Intolerance of uncertainty in children with attention-deficit/hyperactivity disorder

Does intolerance of uncertainty predict child generalised anxiety? A longitudinal study

Intolerance of uncertainty (IU) is the tendency to find uncertainty distressing. IU is related to anxiety in adults and youth but it is unclear whether IU plays a maintenance or causal role, particularly across childhood. Our research examined whether: (1) IU is associated with generalised anxiety in preschool-aged children; (2) IU in preschool-aged children is associated with the trajectory of generalised anxiety into middle childhood; and (3) IU is associated with the trajectory of internalising symptoms and externalising symptoms over time. Parents completed questionnaires (child anxiety, IU, internalising and externalising symptoms) about their children at three timepoints when their child was: 3-4 years old (n = 180); 5-7 years old (n = 162); and 8-10 years old (n = 148). Those with higher IU had higher concurrent generalised anxiety, internalising and externalising symptoms at each measurement point. Preschoolers with higher IU, relative to lower IU, had, on average, higher generalised anxiety across childhood. Unexpectedly though, children who were higher in IU as preschoolers were more likely to show a decrease in generalised anxiety over time. These findings indicate that IU is a consistent correlate of generalised anxiety, internalising and externalising symptoms, but that it may not play a causal role in the onset of generalised anxiety in children.

Thalamocortical dysrhythmia and reward deficiency syndrome as uncertainty disorders

A common anatomical core has been described for psychiatric disorders, consisting of the dorsal anterior cingulate cortex (dACC) and anterior insula, processing uncertainty. A common neurophysiological core has been described for other brain related disorders, called thalamocortical dysrhythmia (TCD), consisting of persistent cross-frequency coupling between low and high frequencies. And a common genetic core has been described for yet another set of hypodopaminergic pathologies called reward deficiency syndromes (RDS). Considering that some RDS have the neurophysiological features of TCD, it can be hypothesized that TCD and RDS have a common anatomical core, yet a differentiating associated neurophysiological mechanism. The EEGs of 683 subjects are analysed in source space for both differences and conjunction between TCD and healthy controls, RDS and healthy controls, and between TCD and RDS. A balance between current densities of the pregenual anterior cingulate cortex (pgACC) extending into the ventromedial prefrontal cortex (vmPFC) and dACC is calculated as well. TCD and RDS share a common anatomical and neurophysiological core, consisting of beta activity in the dACC and theta activity in dACC extending into precuneus and dorsolateral prefrontal cortex. TCD and RDS differ in pgACC/vmPFC activity and demonstrate an opposite balance between pgACC/vmPFC and dACC. Based on the Bayesian brain model TCD and RDS can be defined as uncertainty disorders in which the pgACC/vmPFC and dACC have an opposite balance, possibly explained by an inverted-U curve profile of both pgACC/vmPFC and dACC.

Associations between ADHD traits and self-reported strengths in the general population

BACKGROUND

ADHD research has had a clear focus on symptoms, their negative consequences and the treatment of ADHD. However, previous qualitative research found that people with a diagnosis of ADHD also self-report to experience strengths related to their ADHD. This is one of the first quantitative studies to investigate multiple self-reported strengths in relation to ADHD traits in a general population sample. Therefore, our aim was to investigate the relationship between multiple self-reported strengths with ADHD traits in the general population using quantitative measures.

METHODS

Our sample consisted of individuals from the general population in the UK, aged 18-60, n = 694. Next to assessing ADHD traits, we collected data on ten instruments investigating strengths that in qualitative research were reported to be related to ADHD. Correlation analysis (primary) was supplemented by factor and network analyses (exploratory).

RESULTS

We found positive correlations between ADHD traits and hyperfocus, sensory processing sensitivity, and cognitive flexibility.

CONCLUSIONS

People with more ADHD traits score higher on several strengths, for other strengths we were not able to show a positive correlation in this population-bases sample. Information on strengths may aid people with elevated ADHD traits cope with their condition, and has potential to provide new angles for treatment.

Exploring the Symptom Profiles of Intolerance of Uncertainty in Autistic Children

Intolerance of uncertainty (IU) is a multidimensional construct involving maladaptive responses to uncertainty. IU is strongly associated with autism and anxiety, yet no studies have examined its symptom profile in autistic children. This study compares IU symptom profiles in autistic and NT children and in autistic children with and without anxiety using the Intolerance of Uncertainty Scale for Children. Compared to NT peers, autistic children exhibited heightened IU symptoms in all domains, affective, behavioral, and cognitive; affective symptoms had the highest association with autism. Autistic children with anxiety also exhibited elevated IU symptoms in all domains compared to those without anxiety; behavioral IU symptoms had the highest association with anxiety. IU symptom profiles should be considered in assessment and treatment.

The Effect of Spatial Uncertainty on Visual Search in Older School-Aged Children with and without ADHD

OBJECTIVE

Numerous studies support that simple visual search tests may not be sufficient to differentiate children with and without attention-deficit/hyperactivity disorder (ADHD), especially for older school-aged children. This study aimed to explore whether the high spatial uncertainty visual search tasks can effectively discriminate older school-aged children with ADHD from their typically developing (TD) peers.

