactivity disorder (ADHD) symptoms and the severity of anxiety/depression in adults with ADHD.

METHODS

Medication-free 159 adults diagnosed with ADHD completed a test battery that included a sociodemographic form as well as the Adult ADHD Severity Rating Scale, Hospital Anxiety Depression Scale, Mind Excessively Wandering Scale, Ruminative Response Scale, and Freiburg Mindfulness Inventory after the diagnostic examination according to the Structured Clinical Interview for DSM-5-Clinician Version (SCID-5).

RESULTS

ADHD symptoms exhibited an indirect, but not a direct, association with the severity of anxiety and depression, mediated by increased excessive mind wandering and rumination, as well as decreased trait mindfulness.

LIMITATIONS

This study was carried out within a clinical population using a cross-sectional design. While diagnostic assessments were conducted using SCID-5, psychiatric symptoms were evaluated through self-report measures.

CONCLUSIONS

Coping with EMW and rumination and promoting mindfulness ability may be promising targets in treating comorbid conditions in adults with ADHD. These findings have highlighted the effects of mentation processes on depression and anxiety, which are common comorbidities with ADHD in adults; however, longitudinal studies are needed.

Cross-cultural adaptation of the Mind-Wandering Questionnaire (MWQ) for Brazilian Portuguese and evidence of its validity

OBJECTIVE

To adapt the Mind-Wandering Questionnaire (MWQ) for the Brazilian context and present evidence of validity based on its internal structure.

METHODS

A total of 2,682 Brazilian adults from different regions of the country took part in this study. Confirmatory factor analyses and multigroup confirmatory factor analyses (MGCFA) were performed to assess the factor structure of the MWQ. McDonald's omega (ω) was generated to provide reliability indexes.

RESULTS

The analyses demonstrated an adequate factor structure for the MWQ adapted to the Brazilian context, corroborating the original article's single-factor model and other adaptation studies. Furthermore, the results demonstrated the instrument's reliability in a Brazilian population (ω = 0.88).

CONCLUSION

The MWQ is thus an adequate, reliable, and quickly administered instrument for those whose aim is to measure deliberate and spontaneous MW in Brazil.

Recent advances in the neuroscience of spontaneous and off-task thought: implications for mental health

People spend a remarkable 30-50% of awake life thinking about something other than what they are currently doing. These experiences of being "off-task" can be described as spontaneous thought when mental dynamics are relatively flexible. Here we review recent neuroscience developments in this area and consider implications for mental wellbeing and illness. We provide updated overviews of the roles of the default mode network and large-scale network dynamics, and we discuss emerging candidate mechanisms involving hippocampal memory (sharp-wave ripples, replay) and neuromodulatory (noradrenergic and serotonergic) systems. We explore how distinct brain states can be associated with or give rise to adaptive and maladaptive forms of thought linked to distinguishable mental health outcomes. We conclude by outlining new directions in the neuroscience of spontaneous and off-task thought that may clarify mechanisms, lead to personalized biomarkers, and facilitate therapy developments toward the goals of better understanding and improving mental health.

Disentangling racing thoughts from mind wandering in adult attention deficit hyperactivity disorder

Introduction

Mental restlessness reported by adult with Attention Deficit Hyperactivity Disorder (ADHD) has been mainly explained by excessive mind wandering. However, the description of a mind constantly on the go is also akin to racing thoughts, predominantly described in bipolar disorder. This paper aimed at disentangling mind wandering from racing thoughts in adult with ADHD. Associations between those mental phenomena and the ADHD symptomatology were also investigated.

Methods

To this aim, 84 adults with ADHD completed self-reported questionnaires, including the Mind Wandering-Deliberate and Mind Wandering-Spontaneous questionnaires, the Racing and Crowded Thoughts Questionnaire and the Daydreaming Frequency Scale. Factorial analysis and multiple linear regressions were performed.

Results

The factor analysis yielded a two-factor solution. The first factor encompassed the three facets of racing thoughts and was predicted by emotional lability. The second comprised deliberated-MW, spontaneous-MW and daydreaming, but was neither related to the ADHD symptoms, nor functional impairment.

Discussion

These findings suggest that MW and racing thoughts are two distinguishable mental phenomena. Racing thoughts appear to be a relevant hypothesis to explain the mental restlessness in adult ADHD.

Examining the effects of a modified SART when measuring mind-wandering

OBJECTIVE

Mind-wandering (MW) is defined as a shift of attention from external tasks toward internal thoughts and is popularly measured by the sustained attention to response task (SART). SART is able to capture MW, but cannot track the dynamics of mind-wandering over time well. We thus attempted to modify the sustained attention to response task paradigm (mSART) to capture the participant's mind-wandering state over time and quantify the degree of mind-wandering using the current behavioral data.

