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Fernández-Martín P, Rodríguez-Herrera R, Cánovas R, Díaz-Orueta U, Martínez de Salazar A, Flores P. Data-driven profiles of attention-deficit/hyperactivity disorder using objective and ecological measures of attention, distractibility, and hyperactivity. Eur Child Adolesc Psychiatry 2024; 33:1451-1463. [PMID: 37386204 PMCID: PMC11098896 DOI: 10.1007/s00787-023-02250-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 06/19/2023] [Indexed: 07/01/2023]
Abstract
In the past two decades, the traditional nosology of attention-deficit/hyperactivity disorder (ADHD) has been criticized for having insufficient discriminant validity. In line with current trends, in the present study, we combined a data-driven approach with the advantages of virtual reality aiming to identify novel behavioral profiles of ADHD based on ecological and performance-based measures of inattention, impulsivity, and hyperactivity. One hundred and ten Spanish-speaking participants (6-16 years) with ADHD (medication-naïve, n = 57) and typically developing participants (n = 53) completed AULA, a continuous performance test embedded in virtual reality. We performed hybrid hierarchical k-means clustering methods over the whole sample on the normalized t-scores of AULA main indices. A five-cluster structure was the most optimal solution. We did not replicate ADHD subtypes. Instead, we identified two clusters sharing clinical scores on attention indices, susceptibility to distraction, and head motor activity, but with opposing scores on mean reaction time and commission errors; two clusters with good performance; and one cluster with average scores but increased response variability and slow RT. DSM-5 subtypes cut across cluster profiles. Our results suggest that latency of response and response inhibition could serve to distinguish among ADHD subpopulations and guide neuropsychological interventions. Motor activity, in contrast, seems to be a common feature among ADHD subgroups. This study highlights the poor feasibility of categorical systems to parse ADHD heterogeneity and the added value of data-driven approaches and VR-based assessments to obtain an accurate characterization of cognitive functioning in individuals with and without ADHD.
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Affiliation(s)
- Pilar Fernández-Martín
- Department of Psychology, Faculty of Psychology, University of Almeria, Carretera de Sacramento S/N, La Cañada de San Urbano, 04120, Almería, Spain
- Health Research Center (CEINSA), University of Almeria, Almería, Spain
| | - Rocío Rodríguez-Herrera
- Department of Psychology, Faculty of Psychology, University of Almeria, Carretera de Sacramento S/N, La Cañada de San Urbano, 04120, Almería, Spain
- Health Research Center (CEINSA), University of Almeria, Almería, Spain
| | - Rosa Cánovas
- Neurorehabilitation and Autonomy Center Imparables, Almería, Spain
| | - Unai Díaz-Orueta
- Department of Psychology, Maynooth University, Maynooth, Ireland
- International University of La Rioja (UNIR), Logroño, Spain
| | | | - Pilar Flores
- Department of Psychology, Faculty of Psychology, University of Almeria, Carretera de Sacramento S/N, La Cañada de San Urbano, 04120, Almería, Spain.
- Health Research Center (CEINSA), University of Almeria, Almería, Spain.
- Neurorehabilitation and Autonomy Center Imparables, Almería, Spain.
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Lee MW, Yang NJ, Mok HK, Yang RC, Chiu YH, Lin LC. Music and movement therapy improves quality of life and attention and associated electroencephalogram changes in patients with attention-deficit/hyperactivity disorder. Pediatr Neonatol 2024:S1875-9572(24)00048-2. [PMID: 38641441 DOI: 10.1016/j.pedneo.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/06/2023] [Accepted: 11/10/2023] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder. Treatments for ADHD include pharmacological and nonpharmacological therapy. However, pharmacological treatments have side effects such as poor appetite, sleep disturbance, and headache. Moreover, nonpharmacological treatments are not effective in ameliorating core symptoms and are time-consuming. Hence, developing an alternative and effective treatment without (or with fewer) side effects is crucial. Music therapy has long been used to treat numerous neurological diseases. Although listening to music is beneficial for mood and cognitive functions in patients with ADHD, research on the effects of music and movement therapy in children with ADHD is lacking. METHODS The present study investigated the effects of an 8-week music and movement intervention in 13 children with ADHD. The Pediatric Quality of Life Inventory (PedsQL) was used to evaluate changes in participants' quality of life. Conners' Kiddie Continuous Performance Test (K-CPT 2) and the Swanson, Nolan, and Pelham rating scale (SNAP-IV) were used to assess core symptoms. Electroencephalogram (EEG) recordings were analyzed to determine neurophysiological changes. RESULTS The results revealed that the participants' quality of life increased significantly after the 8-week intervention. Furthermore, the participants' hit reaction times in the block 1 and block 2 tests of K-CPT 2 decreased significantly after the intervention. EEG analysis demonstrated an increase in alpha power and Higuchi's fractal dimension and a decrease in delta power in certain EEG channels. CONCLUSION Our music and movement intervention is a potential alternative and effective tool for ADHD treatment and it can significantly improve patients' quality of life and attention.
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Affiliation(s)
- Mei-Wen Lee
- Department of Music, National Sun Yat-Sen University, Kaohsiung City, Taiwan
| | - Ni-Jung Yang
- Center for Humanities and Arts Education, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Hin-Kiu Mok
- Department of Oceanography, National Sun Yat-Sen University, Kaohsiung City, Taiwan
| | - Rei-Cheng Yang
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Yi-Hung Chiu
- Department of Information Engineering, I-Shou University, Kaohsiung City, Taiwan
| | - Lung-Chang Lin
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.
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Callan PD, Swanberg S, Weber SK, Eidnes K, Pope TM, Shepler D. Diagnostic Utility of Conners Continuous Performance Test-3 for Attention Deficit/Hyperactivity Disorder: A Systematic Review. J Atten Disord 2024; 28:992-1007. [PMID: 38317541 DOI: 10.1177/10870547231223727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
OBJECTIVE To review the literature on the utility of the Conners CPT-3 in persons with ADHD. METHODS A systematic review was conducted. Six databases were searched using inclusion criteria: research studies, year 2000+, English, and ages 8+. Two raters independently screened 1,480 title/abstracts and subsequently reviewed 399 full texts. Data extraction and critical appraisal were conducted. Reflective thematic analysis through inductive coding identified qualitative themes. RESULTS Thirteen studies met inclusion criteria with five themes identified. Five studies found CPT-3 was a weak or poor predictor of ADHD diagnosis while two found it was an adequate predictor. Two studies found CPT-3 could differentiate clients with comorbid ADHD/anxiety from ADHD or ADHD from obsessive-compulsive disorder. One found CPT-3 could not differentiate ADHD from ASD or comorbid ADHD/ASD. CONCLUSIONS Results revealed CPT-3 as a standalone measure is a weak or poor predictor of ADHD. Multiple measures for evaluating persons with ADHD are recommended.
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Affiliation(s)
| | | | - Sarah K Weber
- Michigan School of Psychology, Farmington Hills, MI, USA
| | - Kari Eidnes
- Michigan School of Psychology, Farmington Hills, MI, USA
| | - Tara M Pope
- Michigan School of Psychology, Farmington Hills, MI, USA
| | - Dustin Shepler
- Michigan School of Psychology, Farmington Hills, MI, USA
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Arrondo G, Mulraney M, Iturmendi-Sabater I, Musullulu H, Gambra L, Niculcea T, Banaschewski T, Simonoff E, Döpfner M, Hinshaw SP, Coghill D, Cortese S. Systematic Review and Meta-Analysis: Clinical Utility of Continuous Performance Tests for the Identification of Attention-Deficit/Hyperactivity Disorder. J Am Acad Child Adolesc Psychiatry 2024; 63:154-171. [PMID: 37004919 DOI: 10.1016/j.jaac.2023.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/25/2023] [Accepted: 03/29/2023] [Indexed: 04/04/2023]
Abstract
OBJECTIVE We aimed to quantify the clinical utility of continuous performance tests (CPTs) for the diagnosis of attention-deficit/hyperactivity disorder (ADHD) compared to a clinical diagnosis in children and adolescents. METHOD Four databases (MEDLINE, PsycINFO, EMBASE, and PubMed) were screened until January 2023. Risk of bias of included results was judged with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). We statistically pooled the area under the curve, the sensitivity, and the specificity of 3 commonly used CPTs subscales: omission/inattention, commission/impulsivity, and total number of errors/ADHD subscales (PROSPERO registration: CRD42020168091). RESULTS A total of 19 studies using commercially available CPTs were identified. Results from up to 835 control individuals and 819 cases were combined in the summary receiver operating characteristic (ROC) curve analyses (sensitivity and specificity pooling), and up to 996 cases and 1,083 control individuals in the area under the curve (AUC) analyses. Clinical utility as measured by AUCs could be considered as barely acceptable (between 0.7 and 0.8) for the most part, with the best results for the total/ADHD score, followed by omissions/inattention, and poorest for commission/impulsivity scores. A similar pattern was found when pooling sensitivity and specificity: 0.75 (95% CI = 0.66-0.82) and 0.71 (0.62-0.78) for the total/ADHD score; 0.63 (0.49-0.75) and 0.74 (0.65-0.81) for omissions; and 0.59 (0.38-0.77) and 0.66 (CI = 0.50-0.78) for commissions. CONCLUSION At the clinical level, CPTs as a stand-alone tool have only a modest to moderate ability to differentiate ADHD from non-ADHD samples. Hence, they should be used only within a more comprehensive diagnostic process. STUDY PREREGISTRATION INFORMATION A systematic review of screening tools for ADHD in children and adolescents; https://www.crd.york.ac.uk/prospero/; CRD42020168091.
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Affiliation(s)
| | - Melissa Mulraney
- University of Melbourne, Australia, and Murdoch Children's Research Institute, Melbourne; Institute for Social Neuroscience, Ivanhoe, Australia
| | | | | | | | | | | | - Emily Simonoff
- Institute of Psychiatry, Psychology and Neuroscience, and Maudsley Biomedical Research Centre, King's College, London, United Kingdom
| | | | - Stephen P Hinshaw
- University of California, Berkeley, and the University of California, San Francisco, USA
| | - David Coghill
- University of Melbourne, Australia, and Murdoch Children's Research Institute, Melbourne
| | - Samuele Cortese
- University of Southampton, Southampton, United Kingdom; Solent NHS Trust, Southampton, United Kingdom; New York University, New York, and the University of Nottingham, United Kingdom
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Bayat M, Hernandez M, Curzon M, Garic D, Graziano P, Dick AS. Reduced recruitment of inhibitory control regions in very young children with ADHD during a modified Kiddie Continuous Performance Task: a fMRI study. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.01.17.576033. [PMID: 38293209 PMCID: PMC10827162 DOI: 10.1101/2024.01.17.576033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Attention-Deficit/Hyperactivity Disorder (ADHD) symptom profiles are known to undergo changes throughout development, rendering the neurobiological assessment of ADHD challenging across different developmental stages. Particularly in young children (ages 4 to 7 years), measuring inhibitory control network activity in the brain has been a formidable task due to the lack of child-friendly functional Magnetic Resonance Imaging (fMRI) paradigms. This study aims to address these difficulties by focusing on measuring inhibitory control in very young children within the MRI environment. A total of 56 children diagnosed with ADHD and 78 typically developing (TD) 4-7-year-old children were examined using a modified version of the Kiddie-Continuous Performance Test (K-CPT) during BOLD fMRI to assess inhibitory control. We concurrently evaluated their performance on the established and standardized K-CPT outside the MRI scanner. Our findings suggest that the modified K-CPT effectively elicited robust and expected brain activity related to inhibitory control in both groups. Comparisons between the two groups revealed subtle differences in brain activity, primarily observed in regions associated with inhibitory control, such as the inferior frontal gyrus, anterior insula, dorsal striatum, medial pre-supplementary motor area (pre-SMA), and cingulate cortex. Notably, increased activity in the right anterior insula was associated with improved response time (RT) and reduced RT variability on the K-CPT administered outside the MRI environment, although this did not survive statistical correction for multiple comparisons. In conclusion, our study successfully overcame the challenges of measuring inhibitory control in very young children within the MRI environment by utilizing a modified K-CPT during BOLD fMRI. These findings shed light on the neurobiological correlates of inhibitory control in ADHD and TD children, provide valuable insights for understanding ADHD across development, and potentially inform ADHD diagnosis and intervention strategies. The research also highlights remaining challenges with task fMRI in very young clinical samples.