METHOD

In a randomized, two-period crossover design, 122 school-aged children (61 ADHD and 61 TD subjects), aged 10-12 years old, were measured using comparable visual search tasks with structured and unstructured layouts.

RESULTS

First, the discriminant effectiveness of unstructured visual search tasks, which are associated with high-level spatial uncertainty, is superior to structured ones. Second, combining accuracy and speed into a Q score is a more sensitive measure than accuracy or time calculated alone in visual search tasks. A more in-depth ROC analysis showed that all variables could accurately identify ADHD from their TD peers under unstructured visual search tasks, with the index of the Q score performing best (AUR = 0.956). Third, the development of detectability, which represents the ability to distinguish between target and non-target, is approaching maturity in 10-12-year-old children with ADHD. However, these children showed severe deficits in dealing with disorganized distractors when performing visual search tasks with high-level spatial uncertainty.

CONCLUSIONS

The findings of this study support that older school-aged children with ADHD demonstrate less efficient search performance than their TD peers in complex/difficult visual search tasks, especially under higher spatial uncertainty.

Altered interaction of physiological activity and behavior affects risky decision-making in ADHD

Background

Adult attention-deficit/hyperactivity disorder (ADHD) is often associated with risky decision-making behavior. However, current research studies are often limited by the ability to adequately reflect daily behavior in a laboratory setting. Over the lifespan impairments in cognitive functions appear to improve, whereas affective functions become more severe. We assume that risk behavior in ADHD arises predominantly from deficits in affective processes. This study will therefore aim to investigate whether a dysfunction in affective pathways causes an abnormal risky decision-making (DM) behavior in adult ADHD.

Methods

Twenty-eight participants with ADHD and twenty-eight healthy controls completed a battery of questionnaires regarding clinical symptoms, self-assessment of behavior and emotional competence. Furthermore, skin conductance responses were measured during the performance in a modified version of the Balloon Analogue Risk Task. A linear mixed-effects model analysis was used to analyze emotional arousal prior to a decision and after feedback display.

Results

Results showed higher emotional arousal in ADHD participants before decision-making (β = -0.12, SE = 0.05, t = -2.63, p < 0.001) and after feedback display (β = -0.14, SE = 0.05, t = -2.66, p = 0.008). Although risky behavior was greater in HC than in ADHD, we found a significant interaction effect of group and anticipatory skin conductance responses regarding the response behavior (β = 107.17, SE = 41.91, t = 2.56, p = 0.011). Post hoc analyses revealed a positive correlation between anticipatory skin conductance responses and reaction time in HC, whereas this correlation was negative in ADHD. Self-assessment results were in line with the objective measurements.

Conclusion

We found altered changes in physiological activity during a risky decision-making task. The results confirm the assumption of an aberrant relationship between bodily response and risky behavior in adult ADHD. However, further research is needed with respect to age and gender when considering physiological activities.

Elements That Influence the Development of Attention Deficit Hyperactivity Disorder (ADHD) in Children

Various factors may have a role in the development of attention deficit hyperactivity disorder (ADHD). Although the specific pathophysiology of this disease is still not entirely understood, it is believed to be caused by a mix of genetic, maternal, dietary, and environmental factors. The effect of these factors can determine the severity of ADHD; for example, some of them are dose-dependent, but there is a typical pattern that all are known to be associated with either early childhood exposure or maternal exposure during pregnancy. Some factors share a similar mechanism of affecting pathways and increasing the risk of ADHD. ADHD is not a disorder that can be detected before symptoms appear in a child, making it more challenging to anticipate even if a child has been exposed to a known trigger. Environmental pollutants were investigated, and it was shown that there was a link between ADHD in childhood and exposure to pollutants throughout childhood or during pregnancy. It is well known that maternal health is a significant factor in the unborn child's development in many health aspects. The central nervous system (CNS) is a primary system that can suffer irreversible damage from health conditions, stress, depression, or specific nutritional deficiency when the pregnant mother is subjected to these conditions. Even though numerous studies have been conducted to investigate the probable causes of ADHD, with some of them having robust findings, no conclusive explanation can be provided to identify a definitive cause or a risk factor.

Variables predicting the association between autistic traits and externalizing symptoms among young adults

Purpose

Considering the high comorbidity of autism spectrum disorder (ASD) with externalizing disorders and that ASD is considered as a continuum, which implies the identification of it features in the whole population, the purpose of this paper is to know the characteristics of the association of externalizing symptoms in the population with ASD traits.

Design/methodology/approach

One hundred and seventeen postsecondary students participated in the study, providing responses to a battery of self-reported tests.