METHODS

179 participants from Wenzhou Medical University were recruited to participate in this experiment. The main changes to the experiment included (1) manipulating different no-go stimuli frequencies to control the difficulty of the task and setting 9 modes; (2) extending the experiment time to 30 min; (3) allowing participants to correct errors by pressing the b key. Error rate, Mean RTs, RT CV, and d' were used to reflect MW. Analysis of covariance (ANCOVA) was performed.

RESULTS

ANOVA was used to explore Mean RTs, RT CV and d' for participants with different levels of mind-wandering and significant differences were found (Mean RTs:Welch's F (2, 8606.04) = 579.00, p < .001, ηp 2  = 0.03; RT CV:Welch's F (2, 198.11) = 69.93, p < .001, ηp 2  = 0.18; d':F (2, 176) = 19.88, p < .001, ηp 2  = 0.18). The 30-min experiment was divided into six time windows, and mind-wandering deepens over time.

CONCLUSIONS

The mSART paradigm could quantify the extent of MW based on changes in the frequency at which the no-go stimuli were presented and also revealed that the recommended length of the experiment was about 20 min.

The effect of background sounds on mind wandering

Mind wandering (MW) reflects a situation in which the cognitive system is detached from the main task and involved with inner thoughts. It has been well document that music and other background sounds can have positive effects on number of cognitive functioning. In addition, other body of literature suggests that background sounds might have specifically positive effect on individuals with more attention deficiencies. Hence, the current study examines the effect of background sounds on MW. In two experiments, the effect of background sounds: music (Experiment 1) or an alerting tone (Experiment 2) while performing sustained attention tasks was examined among typical development participants with different severity of attention deficiency. Background sounds were found to reduce MW especially in individuals with more ADHD symptoms. This was further discussed in the context of several theories, and it was suggested that background sound might be used as a tool for MW reduction.

The association between different sources of distraction and symptoms of attention deficit hyperactivity disorder

Introduction

Adults with Attention-Deficit/Hyperactivity Disorder (ADHD) are generally distractible. Yet, the precise relationship between ADHD and distractibility remains under-specified in two respects. First, different sources of distraction, such as background noise or mind wandering, may not be equally associated with ADHD. Second, ADHD itself comprises a variety of symptoms that show considerable heterogeneity and it is unclear which ADHD symptoms are associated with which type of distraction.

Methods

The current study addresses these questions using one clinically evaluated sample (N = 69) and two large non-clinically evaluated samples (N = 569, N = 651). In all samples, participants completed questionnaires about their susceptibility to external distraction, unwanted intrusive thoughts, spontaneous mind-wandering and ADHD symptomatology.

Results

Traditional regression and novel network analyses revealed an overwhelming contribution of spontaneous mind-wandering in explaining ADHD symptoms, although external distraction and unwanted intrusive thoughts were also associated with a small number of ADHD symptoms.

Discussion

Findings support a growing body of literature linking spontaneous mind-wandering and ADHD, and they highlight the heterogeneity in the association between ADHD symptoms and different sources of distraction.

Spanish and cross-cultural validation of the mind excessively wandering scale

Introduction

Over the last decade, excessive spontaneous mind wandering (MW) has been consistently associated with emotional disorders. The main aims of the present study were (1) to re-examine the factor structure of the Mind Excessively Wandering Scale (MEWS); (2) to validate the Spanish version of the MEWS; and (3) to conduct a cross-cultural validation of the MEWS in Spanish and UK samples.

Methods

A forward/backward translation to Spanish was conducted. Data of 391 Spanish and 713 British non-clinical individuals were analysed.

Results

A revised 10-item version of the MEWS (MEWS-v2.0) demonstrated to be a valid instrument to assess MW. A 2-correlated factor structure properly captured the MEWS-v2.0 variance, accounting for two specific but interrelated dimensions (Uncontrolled thoughts and Mental Overactivity).

Discussion

The Spanish MEWS-v2.0 showed adequate internal consistency and construct validity, as well as appropriate convergent/divergent validity. Cross-cultural analyses showed that MEWS-v2.0 captured the same construct in both UK and Spanish samples. In conclusion, both Spanish and English MEWS-v2.0 demonstrated to be reliable measures to capture spontaneous MW phenomenon in non-clinical adult populations.