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Guedj C, Tyrand R, Badier E, Planchamp L, Stringer M, Zimmermann MO, Férat V, Ha-Vinh Leuchter R, Grouiller F. Self-Regulation of Attention in Children in a Virtual Classroom Environment: A Feasibility Study. Bioengineering (Basel) 2023; 10:1352. [PMID: 38135943 PMCID: PMC10741222 DOI: 10.3390/bioengineering10121352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/17/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
Attention is a crucial cognitive function that enables us to selectively focus on relevant information from the surrounding world to achieve our goals. Impairments in sustained attention pose challenges, particularly in children with attention deficit hyperactivity disorder, a neurodevelopmental disorder characterized by impulsive and inattentive behavior. While psychostimulant medications are the most effective ADHD treatment, they often yield unwanted side effects, making it crucial to explore non-pharmacological treatments. We propose a groundbreaking protocol that combines electroencephalography-based neurofeedback with virtual reality (VR) as an innovative approach to address attention deficits. By integrating a virtual classroom environment, we aim to enhance the transferability of attentional control skills while simultaneously increasing motivation and interest among children. The present study demonstrates the feasibility of this approach through an initial assessment involving a small group of healthy children, showcasing its potential for future evaluation in ADHD children. Preliminary results indicate high engagement and positive feedback. Pre- and post-protocol assessments via EEG and fMRI recordings suggest changes in attentional function. Further validation is required, but this protocol is a significant advancement in neurofeedback therapy for ADHD. The integration of EEG-NFB and VR presents a novel avenue for enhancing attentional control and addressing behavioral challenges in children with ADHD.
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Affiliation(s)
- Carole Guedj
- Swiss Center for Affective Sciences, University of Geneva, 1202 Geneva, Switzerland; (R.T.); (E.B.); (F.G.)
- Laboratory of Behavioral Neurology and Imaging of Cognition, Department of Basic Neurosciences, University of Geneva, 1202 Geneva, Switzerland; (L.P.); (M.S.); (M.O.Z.)
| | - Rémi Tyrand
- Swiss Center for Affective Sciences, University of Geneva, 1202 Geneva, Switzerland; (R.T.); (E.B.); (F.G.)
| | - Emmanuel Badier
- Swiss Center for Affective Sciences, University of Geneva, 1202 Geneva, Switzerland; (R.T.); (E.B.); (F.G.)
| | - Lou Planchamp
- Laboratory of Behavioral Neurology and Imaging of Cognition, Department of Basic Neurosciences, University of Geneva, 1202 Geneva, Switzerland; (L.P.); (M.S.); (M.O.Z.)
| | - Madison Stringer
- Laboratory of Behavioral Neurology and Imaging of Cognition, Department of Basic Neurosciences, University of Geneva, 1202 Geneva, Switzerland; (L.P.); (M.S.); (M.O.Z.)
| | - Myriam Ophelia Zimmermann
- Laboratory of Behavioral Neurology and Imaging of Cognition, Department of Basic Neurosciences, University of Geneva, 1202 Geneva, Switzerland; (L.P.); (M.S.); (M.O.Z.)
| | - Victor Férat
- Functional Brain Mapping Laboratory, Department of Basic Neurosciences, University of Geneva, 1202 Geneva, Switzerland;
| | - Russia Ha-Vinh Leuchter
- Division of Development and Growth, Department of Paediatrics, Gynaecology and Obstetrics, Geneva University Hospitals, 1205 Geneva, Switzerland;
| | - Frédéric Grouiller
- Swiss Center for Affective Sciences, University of Geneva, 1202 Geneva, Switzerland; (R.T.); (E.B.); (F.G.)
- Laboratory of Behavioral Neurology and Imaging of Cognition, Department of Basic Neurosciences, University of Geneva, 1202 Geneva, Switzerland; (L.P.); (M.S.); (M.O.Z.)
- CIBM MRI Cognitive and Affective Neuroimaging Section, Center for Biomedical Imaging, University of Geneva, 1202 Geneva, Switzerland
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Mendez-Encinas D, Sujar A, Bayona S, Delgado-Gomez D. Attention and impulsivity assessment using virtual reality games. Sci Rep 2023; 13:13689. [PMID: 37608015 PMCID: PMC10444747 DOI: 10.1038/s41598-023-40455-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 08/10/2023] [Indexed: 08/24/2023] Open
Abstract
The assessment of cognitive functions is mainly based on standardized neuropsychological tests, widely used in various fields such as personnel recruitment, education, or health. This paper presents a virtual reality game that allows collecting continuous measurements of both the performance and behaviour of the subject in an immersive, controllable, and naturalistic experience. The application registers variables related to the user's eye movements through the use of virtual reality goggles, as well as variables of the game performance. We study how virtual reality can provide data to help predict scores on the Attention Control Scale Test and the Barratt Impulsiveness Scale. We design the application and test it with a pilot group. We build a random forest regressor model to predict the attention and impulsivity scales' total score. When evaluating the performance of the model, we obtain a positive correlation with attention (0.434) and with impulsivity (0.382). In addition, our model identified that the most significant variables are the time spent looking at the target or at distractors, the eye movements variability, the number of blinks and the pupil dilation in both attention and impulsivity. Our results are consistent with previous results in the literature showing that it is possible to use data collected in virtual reality to predict the degree of attention and impulsivity.
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Affiliation(s)
| | - Aaron Sujar
- Departamento de Ciencias de la Computación, Universidad Rey Juan Carlos, Móstoles, Spain.
| | - Sofia Bayona
- Departamento de Ciencias de la Computación, Universidad Rey Juan Carlos, Móstoles, Spain
| | - David Delgado-Gomez
- Departamento de Estádistica, Universidad Carlos III de Madrid, Leganes, Spain
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Lin IC, Chang SC, Huang YJ, Kuo TBJ, Chiu HW. Distinguishing different types of attention deficit hyperactivity disorder in children using artificial neural network with clinical intelligent test. Front Psychol 2023; 13:1067771. [PMID: 36710799 PMCID: PMC9875079 DOI: 10.3389/fpsyg.2022.1067771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/22/2022] [Indexed: 01/12/2023] Open
Abstract
Background Attention deficit hyperactivity disorder (ADHD) is a well-studied topic in child and adolescent psychiatry. ADHD diagnosis relies on information from an assessment scale used by teachers and parents and psychological assessment by physicians; however, the assessment results can be inconsistent. Purpose To construct models that automatically distinguish between children with predominantly inattentive-type ADHD (ADHD-I), with combined-type ADHD (ADHD-C), and without ADHD. Methods Clinical records with age 6-17 years-old, for January 2011-September 2020 were collected from local general hospitals in northern Taiwan; the data were based on the SNAP-IV scale, the second and third editions of Conners' Continuous Performance Test (CPT), and various intelligence tests. This study used an artificial neural network to construct the models. In addition, k-fold cross-validation was applied to ensure the consistency of the machine learning results. Results We collected 328 records using CPT-3 and 239 records using CPT-2. With regard to distinguishing between ADHD-I and ADHD-C, a combination of demographic information, SNAP-IV scale results, and CPT-2 results yielded overall accuracies of 88.75 and 85.56% in the training and testing sets, respectively. The replacement of CPT-2 with CPT-3 results in this model yielded an overall accuracy of 90.46% in the training set and 89.44% in the testing set. With regard to distinguishing between ADHD-I, ADHD-C, and the absence of ADHD, a combination of demographic information, SNAP-IV scale results, and CPT-2 results yielded overall accuracies of 86.74 and 77.43% in the training and testing sets, respectively. Conclusion This proposed model distinguished between the ADHD-I and ADHD-C groups with 85-90% accuracy, and it distinguished between the ADHD-I, ADHD-C, and control groups with 77-86% accuracy. The machine learning model helps clinicians identify patients with ADHD in a timely manner.
