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Levy O, Libman Hackmon S, Zvilichovsky Y, Korisky A, Bidet-Caulet A, Schweitzer JB, Zion Golumbic E. Selective attention and sensitivity to auditory disturbances in a virtually real classroom. eLife 2025; 13:RP103235. [PMID: 40354195 PMCID: PMC12068869 DOI: 10.7554/elife.103235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2025] Open
Abstract
Many people, and particularly individuals with attention deficit (hyperactivity) disorder (AD(H)D), find it difficult to maintain attention during classroom learning. However, traditional paradigms used to evaluate attention do not capture the complexity and dynamic nature of real-life classrooms. Using a novel virtual reality platform, coupled with measurement of neural activity, eye-gaze, and skin conductance, here we studied the neurophysiological manifestations of attention and distractibility, under realistic learning conditions. Individuals with AD(H)D exhibited higher neural responses to irrelevant sounds and reduced speech tracking of the teacher, relative to controls. Additional neurophysiological measures, such the power of alpha-oscillations and frequency of gaze-shifts away from the teacher, contributed to explaining variance in self-reported AD(H)D symptoms across the sample. These ecologically valid findings provide critical insight into the neurophysiological mechanisms underlying individual differences in the capacity for sustained attention and the proneness to distraction and mind-wandering, experienced in real-life situations.
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Affiliation(s)
- Orel Levy
- The Gonda Brain Research Center, Bar Ilan UniversityRamat GanIsrael
| | | | | | - Adi Korisky
- The Gonda Brain Research Center, Bar Ilan UniversityRamat GanIsrael
| | | | - Julie B Schweitzer
- Department of Psychiatry and Behavioral Sciences, University of California, DavisSacramentoUnited States
- MIND Institute, University of California, DavisSacramentoUnited States
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Dekkers TJ, Flisar A, Karami Motaghi A, Karl A, Frick MA, Boyer BE. Does Mind-Wandering Explain ADHD-Related Impairment in Adolescents? Child Psychiatry Hum Dev 2025; 56:346-357. [PMID: 37382726 PMCID: PMC11928403 DOI: 10.1007/s10578-023-01557-2] [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] [Accepted: 06/11/2023] [Indexed: 06/30/2023]
Abstract
Currently, diagnostic criteria for ADHD mainly reflect behavioral symptoms, neglecting internal phenomena like mind-wandering. Recent studies found that mind-wandering explains impairment beyond ADHD symptoms in adults. To better capture ADHD-related impairment in adolescents, we aimed to elucidate whether mind-wandering is associated with impairments that are prevalent in adolescents (i.e., risk-taking behavior, homework problems, emotional dysregulation, and general impairment) beyond ADHD symptoms. Furthermore, we sought to validate the Dutch translation of the Mind Excessively Wandering Scale (MEWS). We assessed a community sample of 626 adolescents on ADHD symptoms, mind-wandering, and the impairment domains. The Dutch MEWS had good psychometric properties. Mind-wandering was linked to general impairment and emotional dysregulation beyond ADHD symptoms, but was not linked to risk-taking behavior and homework problems beyond ADHD symptoms. Internal psychological phenomena such as mind-wandering may add to the behavioral symptoms of ADHD in explaining part of the impairment that adolescents with ADHD characteristics experience.
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Affiliation(s)
- Tycho J Dekkers
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands.
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
- Accare Child Study Center, Groningen, the Netherlands.
- Levvel, Academic Center for Child and Adolescent Psychiatry, Amsterdam, the Netherlands.