Psychopathology and mind wandering in young university students

Mind wandering has often been studied in relation to psychopathology. However, debates remain as to whether sluggish cognitive tempo, recently termed cognitive disengagement syndrome (CDS), and ADHD symptoms could be unique predictors of mind wandering. Therefore, this study was aimed at documenting the associations between CDS, ADHD symptoms and mind wandering while controlling for age, sex, internalized symptoms, and sleep. A sample consisting of university students (N = 60; aged between 17 and 32 years; 65% female) completed measures of CDS, ADHD symptoms, internalized functioning and insomnia. Mind wandering was also assessed using the 5-item Mind Wandering Questionnaire (MWQ) and thought sampling during a reading task. Multiple regression analyses show that while younger age and inattention were significant predictors of greater levels of self-reported mind wandering on the MWQ, sex, CDS, hyperactivity/impulsivity, internalized symptoms, and sleep were not. In addition, no variables were able to significantly predict spontaneous and deliberate mind wandering as assessed by thought sampling. These findings raise important questions regarding the equivalence between measures of state-level and trait-level mind wandering. The associations between ADHD, CDS and mind wandering in young adults are still unclear, but our findings highlight critical methodological considerations for future studies that might further our understanding of the relationship between task-unrelated thought and psychopathology.

The Interaction of the Dorsolateral and Ventromedial Prefrontal Cortex During Mind Wandering

BACKGROUND AND AIMS

Mind wandering refers to spontaneously occurring, often disruptive thoughts during an ongoing task or resting state. The ventromedial prefrontal cortex (vmPFC) and dorsolateral prefrontal cortex (dlPFC) are two main cortical areas which are involved in this process. This study aimed to explore the interaction of these areas during mind wandering by enhancing specific oscillatory activity of these areas via transcranial alternating current stimulation (tACS) in the theta frequency range.

MATERIAL AND METHODS

Eighteen healthy adults participated in a randomized, single-blinded, crossover study. tACS (1.5 mA, 6 Hz) was applied in five sessions with one week interval via (1) two channels with synchronized stimulation over the left dlPFC and right vmPFC, (2) the same electrode placement with anti-phase stimulation, (3) stimulation over the left dlPFC only, (4) stimulation over right vmPFC only, and (5) sham stimulation. The return electrodes were placed over the contralateral shoulder in all conditions. The sustained attention to response task (SART) with embedded probes about task-unrelated-thoughts and awareness of these thoughts was performed during intervention.

RESULTS

Stimulation did not alter SART performance. Right vmPFC stimulation decreased mind wandering and increased awareness of mind wandering. Left dlPFC stimulation and desynchronized stimulation over the dlPFC and vmPFC increased mind wandering compared to the sham stimulation condition. Synchronized stimulation had no effect on mind wandering, but increased awareness of mind wandering.

CONCLUSION

The results suggest that regional entrainment of the vmPFC decreases mind wandering and increases awareness of mind wandering, whereas regional entrainment of the dlPFC increases mind wandering, but decreases awareness. Under desynchronized stimulation of both areas, the propensity of mind wandering was increased, whereas synchronized stimulation increased the awareness of mind wandering. These results suggest a role of the dlPFC in initiation of mind wandering, whereas the vmPFC downregulates mind wandering, and might exert this function by counteracting respective dlPFC effects via theta oscillations.

Commonalities between mind wandering and task-set switching: An event-related potential study

Previous research has established that mind wandering does not necessarily disrupt one's task-switching performance. Here we investigated the effects of mind wandering on electrophysiological signatures, measured using event-related potentials (ERPs), during a switching task. In the current study, a final sample of 22 young adults performed a task-switching paradigm while electroencephalography was continuously recorded; mind wandering was assessed via thought probes at the end of each block. Consistent with previous research, we found no significant disruptive effects of mind wandering on task-switching performance. The ERP results showed that at the posterior electrode sites (P3, Pz, and P4), P3 amplitude was higher for mind-wandering switch trials than on-task switch trials, thus opposing the typical pattern of P3 attenuation during periods of mind wandering relative to on-task episodes. Considering that increased P3 amplitude during higher-order switch trials (e.g., response rule switching) may reflect the implementation of new higher-order task sets/rules, the current findings seem to indicate similar executive control processes underlie mind wandering and task-set switching, providing further evidence in favor of a role for switching in mind wandering.