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Affiliation(s)
- I-Cheng Lin
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan,Department of Psychiatry, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Shen-Chieh Chang
- Department of Psychiatry, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yu-Jui Huang
- Department of Psychiatry and Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Terry B. J. Kuo
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hung-Wen Chiu
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan,Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei, Taiwan,Bioinformatics Data Science Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan,*Correspondence: Hung-Wen Chiu,
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Ballout RA, Livinski A, Fu YP, Steiner RD, Remaley AT. Statins for Smith-Lemli-Opitz syndrome. Cochrane Database Syst Rev 2022; 11:CD013521. [PMID: 36373961 PMCID: PMC9661876 DOI: 10.1002/14651858.cd013521.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Smith-Lemli-Opitz syndrome (SLOS) is a multiple congenital malformations syndrome caused by defective cholesterol biosynthesis. Affected individuals show cholesterol deficiency and accumulation of various precursor molecules, mainly 7-dehydrocholesterol and 8-dehydrocholesterol. There is currently no cure for SLOS, with cholesterol supplementation being primarily a biochemical therapy of limited evidence. However, several anecdotal reports and preclinical studies have highlighted statins as a potential therapy for SLOS. OBJECTIVES To evaluate the effects of statins, either alone or in combination with other non-statin therapies (e.g. cholesterol, bile acid, or vitamin co-supplementation), compared to cholesterol supplementation alone or in combination with other non-statin therapies (e.g. bile acid or vitamin supplementation) on several important outcomes including overall survival, neurobehavioral features, and adverse effects in individuals with SLOS. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, five other databases and three trials registers on 15 February 2022, together with reference checking, citation searching and contact with study authors to identify additional studies. SELECTION CRITERIA Randomized controlled trials (RCTs) and quasi-RCTs with parallel or cross-over designs, and non-randomized studies of interventions (NRSIs) including non-randomized trials, cohort studies, and controlled before-and-after studies, were eligible for inclusion in this review if they met our prespecified inclusion criteria, i.e. involved human participants with biochemically or genetically diagnosed SLOS receiving statin therapy or cholesterol supplementation, or both. DATA COLLECTION AND ANALYSIS Two authors screened titles and abstracts and subsequently full-texts for all potentially-relevant references. Both authors independently extracted relevant data from included studies and assessed the risks of bias. We analyzed the data extracted from the included NRSIs and cohort studies separately from the data extracted from the single included RCT. We used a random-effects model to account for the inherent heterogeneity and methodological variation between these different study designs. We used GRADE to assess the certainty of evidence. MAIN RESULTS We included six studies (61 participants with SLOS); one RCT (N = 18), three prospective NRSIs (N = 20), and two retrospective NRSIs (N = 22). Five studies included only children, and two limited their participant inclusion by disease severity. Overall, there were nearly twice as many males as females. All six studies compared add-on statin therapy to cholesterol supplementation alone. However, the dosages, formulations, and durations of treatment were highly variable across studies. We judged the RCT as having a high risk of bias due to missing data and selective reporting. All included NRSIs had a serious or critical overall risk of bias assessed by the Risk Of Bias In Non-randomized Studies of Interventions tool (ROBINS-I). None of the included studies evaluated survival or reported quality of life (QoL). Only the included RCT formally assessed changes in the neurobehavioral manifestations of SLOS, and we are uncertain whether statin therapy improves this outcome (very low-certainty evidence). We are also uncertain whether the adverse events reported in the RCT were statin-related (very low-certainty evidence). In contrast, the adverse events reported in the NRSIs seem to be possibly due to statin therapy (risk ratio 13.00, 95% confidence interval 1.85 to 91.49; P = 0.01; low-certainty evidence), with only one of the NRSIs retrospectively mentioning changes in the irritability of two of their participants. We are uncertain whether statins affect growth based on the RCT or NRSI results (very low-certainty evidence). The RCT showed that statins may make little or no difference to plasma biomarker levels (low-certainty evidence), while we are uncertain of their effects on such parameters in the NRSIs (very low-certainty evidence). AUTHORS' CONCLUSIONS Currently, there is no evidence on the potential effects of statin therapy in people with SLOS regarding survival or QoL, and very limited evidence on the effects on neurobehavioral manifestations. Likewise, current evidence is insufficient and of very low certainty regarding the effects of statins on growth parameters in children with SLOS and plasma or cerebrospinal fluid (CSF) levels of various disease biomarkers. Despite these limitations, current evidence seemingly suggests that statins may increase the risk of adverse reactions in individuals with SLOS receiving statins compared to those who are not. Given the insufficient evidence on potential benefits of statins in individuals with SLOS, and their potential for causing adverse reactions, anyone considering this therapy should take these findings into consideration. Future studies should address the highlighted gaps in evidence on the use of statins in individuals with SLOS by collecting prospective data on survival and performing serial standardized assessments of neurobehavioral features, QoL, anthropometric measures, and plasma and CSF biomarker levels after statin introduction. Future studies should also attempt to use consistent dosages, formulations and durations of cholesterol and statin therapy.
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Affiliation(s)
- Rami A Ballout
- Lipoprotein Metabolism Section, Translational Vascular Medicine Branch, National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD, USA
- Department of Pediatrics, University of Texas Southwestern (UTSW) Medical Center and Children's Health, Dallas, TX, USA
| | - Alicia Livinski
- Division of Library Services, National Institutes of Health Library, Office of Research Services, Bethesda, Maryland, USA
| | - Yi-Ping Fu
- Office of Biostatistics Research, National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Robert D Steiner
- Marshfield Clinic Research Foundation, Marshfield, Wisconsin, USA
| | - Alan T Remaley
- Lipoprotein Metabolism Section, Translational Vascular Medicine Branch, National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD, USA
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Adamou M, Jones SL, Marks L, Lowe D. Efficacy of Continuous Performance Testing in Adult ADHD in a Clinical Sample Using QbTest. J Atten Disord 2022; 26:1483-1491. [PMID: 35255743 DOI: 10.1177/10870547221079798] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Continuous performance tests are widely used to aid diagnostic decision making and measure symptom reduction in adult ADHD clinical populations. The diagnostic accuracy of the Quantified Behavior Test plus (QbTest+), developed to identify ADHD populations as an objective measure of ADHD symptoms, was explored. METHODS The utility of the QbTest+ was investigated in a clinical cohort of 69 adult patients referred to a specialist ADHD clinic in the UK. RESULTS Scores from the QbTest+ failed to differentiate between patients diagnosed with ADHD and those who did not receive a diagnosis after full clinical assessment. CONCLUSIONS Based on our findings, we recommend clinicians are cautious when interpreting results of the QbTest+ in clinical populations. This study highlights the need for investigation into the lack of validation of commonly used objective measures in ADHD populations.
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Affiliation(s)
| | - Sarah L Jones
- South West Yorkshire Partnership NHS Foundation Trust, Wakefield, UK
| | - Laura Marks
- University College London Hospitals NHS Foundation Trust, UK
| | - Deborah Lowe
- Greater Manchester Mental Health NHS Foundation Trust, Bolton, UK
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11
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Galloway-Long H, Huang-Pollock C, Neely K. Ahead of the (ROC) Curve: A Statistical Approach to Utilizing Ex-Gaussian Parameters of Reaction Time in Diagnosing ADHD Across Three Developmental Periods. J Int Neuropsychol Soc 2022; 28:821-834. [PMID: 34488917 PMCID: PMC9521363 DOI: 10.1017/s1355617721000990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Performance on executive function (EF) tasks is only modestly predictive of a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD), despite the common assumption that EF deficits are ubiquitous to the disorder. The current study sought to determine whether ex-Gaussian parameters of simple reaction time are better able to discriminate between children and adults with and without ADHD, compared with traditional measures of inhibitory control. METHODS Receiver Operating Characteristic (ROC) analyses and the area under the curve (AUC) were used to examine the ability of performance on two commonly used tasks of inhibitory control (i.e. stop signal reaction time (SSRT) and go-no-go tasks) to predict ADHD status in preschool (N = 108), middle childhood (N = 309), and young adulthood (N = 133). RESULTS Across all samples, SSRT, go-no-go percentage of failed inhibits, and standard deviation of reaction (SDRT) time to "go" trials, all successfully discriminated between individuals with and without ADHD. Ex-Gaussian decomposition of the RT distribution indicated that both larger tau and larger sigma drove findings for SDRT. Contrary to predictions, traditional measures of inhibitory control were equal if not better predictors of ADHD status than ex-Gaussian parameters. CONCLUSIONS Findings support ongoing work to quantify the separate contributions of cognitive subprocesses that drive task performance, which in turn is critical to developing and improving process-based approaches in clinical assessment.
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Affiliation(s)
- Hilary Galloway-Long
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
- VA Puget Sound Healthcare System, American Lake Division, WA, USA
| | - Cynthia Huang-Pollock
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
| | - Kristina Neely
- School of Kinesiology, Auburn University, Auburn, AL, USA
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12
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Whitehead JC, Neeman R, Doniger GM. Preliminary Real-World Evidence Supporting the Efficacy of a Remote Neurofeedback System in Improving Mental Health: Retrospective Single-Group Pretest-Posttest Study. JMIR Form Res 2022; 6:e35636. [PMID: 35802411 PMCID: PMC9308076 DOI: 10.2196/35636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 05/31/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Neurofeedback training (NFT) has been shown to be effective in treating several disorders (eg, attention-deficit/hyperactivity disorder [ADHD], anxiety, and depression); however, little is currently known regarding the effectiveness of remote NFT systems.
Objective
This retrospective study provides real-world data (N=593) to assess the efficacy of app-based remote NFT in improving brain health and cognitive performance.
Methods
Improvement was measured from pre- to postintervention of in-app assessments that included validated symptom questionnaires (the 12-item General Health Questionnaire, the ADHD Rating Scale IV, the Adult ADHD Self-Report Scale, the 7-item Generalized Anxiety Disorder scale, and the 9-item Patient Health Questionnaire), a cognitive test of attention and executive functioning (ie, continuous performance task), and resting electroencephalography (EEG) markers. Clinically significant improvement was evaluated using standard approaches.
Results
The greatest improvement was reported for the anxiety questionnaire, for which 69% (68/99) of participants moved from abnormal to healthy score ranges. Overall, adult and child participants who engaged in neurofeedback to improve attention and executive functions demonstrated improved ADHD scores and enhanced performance on a cognitive (ie, response inhibition) task. Adults with ADHD additionally demonstrated elevated delta/alpha and theta/alpha ratios at baseline and a reduction in the delta/alpha ratio indicator following neurofeedback.
Conclusions
Preliminary findings suggest the efficacy of app-based remote neurofeedback in improving mental health, given the reduced symptom severity from pre- to postassessment for general psychological health, ADHD, anxiety, and depression, as well as adjusted resting EEG neural markers for individuals with symptoms of ADHD. Collectively, this supports the utility of the in-app assessment in monitoring behavioral and neural indices of mental health.
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Affiliation(s)
- Jocelyne C Whitehead
- Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada
- Myndlift Ltd, Tel Aviv, Israel
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13
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Sujar A, Bayona S, Delgado-Gómez D, Miguélez-Fernández C, Ardoy-Cuadros J, Peñuelas-Calvo I, Baca-García E, Blasco-Fontecilla H. Attention Deficit Hyperactivity Disorder Assessment Based on Patient Behavior Exhibited in a Car Video Game: A Pilot Study. Brain Sci 2022; 12:brainsci12070877. [PMID: 35884684 PMCID: PMC9313446 DOI: 10.3390/brainsci12070877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 11/16/2022] Open
Abstract
Symptoms of Attention Deficit Hyperactivity Disorder (ADHD) include excessive activity, difficulty sustaining attention, and inability to act in a reflective manner. Early diagnosis and treatment of ADHD is key but may be influenced by the observation and communication skills of caregivers, and the experience of the medical professional. Attempts to obtain additional measures to support the medical diagnosis, such as reaction time when performing a task, can be found in the literature. We propose an information recording system that allows to study in detail the behavior shown by children already diagnosed with ADHD during a car driving video game. We continuously record the participants’ activity throughout the task and calculate the error committed. Studying the trajectory graphs, some children showed uniform patterns, others lost attention from one point onwards, and others alternated attention/inattention intervals. Results show a dependence between the age of the children and their performance. Moreover, by analyzing the positions by age over time using clustering, we show that it is possible to classify children according to their performance. Future studies will examine whether this detailed information about each child’s performance pattern can be used to fine-tune treatment.
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Affiliation(s)
- Aaron Sujar
- Department of Computer Engineering, Universidad Rey Juan Carlos, 28933 Madrid, Spain; (A.S.); (S.B.)
- Department of Psychiatry, Puerta de Hierro University Hospital, Health Research Institute Puerta de Hierro-Segovia de Arana (IDIPHISA), 28222 Majadahonda, Spain;
| | - Sofia Bayona
- Department of Computer Engineering, Universidad Rey Juan Carlos, 28933 Madrid, Spain; (A.S.); (S.B.)