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center (AUMC), Amsterdam, the Netherlands.
| | - Ajda Flisar
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Alexandra Karl
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Matilda A Frick
- Department of Psychology, Stockholm University, Stockholm, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Bianca E Boyer
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
- Psychologenpraktijk Kuin, Haarlem, the Netherlands
- Department of Developmental and Educational Psychology, Leiden University, Leiden, the Netherlands
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Levy O, Hackmon SL, Zvilichovsky Y, Korisky A, Bidet-Caulet A, Schweitzer JB, Golumbic EZ. Selective attention and sensitivity to auditory disturbances in a virtually-real Classroom: Comparison of adults with and without AD(H)D. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2025:2024.04.17.590012. [PMID: 38659916 PMCID: PMC11042341 DOI: 10.1101/2024.04.17.590012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Many people, and particularly individuals with Attention Deficit (Hyperactivity) Disorder (AD(H)D), find it difficult to maintain attention during classroom learning. However, traditional paradigms used to evaluate attention do not capture the complexity and dynamic nature of real-life classrooms. Using a novel Virtual Reality platform, coupled with measurement of neural activity, eye-gaze and skin conductance, here we studied the neurophysiological manifestations of attention and distractibility, under realistic learning conditions. Individuals with AD(H)D exhibited higher neural responses to irrelevant sounds and reduced speech tracking of the teacher, relative to controls. Additional neurophysiological measures, such the power of alpha-oscillations and frequency of gaze-shifts away from the teacher, contributed to explaining variance in self-reported AD(H)D symptoms across the sample. These ecologically-valid findings provide critical insight into the neurophysiological mechanisms underlying individual differences in the capacity for sustained attention and the proneness to distraction and mind-wandering, experienced in real-life situations.
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Affiliation(s)
- Orel Levy
- The Gonda Brain Research Center, Bar Ilan University, Ramat Gan, Israel
| | | | - Yair Zvilichovsky
- The Gonda Brain Research Center, Bar Ilan University, Ramat Gan, Israel
| | - Adi Korisky
- The Gonda Brain Research Center, Bar Ilan University, Ramat Gan, Israel
| | | | - Julie B. Schweitzer
- Department of Psychiatry and Behavioral Sciences, Davis, Sacramento, CA U.S.A
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Hasan F, Shah HP, Kam JWY, Murias KR. Unraveling the relationship between executive function and mind wandering in childhood ADHD. Child Neuropsychol 2024:1-22. [PMID: 39639844 DOI: 10.1080/09297049.2024.2435545] [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: 06/05/2024] [Accepted: 11/22/2024] [Indexed: 12/07/2024]
Abstract
Attention Deficit/Hyperactivity Disorder (ADHD) is one of the most prevalent neurodevelopmental disorders in children. According to developmental literature findings, there is a link between executive function (EF) and ADHD. Although EF deficits vary across ADHD presentations in children, working memory capacity is commonly associated with attention impairments. Notably, deficits in working memory capacity are also observed in frequent mind wandering reports for typically developing children. Mind wandering is shifting attention away from a current task to an unrelated thought. To explore the relationship between EF and mind wandering in children with ADHD (n = 47) and further compare our current sample to a typically developing (control) group from a previous study (n = 47), all participants completed three EF-related tasks. They concurrently reported if they were on task or mind wandering. Our results indicate better short-term memory capacity predicted lower mind wandering frequency in children who reported high levels of ADHD symptoms. Similar trends were observed for working memory capacity and ADHD symptomatology. Children with ADHD also reported more overall and unintentional mind wandering on questionnaires compared to children without ADHD. However, the relationship between EF and mind wandering did not differ between these groups. The current study suggests memory-related cognitive abilities may inform our understanding and management of mind wandering in children, driving the development of interventions targeting attention regulation.