The Four Factors of Mind Wandering Questionnaire: Content, Construct, and Clinical Validity

Despite great interest in Mind Wandering, a fully validated questionnaire has been lacking. The Four Factors of Mind Wandering (4FMW) Questionnaire, presented here, meets this demand. First, 80 items were judged for content validity by two panels of experts. Those items that survived this content validity assessment were then tested using exploratory and confirmatory factor analyses on two independent samples of young adults. The 16 resulting items were shown to cluster into four factors (i.e., Failure in social interaction, Failure in interaction with objects, Unawareness, and Inattention). The 4FMW questionnaire showed good reliability, robust structure, and acceptable goodness-of-fit indices, as well as good convergent validity with another Mind Wandering questionnaire. Importantly, the 4FMW questionnaire was able to discriminate between attention-deficit/hyperactivity disorder and obsessive-compulsive disorder symptoms. The 4FMW Questionnaire is a reliable and valid instrument for assessing mind wandering in the young adult population.

Reconceptualizing mind wandering from a switching perspective

Mind wandering is a universal phenomenon in which our attention shifts away from the task at hand toward task-unrelated thoughts. Despite it inherently involving a shift in mental set, little is known about the role of cognitive flexibility in mind wandering. In this article we consider the potential of cognitive flexibility as a mechanism for mediating and/or regulating the occurrence of mind wandering. Our review begins with a brief introduction to the prominent theories of mind wandering-the executive failure hypothesis, the decoupling hypothesis, the process-occurrence framework, and the resource-control account of sustained attention. Then, after discussing their respective merits and weaknesses, we put forward a new perspective of mind wandering focused on cognitive flexibility, which provides an account more in line with the data to date, including why older populations experience a reduction in mind wandering. After summarizing initial evidence prompting this new perspective, drawn from several mind-wandering and task-switching studies, we recommend avenues for future research aimed at further understanding the importance of cognitive flexibility in mind wandering.

Transcranial direct current stimulation (tDCS) combined with cognitive training in adolescent boys with ADHD: a double-blind, randomised, sham-controlled trial

BACKGROUND

Transcranial direct current stimulation (tDCS) could be a side-effect-free alternative to psychostimulants in attention-deficit/hyperactivity disorder (ADHD). Although there is limited evidence for clinical and cognitive effects, most studies were small, single-session and stimulated left dorsolateral prefrontal cortex (dlPFC). No sham-controlled study has stimulated the right inferior frontal cortex (rIFC), which is the most consistently under-functioning region in ADHD, with multiple anodal-tDCS sessions combined with cognitive training (CT) to enhance effects. Thus, we investigated the clinical and cognitive effects of multi-session anodal-tDCS over rIFC combined with CT in double-blind, randomised, sham-controlled trial (RCT, ISRCTN48265228).

METHODS

Fifty boys with ADHD (10-18 years) received 15 weekday sessions of anodal- or sham-tDCS over rIFC combined with CT (20 min, 1 mA). ANCOVA, adjusting for baseline measures, age and medication status, tested group differences in clinical and ADHD-relevant executive functions at posttreatment and after 6 months.

RESULTS

ADHD-Rating Scale, Conners ADHD Index and adverse effects were significantly lower at post-treatment after sham relative to anodal tDCS. No other effects were significant.

CONCLUSIONS

This rigorous and largest RCT of tDCS in adolescent boys with ADHD found no evidence of improved ADHD symptoms or cognitive performance following multi-session anodal tDCS over rIFC combined with CT. These findings extend limited meta-analytic evidence of cognitive and clinical effects in ADHD after 1-5 tDCS sessions over mainly left dlPFC. Given that tDCS is commercially and clinically available, the findings are important as they suggest that rIFC stimulation may not be indicated as a neurotherapy for cognitive or clinical remediation for ADHD.

Drinking alcohol to cope with hyperactive ADHD? Self-reports vs. continuous performance test in patients with ADHD and/or alcohol use disorder

Rationale

Attention deficit/hyperactivity disorder (ADHD) is common in alcohol use disorder (AUD). Continuous performance tests (CPTs) allow to measure ADHD related deficits in a laboratory setting. Most studies on this topic focused on CPTs measuring inattention or impulsivity, disregarding hyperactivity as one of the core symptoms of ADHD.

Methods

We examined N = 47 in three groups (ADHD N = 19; AUD N = 16; ADHD + AUD N = 12) with questionnaires on ADHD core symptoms, executive functioning (EF), mind wandering, and quality of life (QoL). N = 46 (ADHD N = 16; AUD N = 16; ADHD + AUD N = 14) were examined with a CPT (QbTest^®) that also measures motor activity objectively.

Results

Inattention and impulsivity were significantly increased in AUD vs. ADHD and in AUD vs. ADHD + AUD. Hyperactivity was significantly higher in ADHD + AUD vs. ADHD and ADHD + AUD vs. AUD, but not in ADHD vs. AUD. EF was lower in both ADHD groups vs. AUD. Mind wandering was increased in both ADHD groups vs. AUD. QoL was significantly lower in ADHD + AUD compared to AUD. In contrast, results of the QbTest were not significantly different between groups.