- Center for Computational Simulation, Universidad Politécnica de Madrid, 28040 Boadilla del Monte, Spain
| | - David Delgado-Gómez
- Department of Statistics, Universidad Carlos III, 28903 Getafe, Spain
- Correspondence:
| | | | - Juan Ardoy-Cuadros
- Department of Psychology, Faculty of Health Sciences, University Rey Juan Carlos, Avda. Atenas s/n, 28922 Alcorcón, Spain;
| | - Inmaculada Peñuelas-Calvo
- Department of Child and Adolescent Psychiatry, University Hospital 12 de Octubre, 28041 Madrid, Spain;
| | - Enrique Baca-García
- Department of Psychiatry, IIS-Jimenez Diaz Foundation, 28040 Madrid, Spain;
- CIBERSAM (Centro de Investigación en Salud Mental), Carlos III Institute of Health, 28029 Madrid, Spain
- Department of Psychiatry, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - Hilario Blasco-Fontecilla
- Department of Psychiatry, Puerta de Hierro University Hospital, Health Research Institute Puerta de Hierro-Segovia de Arana (IDIPHISA), 28222 Majadahonda, Spain;
- CIBERSAM (Centro de Investigación en Salud Mental), Carlos III Institute of Health, 28029 Madrid, Spain
- Department of Psychiatry, Universidad Autónoma de Madrid, 28049 Madrid, Spain
- ITA Mental Health, 28043 Madrid, Spain
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14
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Ging-Jehli NR, Arnold LE, Roley-Roberts ME, deBeus R. Characterizing Underlying Cognitive Components of ADHD Presentations and Co-morbid Diagnoses: A Diffusion Decision Model Analysis. J Atten Disord 2022; 26:706-722. [PMID: 34085557 DOI: 10.1177/10870547211020087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To Explore whether subtypes and comorbidities of attention-deficit hyperactivity disorder (ADHD) induce distinct biases in cognitive components involved in information processing. METHOD Performance on the Integrated Visual and Auditory Continuous Performance Test (IVA-CPT) was compared between 150 children (aged 7 to 10) with ADHD, grouped by DSM-5 presentation (ADHD-C, ADHD-I) or co-morbid diagnoses (anxiety, oppositional defiant disorder [ODD], both, neither), and 60 children without ADHD. Diffusion decision modeling decomposed performance into cognitive components. RESULTS Children with ADHD had poorer information integration than controls. Children with ADHD-C were more sensitive to changes in presentation modality (auditory/visual) than those with ADHD-I and controls. Above and beyond these results, children with ADHD+anxiety+ODD had larger increases in response biases when targets became frequent than children with ADHD-only or with ADHD and one comorbidity. CONCLUSION ADHD presentations and comorbidities have distinct cognitive characteristics quantifiable using DDM and IVA-CPT. We discuss implications for tailored cognitive-behavioral therapy.
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15
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Chang Y, Stevenson C, Chen IC, Lin DS, Ko LW. Neurological state changes indicative of ADHD in children learned via EEG-based LSTM networks. J Neural Eng 2022; 19. [PMID: 35081524 DOI: 10.1088/1741-2552/ac4f07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 01/26/2022] [Indexed: 11/12/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that pervasively interferes with the lives of individuals starting in childhood. OBJECTIVE To address the subjectivity of current diagnostic approaches, many studies have been dedicated to efforts to identify the differences between ADHD and neurotypical (NT) individuals using EEG and continuous performance tests (CPT). APPROACH In this study, we proposed EEG-based long short-term memory (LSTM) networks that utilize deep learning techniques with learning the cognitive state transition to discriminate between ADHD and NT children via EEG signal processing. A total of thirty neurotypical children and thirty ADHD children participated in CPT tests while being monitored with EEG. Several architectures of deep and machine learning were applied to three EEG data segments including resting state, cognitive execution, and a period containing a fusion of those. MAIN RESULTS The experimental results indicated that EEG-based LSTM networks produced the best performance with an average accuracy of 90.50 ± 0.81 % in comparison with the deep neural networks, the convolutional neural networks, and the support vector machines with learning the cognitive state transition of EEG data. Novel observations of individual neural markers showed that the beta power activity of the O1 and O2 sites contributed the most to the classifications, subjects exhibited decreased beta power in the ADHD group, and had larger decreases during cognitive execution. SIGNIFICANCE These findings showed that the proposed EEG-based LSTM networks are capable of extracting the varied temporal characteristics of high-resolution electrophysiological signals to differentiate between ADHD and NT children, and brought a new insight to facilitate the diagnosis of ADHD. The registration numbers of the institutional review boards are 16MMHIS021 and EC1070401-F.
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Affiliation(s)
- Yang Chang
- Institute of Bioinformatics and Systems Biology, National Yang Ming Chiao Tung University, Rm. 742, Bio-ICT Building, No. 75, Bo'ai St., East Dist., Hsinchu City 300 , Taiwan (R.O.C.), Hsinchu, 300, TAIWAN
| | - Cory Stevenson
- Institute of Bioinformatics and Systems Biology, National Yang Ming Chiao Tung University, Rm. 742, Bio-ICT Building, No. 75, Bo'ai St., East Dist., Hsinchu City 300 , Taiwan (R.O.C.), Hsinchu, 300, TAIWAN
| | - I-Chun Chen
- Department of Physical Medicine and Rehabilitation, Ton-Yen General Hospital, No. 69, Xianzheng 2nd Rd., Zhubei City, Hsinchu County 302, Taiwan (R.O.C.), Hsinchu, 302, TAIWAN
| | - Dar-Shong Lin
- Department of Pediatrics, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City 104, Taiwan (R.O.C.), Taipei, 104, TAIWAN
| | - Li-Wei Ko
- Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Rm. 742, Bio-ICT Building, No. 75, Bo'ai St., East Dist., Hsinchu City 300 , Taiwan (R.O.C.), Hsinchu, 300, TAIWAN
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16
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Kenton JA, Young JW. Preclinical Evaluation of Attention and Impulsivity Relevant to Determining ADHD Mechanisms and Treatments. Curr Top Behav Neurosci 2022; 57:291-320. [PMID: 35606639 DOI: 10.1007/7854_2022_340] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
People with Attention-Deficit Hyperactivity Disorder (ADHD) exhibit inattention, hyperactivity, and/or impulsivity. Symptoms of ADHD emerge in childhood and can continue throughout adulthood. Clinical assessments to diagnose ADHD can include administration of continuous performance tests (CPTs). CPTs provide an objective measure of inattention, requiring individuals to respond to targets (attention), and inhibit response to non-targets (impulsivity). When investigating the mechanisms of, and novel treatments for, ADHD it is important to measure such behavioral domains (attention and impulsivity). Some well-established preclinical tasks purport to assess attention in rodents but, unlike CPTs, do not require non-target inhibition, limiting their ADHD-relevance.Recently developed tasks recreate CPTs for rodents. The 5-Choice CPT (5C-CPT) contains non-target stimuli, enabling use of signal detection theory to evaluate performance, consistent with CPTs. The 5C-CPT has been adapted for use in humans, enabling direct cross-species comparisons of performance. A newer task, the rodent CPT (rCPT), is a touchscreen-based analog of CPTs, utilizing symbols instead of a simple stimulus array. Currently, the rCPT may be more akin to a go/no-go task, equally presenting targets/non-targets, although numerous variants exist - a strength. The 5C-CPT and rCPT emulate human CPTs and provide the most up-to-date information on ADHD-relevant studies for understanding attention/impulsivity.
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Affiliation(s)
- Johnny A Kenton
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Jared W Young
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA.
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17
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Objective Video-Based Assessment of ADHD-Like Canine Behavior Using Machine Learning. Animals (Basel) 2021; 11:ani11102806. [PMID: 34679828 PMCID: PMC8532741 DOI: 10.3390/ani11102806] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/03/2021] [Accepted: 09/13/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary This paper applies machine learning techniques to propose an objective video-based method for assessing the degree of canine ADHD-like behavior in veterinary consultation room. The method is evaluated using clinical data of dog patients in a veterinary clinic, as well as in a focus group of experts. Abstract Canine ADHD-like behavior is a behavioral problem that often compromises dogs’ well-being, as well as the quality of life of their owners; early diagnosis and clinical intervention are often critical for successful treatment, which usually involves medication and/or behavioral modification. Diagnosis mainly relies on owner reports and some assessment scales, which are subject to subjectivity. This study is the first to propose an objective method for automated assessment of ADHD-like behavior based on video taken in a consultation room. We trained a machine learning classifier to differentiate between dogs clinically treated in the context of ADHD-like behavior and health control group with 81% accuracy; we then used its output to score the degree of exhibited ADHD-like behavior. In a preliminary evaluation in clinical context, in 8 out of 11 patients receiving medical treatment to treat excessive ADHD-like behavior, H-score was reduced. We further discuss the potential applications of the provided artifacts in clinical settings, based on feedback on H-score received from a focus group of four behavior experts.
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18
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Son HM, Lee DG, Joung YS, Lee JW, Seok EJ, Chung TM, Oh S. A novel approach to diagnose ADHD using virtual reality. INTERNATIONAL JOURNAL OF WEB INFORMATION SYSTEMS 2021. [DOI: 10.1108/ijwis-03-2021-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The current golden standard for attention deficit hyperactivity disorder (ADHD) diagnosis is clinical diagnosis based on psychiatric interviews and psychological examinations. This is suboptimal, as clinicians are unable to view potential patients in multiple natural settings – a necessary condition for objective diagnosis. The purpose of this paper is to improve the objective diagnosis of ADHD by analyzing a quantified representation of the actions of potential patients in multiple natural environments.
Design/methodology/approach
The authors use both virtual reality (VR) and artificial intelligence (AI) to create an objective ADHD diagnostic test. Diagnostic and statistical manual of mental disorders, 5th Edition (DSM-5) and ADHD Rating Scale are used to create a rule-based system of quantifiable VR-observable actions. As a potential patient completes tasks within multiple VR scenes, certain actions trigger an increase in the severity measure of the corresponding ADHD symptom. The resulting severity measures are input to an AI model, which classifies the potential patient as having ADHD in the form inattention, hyperactivity-impulsivity, combined or neither.
Findings
The result of this study shows that VR-observed actions can be extracted as quantified data, and classification of this quantified data achieves near-perfect sensitivity and specificity with a 98.3% accuracy rate on a convolutional neural network model.
Originality/value
To the best of the authors’ knowledge, this is the first study to incorporate VR and AI into an objective DSM-5-based ADHD diagnostic test. By including stimulation to the visual, auditory and equilibrium senses and tracking movement and recording voice, we present a method to further the research of objective ADHD diagnosis.
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19
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O'Brien AM, Kivisto LR, Deasley S, Casey JE. Executive Functioning Rating Scale as a Screening Tool for ADHD: Independent Validation of the BDEFS-CA. J Atten Disord 2021; 25:965-977. [PMID: 31448664 DOI: 10.1177/1087054719869834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: This study provides independent examination of the validity of the Barkley Deficits of Executive Functioning Scale-Children and Adolescents (BDEFS-CA) in a sample of children diagnosed with ADHD (n = 50) and typically developing controls (n = 50). Method: Parents of participants completed the BDEFS-CA and the Conners 3 rating scales. Validity of BDEFS-CA was examined using a confirmatory factor analysis, correlational analyses with Conners 3 ratings, and receiver operating characteristic (ROC) curve analysis of diagnostic accuracy. Results: Findings support the construct, concurrent, and discriminant validity of the BDEFS-CA in a mixed sample. Conclusion: Findings provide independent examination of the validity of the BDEFS-CA as a measure of executive dysfunction and a screening tool for ADHD.