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Affiliation(s)
- Fiza Hasan
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Harshil P Shah
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Julia W Y Kam
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Kara R Murias
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Owerko Centre, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
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Isfandnia F, El Masri S, Radua J, Rubia K. The effects of chronic administration of stimulant and non-stimulant medications on executive functions in ADHD: A systematic review and meta-analysis. Neurosci Biobehav Rev 2024; 162:105703. [PMID: 38718988 DOI: 10.1016/j.neubiorev.2024.105703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/28/2024] [Accepted: 05/01/2024] [Indexed: 05/12/2024]
Abstract
Attention-Deficit/Hyperactivity Disorder (ADHD) is associated with executive function deficits that are improved with medications. However, meta-analyses of stimulant effects on cognition have mostly tested single-dose effects, and there is no meta-analysis of non-stimulant effects. This systematic review and meta-analysis tested the clinically more relevant longer-term effects of Methylphenidate (20 studies; minimum 1 week) and Atomoxetine (8 studies; minimum 3 weeks) on reaction time, attention, inhibition, and working memory, searching papers on PubMed, Embase, Ovid MEDLINE, and PsycINFO. The meta-analysis of 18 studies in 1667 subjects showed that methylphenidate was superior to placebo in all cognitive domains with small to medium effect sizes (Hedges g of 0.34-0.59). The meta-analysis of atomoxetine included 7 studies in 829 subjects and showed no effects in working memory, but superior effects in the other domains with medium to large effect sizes (Hedge's g of 0.36-0.64). Meta-regression analysis showed no drug differences on cognitive effects. The meta-analyses show for the first time that chronic Methylphenidate and Atomoxetine have comparable effects of improving executive functions in people with ADHD.
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Affiliation(s)
- Ferdous Isfandnia
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Sahid El Masri
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; Department of Child & Adolescent Psychiatry, University Hospital Carl Gustav Dresden, Dresden University of Technology, Germany.
| | - Joaquim Radua
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Katya Rubia
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; Department of Child & Adolescent Psychiatry, University Hospital Carl Gustav Dresden, Dresden University of Technology, Germany.
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Storebø OJ, Storm MRO, Pereira Ribeiro J, Skoog M, Groth C, Callesen HE, Schaug JP, Darling Rasmussen P, Huus CML, Zwi M, Kirubakaran R, Simonsen E, Gluud C. Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD). Cochrane Database Syst Rev 2023; 3:CD009885. [PMID: 36971690 PMCID: PMC10042435 DOI: 10.1002/14651858.cd009885.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed and treated psychiatric disorders in childhood. Typically, children and adolescents with ADHD find it difficult to pay attention and they are hyperactive and impulsive. Methylphenidate is the psychostimulant most often prescribed, but the evidence on benefits and harms is uncertain. This is an update of our comprehensive systematic review on benefits and harms published in 2015. OBJECTIVES To assess the beneficial and harmful effects of methylphenidate for children and adolescents with ADHD. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, three other databases and two trials registers up to March 2022. In addition, we checked reference lists and requested published and unpublished data from manufacturers of methylphenidate. SELECTION CRITERIA We included all randomised clinical trials (RCTs) comparing methylphenidate versus placebo or no intervention in children and adolescents aged 18 years and younger with a diagnosis of ADHD. The search was not limited by publication year or language, but trial inclusion required that 75% or more of participants had a normal intellectual quotient (IQ > 70). We assessed two primary outcomes, ADHD symptoms and serious adverse events, and three secondary outcomes, adverse events considered non-serious, general behaviour, and quality of life. DATA COLLECTION AND ANALYSIS Two review authors independently conducted data extraction and risk of bias assessment for each trial. Six review authors including two review authors from the original publication participated in the update in 2022. We used standard Cochrane methodological procedures. Data from parallel-group trials and first-period data from cross-over trials formed the basis of our primary analyses. We undertook separate analyses using end-of-last period data from cross-over trials. We used Trial Sequential Analyses (TSA) to control for type I (5%) and type II (20%) errors, and we assessed and downgraded evidence according to the GRADE approach. MAIN RESULTS We included 212 trials (16,302 participants randomised); 55 parallel-group trials (8104 participants randomised), and 156 cross-over trials (8033 participants randomised) as well as one trial with a parallel phase (114 participants randomised) and a cross-over phase (165 participants randomised). The mean age of participants was 9.8 years ranging from 3 to 18 years (two trials from 3 to 21 years). The male-female ratio was 3:1. Most trials were carried out in high-income countries, and 86/212 included trials (41%) were funded or partly funded by the pharmaceutical industry. Methylphenidate treatment duration ranged from 1 to 425 days, with a mean duration of 28.8 days. Trials compared methylphenidate with placebo (200 trials) and with no intervention (12 trials). Only 165/212 trials included usable data on one or more outcomes from 14,271 participants. Of the 212 trials, we assessed 191 at high risk of bias and 21 at low risk of bias. If, however, deblinding of methylphenidate due to typical adverse events is considered, then all 212 trials were at high risk of bias. PRIMARY OUTCOMES methylphenidate versus placebo or no intervention may improve teacher-rated ADHD symptoms (standardised mean difference (SMD) -0.74, 95% confidence interval (CI) -0.88 to -0.61; I² = 38%; 21 trials; 1728 participants; very low-certainty evidence). This corresponds to a mean difference (MD) of -10.58 (95% CI -12.58 to -8.72) on the ADHD Rating Scale (ADHD-RS; range 0 to 72 points). The minimal clinically relevant difference is considered to be a change of 6.6 points on the ADHD-RS. Methylphenidate may not affect serious adverse events (risk ratio (RR) 0.80, 95% CI 0.39 to 1.67; I² = 0%; 26 trials, 3673 participants; very low-certainty evidence). The TSA-adjusted intervention effect was RR 0.91 (CI 0.31 to 2.68). SECONDARY OUTCOMES methylphenidate may cause more adverse events considered non-serious versus placebo or no intervention (RR 1.23, 95% CI 1.11 to 1.37; I² = 72%; 35 trials 5342 participants; very low-certainty evidence). The TSA-adjusted intervention effect was RR 1.22 (CI 1.08 to 1.43). Methylphenidate may improve teacher-rated general behaviour versus placebo (SMD -0.62, 95% CI -0.91 to -0.33; I² = 68%; 7 trials 792 participants; very low-certainty evidence), but may not affect quality of life (SMD 0.40, 95% CI -0.03 to 0.83; I² = 81%; 4 trials, 608 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS The majority of our conclusions from the 2015 version of this review still apply. Our updated meta-analyses suggest that methylphenidate versus placebo or no-intervention may improve teacher-rated ADHD symptoms and general behaviour in children and adolescents with ADHD. There may be no effects on serious adverse events and quality of life. Methylphenidate may be associated with an increased risk of adverse events considered non-serious, such as sleep problems and decreased appetite. However, the certainty of the evidence for all outcomes is very low and therefore the true magnitude of effects remain unclear. Due to the frequency of non-serious adverse events associated with methylphenidate, the blinding of participants and outcome assessors is particularly challenging. To accommodate this challenge, an active placebo should be sought and utilised. It may be difficult to find such a drug, but identifying a substance that could mimic the easily recognised adverse effects of methylphenidate would avert the unblinding that detrimentally affects current randomised trials. Future systematic reviews should investigate the subgroups of patients with ADHD that may benefit most and least from methylphenidate. This could be done with individual participant data to investigate predictors and modifiers like age, comorbidity, and ADHD subtypes.
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Affiliation(s)
- Ole Jakob Storebø
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Child and Adolescent Psychiatric Department, Region Zealand, Roskilde, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | | | | | - Maria Skoog
- Clinical Study Support, Clinical Studies Sweden - Forum South, Lund, Sweden
| | - Camilla Groth
- Pediatric Department, Herlev University Hospital, Herlev, Denmark
| | | | | | | | | | - Morris Zwi
- Islington Child and Adolescent Mental Health Service, Whittington Health, London, UK
| | - Richard Kirubakaran
- Cochrane India-CMC Vellore Affiliate, Prof. BV Moses Centre for Evidence Informed Healthcare and Health Policy, Christian Medical College, Vellore, India
| | - Erik Simonsen
- Research Unit, Mental Health services, Region Zealand Psychiatry, Roskilde, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital ─ Rigshospitalet, Copenhagen, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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