Conclusion

Questionnaires are more useful in assessing ADHD core symptoms than the QbTest^®. Hyperactivity appears to be a relevant symptom in ADHD + AUD, suggesting a possible pathway from ADHD to AUD. The lower QoL in ADHD + AUD emphasizes the need for routine screening, diagnostic procedures and treatment strategies for this patient group.

Double-Blind, Sham-Controlled Randomized Trial Testing the Efficacy of fMRI Neurofeedback on Clinical and Cognitive Measures in Children With ADHD

OBJECTIVE

Functional MRI neurofeedback (fMRI-NF) could potentially be a novel, safe nonpharmacological treatment for attention deficit hyperactivity disorder (ADHD). A proof-of-concept randomized controlled trial of fMRI-NF of the right inferior frontal cortex (rIFC), compared to an active control condition, showed promising improvement of ADHD symptoms (albeit in both groups) and in brain function. However, comparison with a placebo condition in a larger trial is required to test efficacy.

METHODS

This double-blind, sham-controlled randomized controlled trial tested the effectiveness and efficacy of fMRI-NF of the rIFC on symptoms and executive functions in 88 boys with ADHD (44 each in the active and sham arms). To investigate treatment-related changes, groups were compared at the posttreatment and 6-month follow-up assessments, controlling for baseline scores, age, and medication status. The primary outcome measure was posttreatment score on the ADHD Rating Scale (ADHD-RS).

RESULTS

No significant group differences were found on the ADHD-RS. Both groups showed similar decreases in other clinical and cognitive measures, except for a significantly greater decrease in irritability and improvement in motor inhibition in sham relative to active fMRI-NF at the posttreatment assessment, covarying for baseline. There were no significant side effects or adverse events. The active relative to the sham fMRI-NF group showed enhanced activation in rIFC and other frontal and temporo-occipital-cerebellar self-regulation areas. However, there was no progressive rIFC upregulation, correlation with ADHD-RS scores, or transfer of learning.

CONCLUSIONS

Contrary to the hypothesis, the study findings do not suggest that fMRI-NF of the rIFC is effective in improving clinical symptoms or cognition in boys with ADHD.

Mainstreaming adult ADHD into primary care in the UK: guidance, practice, and best practice recommendations

BACKGROUND

ADHD in adults is a common and debilitating neurodevelopmental mental health condition. Yet, diagnosis, clinical management and monitoring are frequently constrained by scarce resources, low capacity in specialist services and limited awareness or training in both primary and secondary care. As a result, many people with ADHD experience serious barriers in accessing the care they need.

METHODS

Professionals across primary, secondary, and tertiary care met to discuss adult ADHD clinical care in the United Kingdom. Discussions identified constraints in service provision, and service delivery models with potential to improve healthcare access and delivery. The group aimed to provide a roadmap for improving access to ADHD treatment, identifying avenues for improving provision under current constraints, and innovating provision in the longer-term. National Institute for Health and Care Excellence (NICE) guidelines were used as a benchmark in discussions.

RESULTS

The group identified three interrelated constraints. First, inconsistent interpretation of what constitutes a 'specialist' in the context of delivering ADHD care. Second, restriction of service delivery to limited capacity secondary or tertiary care services. Third, financial limitations or conflicts which reduce capacity and render transfer of care between healthcare sectors difficult. The group recommended the development of ADHD specialism within primary care, along with the transfer of routine and straightforward treatment monitoring to primary care services. Longer term, ADHD care pathways should be brought into line with those for other common mental health disorders, including treatment initiation by appropriately qualified clinicians in primary care, and referral to secondary mental health or tertiary services for more complex cases. Long-term plans in the NHS for more joined up and flexible provision, using a primary care network approach, could invest in developing shared ADHD specialist resources.

CONCLUSIONS

The relegation of adult ADHD diagnosis, treatment and monitoring to specialist tertiary and secondary services is at odds with its high prevalence and chronic course. To enable the cost-effective and at-scale access to ADHD treatment that is needed, general adult mental health and primary care must be empowered to play a key role in the delivery of quality services for adults with ADHD.