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20
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Alqithami S. A serious-gamification blueprint towards a normalized attention. Brain Inform 2021; 8:6. [PMID: 33856585 PMCID: PMC8050194 DOI: 10.1186/s40708-021-00127-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 02/19/2021] [Indexed: 12/16/2022] Open
Abstract
Attention is an important commodity in the human skills set. It can be trained to overcome deficits in the short term which might be based on multiple cognitive complications to entail inability to keep focus and mined wondering. On the long term, however, it might be a symptom of chronic diseases that acquire attention to include the spectra of many mental health disorders, e.g., attention deficit hyperactivity disorder (ADHD). This paper, therefore, introduces a generic reference model that guides in the design of proper treatment method for patients in short of attention to engage in a game-based environment in order to enhance the behavior of their current state of attention which may hopefully lead to a better focus. When considering the volatility of traditional cognitive behavioral therapies (CBTs), the model reflects and analyzes evolving serious games design directed for the treatment of ADHD. It serves as an instrument that spawn over a specific treatment design since it introduces essential components that depicts essential units of traditional CBT when they are modularly combined. The components will be introduced and the processes of the reference model will be elaborated as a roadmap for the formation and the operation of augmented reality treatment games.
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Affiliation(s)
- Saad Alqithami
- Department of Computer Science, Albaha University, Al Bahah, Saudi Arabia.
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21
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Ng R, Heinrich K, Hodges E. Associations Between ADHD Subtype Symptomatology and Social Functioning in Children With ADHD, Autism Spectrum Disorder, and Comorbid Diagnosis: Utility of Diagnostic Tools in Treatment Considerations. J Atten Disord 2021; 25:820-828. [PMID: 31200611 DOI: 10.1177/1087054719855680] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To assess associations between objective-/caregiver-report measures of attention functioning and social impairment among children with ADHD, autism spectrum disorder (ASD), and co-occurring ASD + ADHD. Method: Patients with ADHD (N = 27), ASD (N = 23), and ASD + ADHD (N = 44) completed measures of intellectual functioning (Wechsler tests) and attention functioning (Continuous Performance Test-Second Edition [CPT-II]) as part of a neurocognitive assessment. Caregivers completed the Conners Third Edition to assess day-to-day inattentiveness, hyperactivity/impulsivity, and the Social Responsiveness Scale (SRS) to assess social functioning. Results: Among patients with ADHD, attention measures contributed to 48% of the variance in total SRS scores, with caregiver-reported hyperactivity/impulsivity as the strongest factor. In contrast, among those with ASD + ADHD, attention measures accounted for 40% of the variance, largely due to inattention problems. No associations between domains were observed among patients with ASD. Conclusion: Differential ADHD symptoms are associated with social impairment among children with ADHD versus ASD + ADHD; whereas, no associations were observed among those with ASD.
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Affiliation(s)
- Rowena Ng
- University of Michigan, Ann Arbor, USA
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22
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Chen M, Xu Q, Cui M. Sleep problems, attention, and classroom learning behaviors of Chinese elementary school children: The moderating role of gender. SCHOOL PSYCHOLOGY INTERNATIONAL 2021. [DOI: 10.1177/0143034321993502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The present study investigated (1) the mediating role of attention in the associations between children’s sleep problems and classroom learning behaviors in elementary school, and (2) the moderating role of gender in these associations. Results from structural equation modeling showed that children’s sleep problems had a significant and negative association with their attention level (β = –.08), and their attention level had a significant and positive association with their classroom learning behaviors (β = .20). The indirect effect of sleep problems on classroom learning behaviors, however, was not significant (β = .02). Gender of a child had significant moderating effects on the associations between sleep problems and attention level and between attention level and classroom learning behaviors. Related intervention programs can be implemented to reduce children’s sleep problems and to improve their academic performance.
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Affiliation(s)
| | - Qinmei Xu
- Zhejiang University Education College, China
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23
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Bearden DJ, Shakil S, O'Banion D, Ono KE, Drane DL, Loring DW, Tarquinio DC. Methylphenidate treatment for cognitive symptoms associated with ADHD in a pediatric epilepsy patient following resection of a left frontal cortical dysplasia. Epilepsy Behav Rep 2021; 16:100435. [PMID: 33981985 PMCID: PMC8085698 DOI: 10.1016/j.ebr.2021.100435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/02/2021] [Accepted: 01/17/2021] [Indexed: 11/17/2022] Open
Abstract
ADHD symptoms can emerge or worsen after epilepsy surgery. Methylphenidate use improved cognitive symptoms of ADHD in our patient. Seizure aggravation did not occur following use of a neurostimulant in our patient. Our patient benefitted from a multidisciplinary intervention approach.
We present data on a 10-year-old patient with drug-resistant epilepsy who was treated with methylphenidate for symptoms of attention deficit hyperactivity disorder (ADHD) that developed after she underwent surgical resection of a left frontal cortical dysplasia. . The patient’s parents reported methylphenidate was helpful in improving their child’s reading performance. Based on parents’ report, we examined benefits of methylphenidate on our patient’s cognitive problems in a controlled setting. The patient underwent a neuropsychological evaluation completed in three sessions over a five-day period. Methylphenidate was administered prior to the second testing session only and was associated with improvements in the patient’s attention, executive function, processing speed, and short-term memory performances. In comparison, word-reading performance, a task less susceptible to neurological impairment, was stable over the three sessions. The patient remained seizure-free after surgery and use of methylphenidate did not reduce seizure threshold. These findings support the use of methylphenidate in treating targeted cognitive problems associated with ADHD emerging after epilepsy surgery in children.
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Affiliation(s)
- Donald J. Bearden
- Department of Neuropsychology, Children’s Healthcare of Atlanta, Atlanta, GA, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Corresponding author at: Center for Advanced Pediatrics, Children’s Healthcare of Atlanta, 1400 Tullie Rd. NE, Ste. 430, Atlanta, GA 30329, USA.
| | - Sidra Shakil
- Alabama College of Osteopathic Medicine, Dothan, AL, USA
| | - David O'Banion
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Developmental Pediatrics, Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Kim E. Ono
- Department of Neuropsychology, Children’s Healthcare of Atlanta, Atlanta, GA, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Daniel L. Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Neurology University of Washington School of Medicine, Seattle, WA, USA
| | - David W. Loring
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
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24
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Delgado-Gómez D, Sújar A, Ardoy-Cuadros J, Bejarano-Gómez A, Aguado D, Miguelez-Fernandez C, Blasco-Fontecilla H, Peñuelas-Calvo I. Objective Assessment of Attention-Deficit Hyperactivity Disorder (ADHD) Using an Infinite Runner-Based Computer Game: A Pilot Study. Brain Sci 2020; 10:brainsci10100716. [PMID: 33050130 PMCID: PMC7599622 DOI: 10.3390/brainsci10100716] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/02/2020] [Accepted: 10/06/2020] [Indexed: 11/16/2022] Open
Abstract
In the last few years, several computerized tasks have been developed to increase the objectivity of the diagnosis of attention-deficit hyperactivity disorder (ADHD). This article proposes the "running raccoon" video game to assess the severity of inattention in patients diagnosed with ADHD. Unlike existing tests, the proposed tool is a genuine video game in which the patient must make a raccoon avatar jump to avoid falling into different gaps. The distance to the gap is recorded for each jump. To evaluate the proposed game, an experiment was conducted in which 32 children diagnosed with ADHD participated. For each participant, the median and interquartile range of these distances were calculated, along with the number of omissions. Experimental results showed a significant correlation between the participants' inattention (measured by the Attention-Deficit/Hyperactivity Disorder Symptoms and Normal Behavior rating scale (SWAN) inattention subscale) with each of these three measures. In addition to its accuracy, other benefits are its short duration and the possibility of being run on both standard computers and mobile devices. These characteristics facilitate its acceptance in clinical environments or even its telematic use. The obtained results, together with the characteristics of the video game, make it an excellent tool to support clinicians in the diagnosis of ADHD.
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Affiliation(s)
- David Delgado-Gómez
- Department of Statistics, Universidad Carlos III, Getafe, 28903 Madrid, Spain; (D.D.-G.); (A.B.-G.)
| | - Aaron Sújar
- Department of Psychiatry, Puerta de Hierro University Hospital, Health Research Institute Puerta de Hierro-Segovia de Arana (IDIPHISA), 28222 Majadahonda, Spain; (A.S.); (H.B.-F.)
| | - Juan Ardoy-Cuadros
- Department of Psychology, Faculty of Health Sciences, University Rey Juan Carlos, Avda. Atenas s/n, 28922 Alcorcón, Madrid, Spain
- Correspondence:
| | - Alejandro Bejarano-Gómez
- Department of Statistics, Universidad Carlos III, Getafe, 28903 Madrid, Spain; (D.D.-G.); (A.B.-G.)
| | - David Aguado
- Department of Social Psychology and Methodology, Autonoma University of Madrid, 28040 Madrid, Spain;
- Instituto Ingeniería del Conocimiento, Autonoma University of Madrid, 28040 Madrid, Spain
| | | | - Hilario Blasco-Fontecilla
- Department of Psychiatry, Puerta de Hierro University Hospital, Health Research Institute Puerta de Hierro-Segovia de Arana (IDIPHISA), 28222 Majadahonda, Spain; (A.S.); (H.B.-F.)
- CIBERSAM, Autonoma University of Madrid, ITA-Mental Health, 28049 Madrid, Spain;
| | - Inmaculada Peñuelas-Calvo
- Department of Child and Adolescent Psychiatry, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain;
- School of Psychology, Universidad Complutense de Madrid, Pozuelo de Alarcón, 28223 Madrid, Spain
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Slobodin O, Yahav I, Berger I. A Machine-Based Prediction Model of ADHD Using CPT Data. Front Hum Neurosci 2020; 14:560021. [PMID: 33093829 PMCID: PMC7528635 DOI: 10.3389/fnhum.2020.560021] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/24/2020] [Indexed: 11/17/2022] Open
Abstract
Despite the popularity of the continuous performance test (CPT) in the diagnosis of attention-deficit/hyperactivity disorder (ADHD), its specificity, sensitivity, and ecological validity are still debated. To address some of the known shortcomings of traditional analysis and interpretation of CPT data, the present study applied a machine learning-based model (ML) using CPT indices for the Prediction of ADHD.Using a retrospective factorial fitting, followed by a bootstrap technique, we trained, cross-validated, and tested learning models on CPT performance data of 458 children aged 6–12 years (213 children with ADHD and 245 typically developed children). We used the MOXO-CPT version that included visual and auditory stimuli distractors. Results showed that the ML proposed model performed better and had a higher accuracy than the benchmark approach that used clinical data only. Using the CPT total score (that included all four indices: Attention, Timeliness, Hyperactivity, and Impulsiveness), as well as four control variables [age, gender, day of the week (DoW), time of day (ToD)], provided the most salient information for discriminating children with ADHD from their typically developed peers. This model had an accuracy rate of 87%, a sensitivity rate of 89%, and a specificity rate of 84%. This performance was 34% higher than the best-achieved accuracy of the benchmark model. The ML detection model could classify children with ADHD with high accuracy based on CPT performance. ML model of ADHD holds the promise of enhancing, perhaps complementing, behavioral assessment and may be used as a supportive measure in the evaluation of ADHD.