Mind-Wandering and Childhood ADHD: Experimental Manipulations across Laboratory and Naturalistic Settings

The conceptual overlap between mind-wandering and attention-deficit/hyperactivity disorder (ADHD)-related impairments is considerable, yet little experimental research examining this overlap among children is available. The current study aims to experimentally manipulate mind-wandering among children with and without ADHD and examine effects on task performance. Participants were 59 children with ADHD and 55 age-matched controls. Participants completed a novel mind-wandering sustained attention to response task (SART) that included non-self-referential and self-referential stimuli to experimentally increase self-referential mind-wandering, reflected by increases in reaction time variability (RTV) following self-referential stimuli. The ADHD group participated in a classroom study with analogue conditions aimed at encouraging self-referential future-oriented thinking (free play/movie before and after class work) compared to a control condition (newscast) and a cross-over methylphenidate trial. The significant interaction between ADHD status and self-referential stimuli on SART performance indicated that self-referential stimuli led to greater RTV among children with ADHD (within-subject d = 1.29) but not among controls. Methylphenidate significantly reduced RTV among youth with ADHD across self-referential (d = 1.07) and non-self-referential conditions (d = 0.72). In the ADHD classroom study, the significant interaction between mind-wandering condition and methylphenidate indicated that methylphenidate led to higher work completion (ds > 5.00), and the free-play mind-wandering condition had more consistent detrimental effects on productivity (ds ≥ 1.25) than the movie mind-wandering condition. This study is the first to manipulate mind-wandering and assess effects among children with ADHD using a behavioral task. Results provide evidence that children with ADHD are uniquely susceptible to mind-wandering interference.

Linguistic Equivalence, Validity and Reliability Study of the Mind Excessively Wandering Scale

INTRODUCTION

The main objective was to study the linguistic equivalence, validity and reliability of the transliterated Turkish version of Mind Excessively Wandering Scale (MEWS) developed by Prof. Philip Asherson in England (2016). Mind excessively wandering defines uncontrolled mental phenomena, which is proposed as the psychological counterpart of Default Mode Network in literature.

METHOD

Mind Excessively Wandering Scale, Adult Attention Deficit Hyperactivity Disorder Self-Report Scale, Barratt Impulsiveness Scale, Difficulties in Emotion Regulation Scale have been used. The sample group consists of 64 patients previously diagnosed as adult Attention Deficit Hyperactivity Disorder for validity, 60 students for transliteral equivalence, and 80 healthy controls for test re-test reliability.

RESULTS

Transliteral equivalence study demonstrates that Turkish version of MEWS is highly correlated with the English version and is statistically significant. The sixth item in the scale was removed in order to ensure the consistency model established by LISREL in the validity study according to the confirmatory factor analysis. When the sixth item was excluded, it was concluded that the structure of the scale was compatible. In the reliability study of the MEWS, the Cronbach's alpha value (α) of the scale was found to be 0.826. It is seen that the item with the highest distinctiveness feature is Item-10 (0.618) and the item with the lowest distinctiveness feature is Item-5 (0.318). In the linguistic equivalence study, no statistical difference was found between the English form and the Turkish versions of the scale.

CONCLUSION

As a result of the practical and statistical evaluations, our study demonstrated that the Turkish version of the MEWS is a valid and reliable measurement tool.

Social Cognition in Adult ADHD: A Systematic Review

The aim of this systematic review was to collect and align the research on social cognition impairments in adults with Attention-deficit/hyperactivity disorder (ADHD). In particular, we selected and analyzed papers on emotion recognition and processing, Theory of Mind (TOM), empathy, and other facets of social cognition as decision making. We identified 16 papers published between 2012 and 2022 which meet inclusion criteria. Papers search, selection, and extraction followed the PRISMA guidelines. In order to summarize data from papers, we used a narrative synthesis approach. Results show different evidence of impairment in social cognition domains in adults with ADHD. Our systematic review suggests the importance of promoting more research on this topic because it is essential to keep in mind that social cognition plays a central role in socialization and social relationships.

Measurement Informed Care in Attention-Deficit/Hyperactivity Disorder (ADHD)

Measurement-informed care is a cornerstone of evidence-based practice and shared decision-making. A structured diagnostic interview specific to ADHD provides a globally agreed-on standard of evaluation. These interviews are accessible in the public domain in multiple languages and are helpful to clinicians new to the diagnosis of ADHD. Broad-based rating scales looking at multiple domains of psychopathology are critical to assuring recognition of comorbid diagnoses, which might otherwise be missed, differential diagnoses, and identification of the most prominent or treatable diagnosis. Recent innovations in computerized adaptive testing have improved the efficiency and accuracy of diagnostic screening. Rating scales specific to ADHD and disruptive behavior disorders establish the severity of the disorder and response to intervention. Age- and gender-normed symptom rating scales for ADHD capture clinically salient differences between what is normative in different demographic groups. An evaluation of functional impairment in ADHD has been critical to understanding the patient's perspective of the presenting problem. Best practice care for ADHD treatment goes beyond improvement to well-defined standards for both symptom and functional remission. Studies of executive function, emotional regulation, mind-wandering, and sluggish cognitive tempo have led to a richer understanding of the breadth and depth of associated deficits commonly experienced by ADHD patients. Psychometrically validated tools are available to complement every aspect of ADHD care and provide global standards for research.

Mind wandering in adults with attention deficit hyperactivity disorder: Preliminary evaluation using the Mind Excessively Wandering Scale in a Japanese clinical population

Aim

Mind wandering (MW) has been closely associated with attention deficit hyperactivity disorder (ADHD); however, the field remains understudied in Japan. The present study examined MW in adults with ADHD using the Mind Excessively Wandering Scale (MEWS) in a Japanese clinical population.

Methods

Fifty-two adults with ADHD (mean age, 33.0 years; 33 men), diagnosed per the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria, completed the MEWS, Mind Wandering Questionnaire, Conners' Adult ADHD Rating Scale (CAARS), Autism Spectrum Quotient (AQ), and Japanese Adult Reading Test-25.

Results

The mean MEWS score was 18.8 (standard deviation, 7.6). MEWS scores showed significant correlations with the CAARS Inattention/Memory Problems, Problems with Self-Concept, DSM-IV ADHD Symptoms Total, ADHD Index, and AQ scores. Higher MEWS scores were associated with greater ADHD and autism spectrum disorder symptoms in patients with ADHD.

Conclusion

Our results not only provide supporting evidence of the presence of excessive MW in adults with ADHD, but also indicate the heterogeneous nature of MW in ADHD.

The effect of transcranial direct current stimulation (tDCS) combined with cognitive training on EEG spectral power in adolescent boys with ADHD: A double-blind, randomized, sham-controlled trial

Transcranial direct current stimulation (tDCS) is a possible alternative to psychostimulants in Attention-Deficit/Hyperactivity Disorder (ADHD), but its mechanisms of action in children and adolescents with ADHD are poorly understood. We conducted the first 15-session, sham-controlled study of anodal tDCS over right inferior frontal cortex (rIFC) combined with cognitive training (CT) in 50 children/adolescents with ADHD. We investigated the mechanisms of action on resting and Go/No-Go Task-based QEEG measures in a subgroup of 23 participants with ADHD (n, sham = 10; anodal tDCS = 13). We failed to find a significant sham versus anodal tDCS group differences in QEEG spectral power during rest and Go/No-Go Task performance, a correlation between QEEG and Go/No-Go Task performance, and changes in clinical and cognitive measures. These findings extend the non-significant clinical and cognitive effects in our sample of 50 children/adolescents with ADHD. Given that the subgroup of 23 participants would have been underpowered, the interpretation of our findings is limited and should be used as a foundation for future investigations. Larger, adequately powered randomized controlled trials should explore different protocols titrated to the individual and using comprehensive measures to assess cognitive, clinical, and neural effects of tDCS and its underlying mechanisms of action in ADHD.

ADHD and Interfering Thoughts in High and Low Conflict Conditions

BACKGROUND

Individuals with an ADHD diagnosis have increased levels of interfering thoughts, especially in the form of mind wandering. This was mostly investigated in sustained attention tasks; hence it is unclear whether the findings are only due to their difficulties in those types of tasks. Moreover, it is unclear how the amount of control invested in the task will affect those differences between control and ADHD groups.

METHOD

ADHD and matched control groups performed the Stroop task under high and low conflict conditions while measuring their interfering thoughts level.

RESULTS

Individuals with ADHD have more interfering thoughts compared to a control group even when they are able to change their control level according to the task conflict.

CONCLUSION

Interfering thoughts are an independent predictor of ADHD impairments, observed regardless of the degree of control invested in the task.

Disentangling the Phenomenology of Mind-Wandering

OBJECTIVE

In the last decade, the research about mind-wandering (MW) significantly improved and allowed us to depth the phenomenology of thoughts. Prototypically, excessive MW was linked with ADHD symptoms. However, many studies have demonstrated the need to relate the type of mind-wandering with specific phenomenological presentations.

METHOD

Participants (N = 53; 54.7% male; age range 18-36 years) selfreported the Mind Excessively Wandering Scale (MEWS), and they were investigated for ADHD, impulsivity levels, and anxiety/depressive symptoms.

RESULTS

The exploratory analysis indicated a meaningful correlation between MEWS and anxiety traits and depressive symptoms. There was no significant relationship with ADHD symptoms.