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Affiliation(s)
- Ortal Slobodin
- Department of Education, Ben-Gurion University, Beer-Sheva, Israel
- *Correspondence: Ortal Slobodin
| | - Inbal Yahav
- Coller School of Management, Tel Aviv University, Tel Aviv, Israel
| | - Itai Berger
- Pediatric Neurology, Assuta Ashdod University Hospital, Ashdod, Israel
- Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
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Slobodin O. The Utility of the CPT in the Diagnosis of ADHD in Individuals with Substance Abuse: A Systematic Review. Eur Addict Res 2020; 26:283-294. [PMID: 32535592 DOI: 10.1159/000508041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 04/20/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Early identification of attention-deficit/hyperactivity disorder (ADHD) in individuals with substance use disorders (SUD) is important because ADHD has an adverse effect on the development and course of SUD. Given the limited validity of self-report measures of ADHD in individuals with SUD, it is important to investigate the utility of the continuous performance test (CPT) in classifying ADHD in adults with SUD. OBJECTIVE This review aims to examine the quantitative similarities and differences in CPT performance of adults with ADHD, SUD, and their comorbidity to determine if a distinct neurocognitive profile exists for each. METHOD A systematic review of CPT studies that included patients with the comorbidity of ADHD and SUD and a comparison group of one of the disorders alone was conducted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. RESULTS Eight studies were identified with sample sizes ranging from n = 17 to n = 386. The comorbidity of ADHD and SUD was, mostly, not associated with higher rates of commission and omission errors than either disorder alone. However, the comorbidity of ADHD and SUD was more likely to be associated with increased deficits in response time variability compared with individuals with ADHD alone. CONCLUSIONS This review highlights the shortage of large-scale CPT research involving patients with ADHD and SUD. The CPT might be sensitive to attentional deficits, but it lacks specificity for the classification of adult ADHD, SUD, or their comorbidity, and the CPT is thus not useful in discriminating comorbid ADHD and SUD from either disorder alone. Future CPT research should explore whether specific attentional deficits account for the development and persistence of SUD. Such research should also reach beyond traditional CPT measures and include other cognitive and behavioral deficits that were associated with ADHD, such as distractibility and hyperactivity.
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Affiliation(s)
- Ortal Slobodin
- Department of Education, Ben-Gurion University, Beer-Sheva, Israel,
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Ballout RA, Bianconi S, Livinski A, Fu Y, Remaley AT, Porter FD. Statins for Smith-Lemli-Opitz syndrome. Cochrane Database Syst Rev 2020; 2020:CD013521. [PMID: 32132878 PMCID: PMC7055734 DOI: 10.1002/14651858.cd013521] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: 1. To evaluate the efficacy of statin therapy in reducing the frequency or severity of the neurobehavioral abnormalities seen in people with SLOS (e.g. aggression, anxiety, irritability, self-mutilation, autistic behaviors, sleep disturbances, etc.) (Wassif 2017). 2. To evaluate the potential effects of statin therapy on survival.
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Affiliation(s)
- Rami A Ballout
- National Heart, Lung and Blood Institute, NIHLipoprotein Metabolism Section, Translational Vascular Medicine Branch10 Center Drive, Bldg 10, Rm 5D11BethesdaMDUSA20892
| | - Simona Bianconi
- NIHNational Institute of Child Health and Development10 Center Drive, Building 10, CRC‐ 2‐5132BethesdaUSAMD 20892
| | - Alicia Livinski
- National Institutes of Health Library, Office of Research ServicesDivision of Library ServicesBldg 10, Room 1L19B, MSC 1150BethesdaMarylandUSAMD 20892‐1150
| | - Yi‐Ping Fu
- National Heart, Lung, and Blood Institute, NIHOffice of Biostatistics Research6701 Rockledge Drive, RKL2 Rm9195BethesdaUSAMD 20892
| | - Alan T Remaley
- National Heart, Lung and Blood Institute, NIHLipoprotein Metabolism Laboratory, Translational Vascular Medicine BranchBethesdaUSAMD 20892
| | - Forbes D Porter
- Eunice Kennedy Shriver National Institute of Child Health and Development, National Institutes of HealthDivision of Translational Research10 Center DriveBethesdaMarylandUSA20892
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Slobodin O, Davidovitch M. Gender Differences in Objective and Subjective Measures of ADHD Among Clinic-Referred Children. Front Hum Neurosci 2019; 13:441. [PMID: 31920599 PMCID: PMC6923191 DOI: 10.3389/fnhum.2019.00441] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 12/02/2019] [Indexed: 11/25/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD), one of the most prevalent childhood disorders today, is generally more likely to be diagnosed and treated in boys than in girls. However, gender differences in ADHD are currently poorly understood, partly because previous research included only a limited proportion of girls and relied mainly on subjective measures of ADHD, which are highly vulnerable to reporter's bias. To further examine gender differences in ADHD and to address some of the shortcomings of previous studies, this study examined gender differences in subjective and objective measures of ADHD among clinic-referred children with ADHD. Participants were 204 children aged 6-17 years-old with ADHD (129 boys, 75 girls). A retrospective analysis was conducted using records of a clinical database. Obtained data included parent and teacher forms of the Conners ADHD rating scales, Child Behavior Checklist (CBCL), Teacher's Report Form (TRF), and child's continuous performance test (CPT) scores. Results showed that according to parents' and teachers' reports of ADHD-related symptoms (Conners ADHD rating scales), girls had more inattention problems than boys, but no differences were identified in the level of hyperactivity and impulsivity symptoms. CPT data, however, revealed higher impulsivity among boys. We did not find gender differences in the level of distractibility during CPT performance. Specifically, the effects of distractors type (visual environmental stimuli, auditory stimuli, or a combination of them) and distractors load (one or two distracting stimuli at a time) on CPT performance did not differ between boys and girls with ADHD. These findings suggest that gender effects on ADHD symptoms may differ between subjective and objective measures. Understanding gender differences in ADHD may lead to improved identification of girls with the disorder, helping to reduce the gender gap in diagnosis and treatment.
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Affiliation(s)
- Ortal Slobodin
- Department of Education, Ben-Gurion University, Beer-Sheva, Israel
| | - Michael Davidovitch
- Medical Department and Research Institute, Maccabi Healthcare Services, Tel Aviv, Israel
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Alqithami S, Alzahrani M, Alzahrani A, Mustafa A. AR-Therapist: Design and Simulation of an AR-Game Environment as a CBT for Patients with ADHD. Healthcare (Basel) 2019; 7:E146. [PMID: 31731576 PMCID: PMC6955707 DOI: 10.3390/healthcare7040146] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/23/2019] [Accepted: 10/28/2019] [Indexed: 12/29/2022] Open
Abstract
Attention Deficit Hyperactivity Disorder is one of the most common neurodevelopmental disorders in which patients have difficulties related to inattention, hyperactivity, and impulsivity. Those patients are in need of a psychological therapy use Cognitive Behavioral Therapy (CBT) to enhance the way they think and behave. This type of therapy is mostly common in treating patients with anxiety and depression but also is useful in treating autism, obsessive compulsive disorder and post-traumatic stress disorder. A major limitation of traditional CBT is that therapists may face difficulty in optimizing patients' neuropsychological stimulus following a specified treatment plan. Other limitations include availability, accessibility and level-of-experience of the therapists. Hence, this paper aims to design and simulate a generic cognitive model that can be used as an appropriate alternative treatment to traditional CBT, we term as "AR-Therapist." This model takes advantage of the current developments of augmented reality to engage patients in both real and virtual game-based environments.
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Affiliation(s)
- Saad Alqithami
- Department of Computer Science, Albaha University; Albaha 65799, Saudi Arabia; (M.A.); (A.A.); (A.M.)
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Ben Amor L, Lachal J. [Impulsivity and obesity in children with Attention Deficit Hyperactivity Disorder: A clinical, neuropsychological and magnetic resonance spectroscopy exploratory study]. Encephale 2019; 45:494-500. [PMID: 31492416 DOI: 10.1016/j.encep.2019.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/15/2019] [Accepted: 06/19/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Relationship between Attention Deficit Hyperactivity Disorder (ADHD) and obesity in adults and children had previously been established in research studies. Brain imaging studies pointed out the important role of the prefrontal region in both ADHD and obesity. However, the underlying link between ADHD and obesity is not well understood. The hypothesis that impulsivity could play a role has been explored in clinical studies of ADHD and Binge Eating Disorders or Loss of Control Eating, with contradictory results. Our study aims to compare children with ADHD and obesity to children with ADHD and normal weight. We propose to compare these two populations with clinical, neuropsychological and brain spectroscopy investigation, focusing specifically on impulsivity items. METHOD Ten children presenting overweight or obesity were selected from a larger population of children with ADHD (5-12y) and paired with regard to gender and age with ten children with ADHD and normal weight from the same population. Conners Rating scales version parents (CPRS) and teachers (CTRS), Conners' Continuous Performance Test II (CPT-II), and Magnetic Resonance Spectroscopy (MRS) metabolites in five regions of interest (left and right prefrontal, left and right striatal and left cerebellum regions) were measured for all the children. For MRS, ratio to creatinine levels of following metabolites were measured: glycerophosphocholine+phosphocholine/creatinine (GPC+PCh/Cr), glutamate+glutamine (Glu+Gln/Cr), myoinositol (mI/Cr) et N-acétylaspartate+N-acétylaspartylglutamate (NAA+NAAG/Cr). RESULTS Hyperactivity/Impusivity and Conners Global Index (CGI) subscales of Conners rating scales showed a higher rate of impulsivity in children with ADHD and obesity as compared to children with ADHD and normal weight. Neuropsychological results were comparable in the two groups. Finally, MRS showed a higher GPC+PCh/Cr ratio in right prefrontal cortex in children with ADHD and obesity as compared to children with ADHD and normal weight. CONCLUSIONS Our results are concordant with the hypothesis that impulsivity could be the link between obesity and ADHD in a population of children with ADHD. The right prefrontal regions seem to be areas of interests that need more research in the study of the link between obesity and ADHD.
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Affiliation(s)
- L Ben Amor
- Département de psychiatrie, CHU de Sainte-Justine, 3175, chemin de la Côte-Sainte-Catherine, Montréal, QC H3T 1C5, Canada; Département de psychiatrie, université de Montréal, Montréal, QC H3T 1J4, Canada
| | - J Lachal
- Département de psychiatrie, université de Montréal, Montréal, QC H3T 1J4, Canada; APHP, hôpital Cochin, Maison de Solenn, 75014 Paris, France; Université de Paris, PCPP, Boulogne-Billancourt, France; Inserm, CESP, faculté de médecine, UVSQ, université Paris-Sud, université Paris-Saclay, 94805 Villejuif, France.
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Ali S, Macoun SJ, Bedir B, MacDonald SWS. Intraindividual variability in children is related to informant ratings of attention and executive function. J Clin Exp Neuropsychol 2019; 41:740-748. [PMID: 31132921 DOI: 10.1080/13803395.2019.1617249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Attention and executive function (EF) deficits are ubiquitous in neurodevelopmental disorders including Attention Deficit/Hyperactivity Disorder (ADHD), as are high levels of intraindividual variability (IIV). Attention and EF are typically assessed using informant ratings and objective measures; however, discrepancies between different metrics often make it difficult to fully characterize a child's attention capabilities, and IIV has been proposed as a potentially useful discriminator. Our objective was to explore the relationship between IIV, using the residualized intraindividual standard deviation (rISD) method, and informant ratings of attention and EF in a mixed pediatric sample, to determine the potential utility of IIV for aiding attention diagnostics. Another commonly used, though controversial, IIV indicator, the coefficient of variation (ICV), was calculated for comparison purposes. Method: We assessed 51 children with varying degrees of attention and EF deficits. Measures included parent and teacher responses on the Comprehensive Executive Function Inventory (CEFI) and response times (RT) on a go/no-go task, which were used to estimate IIV. Results: Mean RT, rISD, and ICV were significantly related to parent and teacher ratings of attention, though ICV showed a relatively weaker association. rISD also showed associations with parent ratings of working memory and self-monitoring, as well as teacher ratings of working memory. Conclusion: The significant, and relatively stronger, relationship between rISD and parent and teacher ratings of attention supports the use of this metric, compared to mean RT and ICV. The rISD indicator of IIV thus shows potential utility as a unique and objective measure of attention in children across various neurodevelopmental disorders and, with additional research, may prove useful for diagnosis of attention problems.