CONCLUSION

These findings based our discussion about MW's phenomenology considering the novel classification model based on the consideration of clinical markers such as thoughts' content.

Resting-State Brain Variability in Youth With Attention-Deficit/Hyperactivity Disorder

In this study, we sought to determine the nature of the abnormality in resting-state default mode network (DMN) activation and explore its correlation with functional connectivity in attention-deficit/hyperactivity disorder (ADHD). We obtained resting-state functional magnetic resonance images of youth with ADHD and typically developing counterparts from the publicly available ADHD-200 database. We used data from Peking University (232 scans) and New York University (172 scans); the scan repetition time was 2 s for both data collection sites. We applied generalized estimating equations to estimate the variability of the averaged blood-oxygen-level-dependent (BOLD) time series extracted from the DMN at rest. We performed network-based statistics to determine the association between the observed differences in BOLD signal variability and altered functional connectivity. We analyzed data from 105 youth with ADHD (age: mean 12.17, standard deviation 2.31, median 12.25; 15.2% female, 84.8% male) and 140 typically developing youth (age: mean 11.99, standard deviation 2.28, median 11.85; 47.1% female, 52.9% male), who aged 7-17 years. The imaging data were cross-sectionally collected for each participant at one time point. We observed a greater number of significant BOLD signal changes and higher-order polynomial significant associations in youth with ADHD. Moreover, there were significant between-group differences in BOLD signal change after the first 140 s, which coincided with decreased resting-state functional connectivity within the DMN in youth with ADHD. Increased variability of neural signaling was intermittently observed in the brains of youth with ADHD at rest, thereby indicating their default mode state was more unstable than that of typically developing youth.

Attentive-executive functioning and compensatory strategies in adult ADHD: A retrospective case series study

Background

Adults with ADHD exhibit a neuropsychological profile that may present deficits in many cognitive domains, particularly attention and executive functions (EFs). However, some authors do not consider executive disfunction as an important part of the clinical profile of the syndrome; this could be related to the use of inappropriate neuropsychological tests, probably not adapted and not sufficiently ecological. Moreover, new data are required on specific correlation of attentive-executive symptoms with socio-demographic factors. Therefore, the aim of this study is to analyze the neuropsychological performance of a group of adults with ADHD, also evaluating the influence of gender, age and education level.

Methods

We retrospectively collected health-related personal data of 40 adult ADHD patients, clinically diagnosed and evaluated via a battery of 4 neuropsychological tests and 1 self-administered questionnaire. Gender, age and years of education differences were assessed.

Results

Attention and EFs deficits have been highlighted mainly on the d2-R and 5-point neuropsychological tests, which therefore seem to be more sensitive in measuring the attention-executive dysfunction in an adult ADHD population, than TAP Go/No-go and ROCFT. ADHD patients also manifested subjective behavioral impulsivity disorders on BIS-11. There were no statistically significant gender differences in cognitive performance. On the contrary, younger patients performed worse on subscales TAP Go/No-go errors and 5-points number of drawings, while participants with a higher education level performed better on subscales d2-R speed of execution and d2-R errors. This supports a reduction in the number of errors and the execution time as a function of older age and a higher level of education. Finally, patients with higher education also self-reported greater impulsivity in planning.

Conclusion

Our preliminary findings suggest that adult ADHD is not a lifelong stable disorder, but it may change over time. Moreover, attention-executive deficits may be influenced and partially counterbalanced by experience (i.e., advancing age) and a higher level of education. This could underlie the development of specific psycho-behavioral and cognitive compensatory strategies. The use of self-administered questionnaires is therefore recommended to highlight attentional and executive difficulties that may not result in neuropsychological tests.

Context Regulation of Mind Wandering in ADHD

OBJECTIVE

We aimed to understand the association between MW frequency and clinical measures, context regulation of MW and group differences in task performance.

METHOD

27 adults with ADHD and 29 controls performed tasks manipulating demand on working memory and sustained attention, and recorded their MW frequency using probes.

RESULTS

A significant association between MW frequency and the clinical measures was demonstrated. Along with increased MW frequency, individuals with ADHD reported decreasing MW frequency during increasing demands on working memory (context regulation), but not on sustained attention (deficient context regulation). Controls, however, maintained continuous task focus across all conditions. Group differences in task performance were no longer significant after adding MW frequency as a covariate.

CONCLUSION

Deficient context regulation during increasing demands on sustained attention suggests that sustained attention deficits may play a more important role in regulation of MW in ADHD. MW frequency might also underpin performance deficits in ADHD.