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Affiliation(s)
- Sheliza Ali
- a Department of Psychology , University of Victoria , Victoria , Canada
| | - Sarah J Macoun
- a Department of Psychology , University of Victoria , Victoria , Canada
| | - Buse Bedir
- a Department of Psychology , University of Victoria , Victoria , Canada
| | - Stuart W S MacDonald
- a Department of Psychology , University of Victoria , Victoria , Canada.,b Institute on Aging and Lifelong Health , University of Victoria , Victoria , Canada
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Barkley RA. Neuropsychological Testing is Not Useful in the Diagnosis of ADHD: Stop It (or Prove It)! ACTA ACUST UNITED AC 2019. [DOI: 10.1521/adhd.2019.27.2.1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Russell A. Barkley
- Clinical Professor of Psychiatry at Virginia Commonwealth University Medical Center and the Virginia Treatment Center for Children. He is triple board certified in Clinical Neuropsychology (ABCN), Clinical Psychology (ABPP), and Clinical Child and Adolescent Psychology (ABC-CAP). His e-mail address is:
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Shaked D, Faulkner LMD, Tolle K, Wendell CR, Waldstein SR, Spencer RJ. Reliability and validity of the Conners' Continuous Performance Test. APPLIED NEUROPSYCHOLOGY-ADULT 2019; 27:478-487. [PMID: 30793982 DOI: 10.1080/23279095.2019.1570199] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The Conners' Continuous Performance Test-Second Edition (CCPT-2) is a widely used measure of attention and impulsivity, however, only a minimal amount is known about its reliability. To clarify the psychometric properties of the CCPT-2, we assessed its performance stability and related it to criterion measures. A total of 91 undergraduate students completed the CCPT-2, the State-Trait Personality Inventory (STPI), and reported on sleep during two sessions approximately one week apart. They completed the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) at session one and the Stroop Color and Word Test at session two. Findings indicated that the CCPT-2 had strong internal consistency, adequate test-retest reliability for commission errors and response time, poor test-retest reliability for omission errors, and practice effects for omission and commission errors. The CCPT-2 was largely unrelated to the BRIEF-A, Stroop Color and Word Test, and the STPI. More sleep was related to a quicker response time and more commission errors on the CCPT-2, and the BRIEF-A's Behavior Regulation Index was positively related to commission errors. Relative to the omission error component of the CCPT-2, commission errors and response time may be useful and stable measures of sustained attention and impulsivity.
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Affiliation(s)
- Danielle Shaked
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland, USA
| | - Lauren M. D. Faulkner
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland, USA
| | - Kathryn Tolle
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Carrington R. Wendell
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland, USA
| | - Shari R. Waldstein
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland, USA
| | - Robert J. Spencer
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland, USA
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
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Kostyrka-Allchorne K, Cooper NR, Simpson A. Disentangling the effects of video pace and story realism on children’s attention and response inhibition. COGNITIVE DEVELOPMENT 2019. [DOI: 10.1016/j.cogdev.2018.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Slobodin O, Cassuto H, Berger I. Age-Related Changes in Distractibility: Developmental Trajectory of Sustained Attention in ADHD. J Atten Disord 2018; 22:1333-1343. [PMID: 25791438 DOI: 10.1177/1087054715575066] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study investigated age-related changes in sustained attention in children with ADHD and in their typically developed peers. METHOD The study used a Continuous Performance Test (CPT) that includes visual and auditory stimuli serving as distractors. The rate of omission errors was used as a measurement of difficulty in sustained attention. Participants were children and adolescents aged 7 to 18 years (478 with ADHD and 361 without ADHD). RESULTS Both groups of adolescents (with and without ADHD) showed reduced distractibility than younger children from the same group. However, distractibility tended to diminish in non-ADHD adolescents, but not in adolescents with ADHD. CONCLUSION Although part of the difficulties in ADHD could be explained by developmental delay that improves with time, other deficits, such as increased distractibility causing more omission errors, do not show a clear developmental trajectory. The results suggest that deficits in inhibitory control might be the core of ADHD.
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Affiliation(s)
- Ortal Slobodin
- 1 Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Itai Berger
- 1 Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Elliott L, Feigenson L, Halberda J, Libertus ME. Bidirectional, Longitudinal Associations Between Math Ability and Approximate Number System Precision in Childhood. JOURNAL OF COGNITION AND DEVELOPMENT 2018. [DOI: 10.1080/15248372.2018.1551218] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Abstract
OBJECTIVE We assess the diagnostic accuracy of the QbTest, which measures the cardinal symptoms of ADHD. METHOD The study group comprised 182 children (mean age about 10 years), of whom 124 had ADHD and 58 had other clinical diagnosis of which 81% had ASD. RESULTS Only QbTest parameters for inattention and hyperactivity differentiated between ADHD and other clinical diagnoses at the p ≤ .01 level, not for measures of impulsivity. Sensitivity ranged from 47% to 67% and specificity from 72% to 84%. Positive predictive value ranged from 41% to 86%, and negative predictive value from 43% to 86%. Area under the curve varied from .70 to .80. CONCLUSION The ability of the individual QbTest parameters to identify ADHD was moderate. The test's ability to discriminate between ADHD subtypes was unsatisfactory.
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Emser TS, Johnston BA, Steele JD, Kooij S, Thorell L, Christiansen H. Assessing ADHD symptoms in children and adults: evaluating the role of objective measures. Behav Brain Funct 2018; 14:11. [PMID: 29776429 PMCID: PMC5960089 DOI: 10.1186/s12993-018-0143-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 05/07/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diagnostic guidelines recommend using a variety of methods to assess and diagnose ADHD. Applying subjective measures always incorporates risks such as informant biases or large differences between ratings obtained from diverse sources. Furthermore, it has been demonstrated that ratings and tests seem to assess somewhat different constructs. The use of objective measures might thus yield valuable information for diagnosing ADHD. This study aims at evaluating the role of objective measures when trying to distinguish between individuals with ADHD and controls. Our sample consisted of children (n = 60) and adults (n = 76) diagnosed with ADHD and matched controls who completed self- and observer ratings as well as objective tasks. Diagnosis was primarily based on clinical interviews. A popular pattern recognition approach, support vector machines, was used to predict the diagnosis. RESULTS We observed relatively high accuracy of 79% (adults) and 78% (children) applying solely objective measures. Predicting an ADHD diagnosis using both subjective and objective measures exceeded the accuracy of objective measures for both adults (89.5%) and children (86.7%), with the subjective variables proving to be the most relevant. CONCLUSIONS We argue that objective measures are more robust against rater bias and errors inherent in subjective measures and may be more replicable. Considering the high accuracy of objective measures only, we found in our study, we think that they should be incorporated in diagnostic procedures for assessing ADHD.
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Affiliation(s)
- Theresa S Emser
- Clinical Child and Adolescent Psychology, Department of Psychology, Philipps University Marburg, Gutenbergstr. 18, 35037, Marburg, Germany. .,Clinic for Child and Adolescent Psychiatry, University Clinic Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany.
| | - Blair A Johnston
- Division of Neuroscience, Medical Research Institute, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, UK
| | - J Douglas Steele
- School of Medicine (Neuroscience), University of Dundee, Dundee, DD1 9SY, UK
| | - Sandra Kooij
- PsyQ, Psycho-medical Programs, Expertise Center Adult ADHD, Jan van Nassaustraat 125, 2596 BS, The Hague, The Netherlands
| | - Lisa Thorell
- Department of Clinical Neuroscience, Karolinska Institutet, Tomtebodavägen 18A, 5th floor, 171 77, Stockholm, Sweden
| | - Hanna Christiansen
- Clinical Child and Adolescent Psychology, Department of Psychology, Philipps University Marburg, Gutenbergstr. 18, 35037, Marburg, Germany
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Chen K, Didsbury M, van Zwieten A, Howell M, Kim S, Tong A, Howard K, Nassar N, Barton B, Lah S, Lorenzo J, Strippoli G, Palmer S, Teixeira-Pinto A, Mackie F, McTaggart S, Walker A, Kara T, Craig JC, Wong G. Neurocognitive and Educational Outcomes in Children and Adolescents with CKD: A Systematic Review and Meta-Analysis. Clin J Am Soc Nephrol 2018; 13:387-397. [PMID: 29472306 PMCID: PMC5967677 DOI: 10.2215/cjn.09650917] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 12/11/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Poor cognition can affect educational attainment, but the extent of neurocognitive impairment in children with CKD is not well understood. This systematic review assessed global and domain-specific cognition and academic skills in children with CKD and whether these outcomes varied with CKD stage. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Electronic databases were searched for observational studies of children with CKD ages 21 years old or younger that assessed neurocognitive or educational outcomes. Risk of bias was assessed using a modified Newcastle-Ottawa scale. We used random effects models and expressed the estimates as mean differences with 95% confidence intervals stratified by CKD stage. RESULTS Thirty-four studies (25 cross-sectional, n=2095; nine cohort, n=991) were included. The overall risk of bias was high because of selection and measurement biases. The global cognition (full-scale intelligence quotient) of children with CKD was classified as low average. Compared with the general population, the mean differences (95% confidence intervals) in full-scale intelligence quotient were -10.5 (95% confidence interval, -13.2 to -7.72; all CKD stages, n=758), -9.39 (95% confidence interval, -12.6 to -6.18; mild to moderate stage CKD, n=582), -16.2 (95% confidence interval, -33.2 to 0.86; dialysis, n=23), and -11.2 (95% confidence interval, -17.8 to -4.50; transplant, n=153). Direct comparisons showed that children with mild to moderate stage CKD and kidney transplants scored 11.2 (95% confidence interval, 2.98 to 19.4) and 10.1 (95% confidence interval, -1.81 to 22.0) full-scale intelligence quotient points higher than children on dialysis. Children with CKD also had lower scores than the general population in executive function and memory (verbal and visual) domains. Compared with children without CKD, the mean differences in academic skills (n=518) ranged from -15.7 to -1.22 for mathematics, from -9.04 to -0.17 for reading, and from -14.2 to 2.53 for spelling. CONCLUSIONS Children with CKD may have low-average cognition compared with the general population, with mild deficits observed across academic skills, executive function, and visual and verbal memory. Limited evidence suggests that children on dialysis may be at greatest risk compared with children with mild to moderate stage CKD and transplant recipients.
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Affiliation(s)
- Kerry Chen
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
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Fuermaier ABM, Fricke JA, de Vries SM, Tucha L, Tucha O. Neuropsychological assessment of adults with ADHD: A Delphi consensus study. APPLIED NEUROPSYCHOLOGY-ADULT 2018; 26:340-354. [DOI: 10.1080/23279095.2018.1429441] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Anselm B. M. Fuermaier
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Jan A. Fricke
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Stefanie M. de Vries
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Lara Tucha
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Oliver Tucha
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
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Willard VW, Conklin HM, Huang L, Zhang H, Kahalley LS. Concordance of parent-, teacher- and self-report ratings on the Conners 3 in adolescent survivors of cancer. Psychol Assess 2017; 28:1110-8. [PMID: 27537005 DOI: 10.1037/pas0000265] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Survivors of childhood cancer are at risk for attention problems. The objectives of this study were to assess concordance between parent-, teacher-, and self-report ratings on a measure of attention (Conners Rating Scales, 3rd ed.; Conners, 2008) in adolescent survivors of childhood cancer and to examine associations with a performance-based task. The Conners 3 was completed by 80 survivors of pediatric cancer (39 brain tumor, 41 acute lymphoblastic leukemia; ages 12–17; at least 1 year posttreatment; 51.3% male) as well as their parents and 1 teacher. In addition, survivors completed a continuous performance test. Parents and teachers demonstrated moderate agreement on most subscales; however, agreement was weaker than would be expected based on the normative sample. Agreement between self- and proxy ratings was more variable. The strongest associations for all raters were observed on the Learning Problems subscale. There were significant mean differences between parent and teacher ratings, with parents reporting more problems across subscales. Only self-ratings of Inattention were significantly associated with the continuous performance test (omission errors). Agreement across raters in assessment of attentional functioning in adolescent survivors of childhood cancer is modest. Findings support the need to obtain multiple ratings of behavior, including both proxy- and self-report, when assessing youth with cancer, particularly adolescents.
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Affiliation(s)
| | | | - Lu Huang
- Department of Biostatistics, St. Jude Children's Research Hospital
| | - Hui Zhang
- Department of Biostatistics, St. Jude Children's Research Hospital
| | - Lisa S Kahalley
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine
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Ebert KD. Convergence between parent report and direct assessment of language and attention in culturally and linguistically diverse children. PLoS One 2017; 12:e0180598. [PMID: 28683131 PMCID: PMC5500341 DOI: 10.1371/journal.pone.0180598] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/16/2017] [Indexed: 11/23/2022] Open
Abstract
Parent report is commonly used to assess language and attention in children for research and clinical purposes. It is therefore important to understand the convergent validity of parent-report tools in comparison to direct assessments of language and attention. In particular, cultural and linguistic background may influence this convergence. In this study a group of six- to eight-year old children (N = 110) completed direct assessments of language and attention and their parents reported on the same areas. Convergence between assessment types was explored using correlations. Possible influences of ethnicity (Hispanic or non-Hispanic) and of parent report language (English or Spanish) were explored using hierarchical linear regression. Correlations between parent report and direct child assessments were significant for both language and attention, suggesting convergence between assessment types. Ethnicity and parent report language did not moderate the relationships between direct child assessments and parent report tools for either attention or language.
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Affiliation(s)
- Kerry Danahy Ebert
- Department of Communication Disorders & Sciences, College of Health Sciences, Rush University, Chicago, IL, United States of America
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Tandon M, Pergjika A. Attention Deficit Hyperactivity Disorder in Preschool-Age Children. Child Adolesc Psychiatr Clin N Am 2017; 26:523-538. [PMID: 28577607 DOI: 10.1016/j.chc.2017.02.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Attention deficit hyperactivity disorder is a neurodevelopmental disorder marked by age-inappropriate deficits in attention or hyperactivity/impulsivity that interfere with functioning or development. It is highly correlated with other disorders, such as oppositional defiant disorder, conduct disorder, and mood symptoms. The etiology is multifactorial, and neuroimaging findings are nonspecific. Although assessment tools exist, there is variability among them, and historically, parent-teacher agreement has not been consistent. Treatment algorithm for attention deficit hyperactivity disorder in preschoolers includes behavioral interventions first followed by psychopharmacologic treatment when behavioral therapies fail. Other nonpharmacologic and nonbehavioral interventions are discussed including the role of exercise and nutrition.
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Affiliation(s)
- Mini Tandon
- Division of Child and Adolescent Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8134, St Louis, MO 63110, USA
| | - Alba Pergjika
- Division of Child and Adolescent Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8134, St Louis, MO 63110, USA.
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Polymorphisms of STS gene and SULT2A1 gene and neurosteroid levels in Han Chinese boys with attention-deficit/hyperactivity disorder: an exploratory investigation. Sci Rep 2017; 7:45595. [PMID: 28367959 PMCID: PMC5377367 DOI: 10.1038/srep45595] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 02/28/2017] [Indexed: 11/16/2022] Open
Abstract
This study examined the relationships among polymorphisms of the STS gene and SULT2A1 gene, dehydroepiandrosterone (DHEA) and its sulfated form (DHEA-S), and characteristics of attention-deficit/hyperactivity disorder (ADHD). We used cheek swabs to obtain the genomic DNA of 200 ADHD male probands (mean age: 8.7 years), 192 patients’ mothers and 157 patients’ fathers. Three SNPs in the STS gene (rs6639786, rs2270112, and rs17268988) and one SNP in the SULT2A1 gene (rs182420) were genotyped. Saliva samples were collected from the ADHD patients to analyze DHEA and DHEA-S levels. The behavioral symptoms were evaluated with the Swanson, Nolan, and Pelham, and Version IV Scale for ADHD (SNAP-IV), and the neuropsychological function was assessed using the Conners’ Continuous Performance Tests (CPT). We found the C allele of rs2270112 within the STS gene to be over-transmitted in males with ADHD. Polymorphisms of rs182420 within the SULT2A1 gene were not associated with ADHD. In addition, the C allele carriers of rs2270112 demonstrated significantly higher DHEA-S levels than the G allele carriers. Levels of DHEA were positively correlated with attention as measured by the CPT. These findings support a potential role in the underlying biological pathogenesis of ADHD with regard to STS polymorphisms and neurosteroid levels.
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The risk of misdiagnosing posture weakness as hyperactivity in ADHD: a case study. ACTA ACUST UNITED AC 2017; 9:239-251. [DOI: 10.1007/s12402-017-0221-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 02/04/2017] [Indexed: 10/20/2022]
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Abstract
PURPOSE To further characterize Attention-Deficit/Hyperactivity Disorder (ADHD) in a clinic-referred sample of youth with epilepsy. METHODS Children and adolescents with epilepsy who were referred for comprehensive neuropsychological evaluation comprised the sample. Data were obtained via archival record review. Youth with epilepsy were grouped according to ADHD diagnosis (no ADHD, ADHD - Combined Type, and ADHD - Predominantly Inattentive Type) and compared for a number of neurocognitive variables, seizure-related variables, and parent and teacher completed behavior rating scale variables. Data was examined via analysis of variance and logistic regression models with post hoc pairwise comparisons, employing Tukey procedure where appropriate. RESULTS Youth in this clinical case series (N = 204) demonstrated a high rate of ADHD diagnosis. ADHD - Combined Type was identified with slightly greater frequency than ADHD - Predominantly Inattentive Type. Age of seizure onset, seizure classification, and seizure frequency did not differ significantly between the groups. The groups also did not differ on most cognitive variables examined. Significant group differences were found for parent and teacher completed behavior rating scales assessing inattention, hyperactivity, and executive dysfunction. CONCLUSION Screening for ADHD in youth with epilepsy is important as these symptoms can significantly interfere with rehabilitative efforts. Behavior rating scales may be the most efficient and cost effective way to identify ADHD in youth with epilepsy.
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Affiliation(s)
- Mary C Kral
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Michelle D Lally
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Andrea D Boan
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.,Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
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Christiansen H. Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung über die Lebensspanne. VERHALTENSTHERAPIE 2016. [DOI: 10.1159/000446337] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Bennett MR, Hatton S, Hermens DF, Lagopoulos J. Behavior, neuropsychology and fMRI. Prog Neurobiol 2016; 145-146:1-25. [PMID: 27393370 DOI: 10.1016/j.pneurobio.2016.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 06/14/2016] [Accepted: 07/03/2016] [Indexed: 11/19/2022]
Abstract
Cognitive neuroscientists in the late 20th century began the task of identifying the part(s) of the brain concerned with normal behavior as manifest in the psychological capacities as affective powers, reasoning, behaving purposively and the pursuit of goals, following introduction of the 'functional magnetic resonance imaging' (fMRI) method for identifying brain activity. For this research program to be successful two questions require satisfactory answers. First, as the fMRI method can currently only be used on stationary subjects, to what extent can neuropsychological tests applicable to such stationary subjects be correlated with normal behavior. Second, to what extent can correlations between the various neuropsychological tests on the one hand, and sites of brain activity determined with fMRI on the other, be regarded as established. The extent to which these questions have yet received satisfactory answers is reviewed, and suggestions made both for improving correlations of neuropsychological tests with behavior as well as with the results of fMRI-based observations.
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Affiliation(s)
- Maxwell R Bennett
- Brain & Mind Centre, University of Sydney, Camperdown, NSW 2050, Australia.
| | - Sean Hatton
- Brain & Mind Centre, University of Sydney, Camperdown, NSW 2050, Australia.
| | - Daniel F Hermens
- Brain & Mind Centre, University of Sydney, Camperdown, NSW 2050, Australia.
| | - Jim Lagopoulos
- Brain & Mind Centre, University of Sydney, Camperdown, NSW 2050, Australia; Sunshine Coast Mind and Neuroscience - Thompson Institute, Birtinya, QLD, Australia.
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Lundervold AJ, Stickert M, Hysing M, Sørensen L, Gillberg C, Posserud MB. Attention Deficits in Children With Combined Autism and ADHD: A CPT Study. J Atten Disord 2016; 20:599-609. [PMID: 22940852 DOI: 10.1177/1087054712453168] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To investigate characteristics of attention in children with the combination of autism spectrum disorder (ASD) and ADHD. METHOD Four groups of 8- to 10-year-old children were compared on the Conners' Continuous Performance Test-Second Edition (CCPT-II): (a) ASD + ADHD (n = 11), (b) ASD only (n = 9), (c) ADHD only (n = 38), and (d) no diagnosis (n = 134). RESULTS There was an overall effect of group on the Continuous Performance Test (CPT) index and measures of hit reaction time, accuracy, response style, variability, and consistency. The ASD + ADHD group, much like the ADHD only group, had a more risky response style, a higher variability, and a lower consistency than the ASD only group. The impact of intellectual function on CCPT-II performance was considerable in children within the ASD subgroups. CONCLUSION The findings underscore the importance of including measures of attention and intellectual function when assessing children with the combination of ASD and ADHD.
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Affiliation(s)
- Astri J Lundervold
- Department of Biological and Medical Psychology, University of Bergen, Norway Uni Research, Bergen, Norway K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, Bergen, Norway
| | - Marte Stickert
- Department of Biological and Medical Psychology, University of Bergen, Norway
| | - Mari Hysing
- Department of Biological and Medical Psychology, University of Bergen, Norway Uni Research, Bergen, Norway
| | - Lin Sørensen
- Department of Biological and Medical Psychology, University of Bergen, Norway K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, Bergen, Norway Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Christopher Gillberg
- Uni Research, Bergen, Norway Gillberg Neuropsychiatric Centre, University of Gothenburg, Sweden
| | - Maj-Britt Posserud
- Uni Research, Bergen, Norway Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
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