Findings

The existence of a significant association between ASD and attention deficit hyperactivity disorder (ADHD) (0.519; p < 0.01) was proved. Regression analyses showed that problems in executive functioning, working memory deficits and difficulties in the use of emotion regulation strategies predicted the presence of ADHD traits (F = 36.757, R2 = 62.3%, p < 0. 01) and impulsivity behavior (F = 18.249, R2 = 45.1%, p < 0.01).

Research limitations/implications

Externalizing symptomatology in people with higher ASD traits is extended to the general population. Future research should study other problematic behaviors, such as aggression or self-harm, to continue generating appropriate interventions.

Originality/value

The results reported reinforce the study of ASD as a dimensional disorder, in line with the latest advances in the classification of psychopathology. Considering which variables are behind the problematic behaviors allows interventions to be focused on these factors, contributing to their reduction and to the improvement of professional practices.

Ventral Striatal Activation During Reward Anticipation of Different Reward Probabilities in Adolescents and Adults

Adolescence has been linked to an enhanced tolerance of uncertainty and risky behavior and is possibly connected to an increased response toward rewards. However, previous research has produced inconsistent findings. To investigate whether these findings are due to different reward probabilities used in the experimental design, we extended a monetary incentive delay (MID) task by including three different reward probabilities. Using functional magnetic resonance imaging, 25 healthy adolescents and 22 adults were studied during anticipation of rewards in the VS. Differently colored cue stimuli indicated either a monetary or verbal trial and symbolized different reward probabilities, to which the participants were blinded. Results demonstrated faster reaction times for lower reward probabilities (33%) in both age groups. Adolescents were slower through all conditions and had less activation on a neural level. Imaging results showed a three-way interaction between age group x condition x reward probability with differences in percent signal change between adolescents and adults for the high reward probabilities (66%, 88%) while adolescents demonstrated differences for the lowest (33%). Therefore, previous inconsistent findings could be due to different reward probabilities, which makes examining these crucial for a better understanding of adolescent and adult behavior.

How to Improve Behavioral Parent and Teacher Training for Children with ADHD: Integrating Empirical Research on Learning and Motivation into Treatment

Attention deficit hyperactivity disorder [ADHD] is one of the most common psychiatric disorders of childhood with poor prognosis if not treated effectively. Recommended psychosocial evidence-based treatment for preschool and school-aged children is behavioral parent and teacher training [BPT]. The core elements of BPT are instrumental learning principles, i.e., reinforcement of adaptive and the ignoring or punishment of non-adaptive behaviors together with stimulus control techniques. BPT is moderately effective in reducing oppositional behavior and improving parenting practices; however, it does not reduce blinded ratings of ADHD symptoms. Also after training effects dissipate. This practitioner review proposes steps that can be taken to improve BPT outcomes for ADHD, based on purported causal processes underlying ADHD. The focus is on altered motivational processes (reward and punishment sensitivity), as they closely link to the instrumental processes used in BPT. Following a critical analysis of current behavioral treatments for ADHD, we selectively review motivational reinforcement-based theories of ADHD, including the empirical evidence for the behavioral predictions arising from these theories. This includes consideration of children's emotional reactions to expected and unexpected outcomes. Next we translate this evidence into potential ADHD-specific adjustments designed to enhance the immediate and long-term effectiveness of BPT programs in addressing the needs of children with ADHD. This includes the use of remediation strategies for proposed deficits in learning not commonly used in BPT programs and cautions regarding the use of punishment. Finally, we address how these recommendations can be effectively transferred to clinical practice.

Functional connectivity of the anterior insula associated with intolerance of uncertainty in youth

Intolerance of uncertainty (IU) is a trait characteristic marked by distress in the face of insufficient information. Elevated IU has been implicated in the development and maintenance of anxiety disorders, particularly during adolescence, which is characterized by dramatic neural maturation and the onset of anxiety disorders. Previous task-based work implicates the bilateral anterior insula in IU. However, the association between anterior insula intrinsic functional connectivity (iFC) and IU has not been examined in adolescents. Fifty-eight healthy youth (mean age = 12.56; 55% boys) completed the Intolerance of Uncertainty Scale for Children (IUSC-12) and a 6-minute resting state fMRI scan. Group-level analyses were conducted using a random-effects, ordinary least-squares model, including IUSC-12 scores (Total, Inhibitory subscale, Prospective subscale), and three nuisance covariates (age, sex, and mean framewise displacement). IUSC-12 Inhibitory subscale scores were predictive of iFC between the left and right anterior insula and right prefrontal regions. IUSC-12 Prospective subscale scores significantly predicted iFC between the anterior insula and the anterior cingulate cortex. IUSC-12 total scores did not predict significant iFC of the bilateral anterior insula. Follow-up analyses, including anxiety (MASC Total Score) in the models, failed to find significant results. This could suggest that the associations found between IUSC-12 scores and anterior insula iFC are not unique to IU and, rather, reflect a broader anxiety-related connectivity pattern. Further studies with larger samples are needed to tease apart unique associations. These findings bear significance in contributing to the literature evaluating the neural correlates of risk factors for anxiety in youth.

The research domain criteria framework in drug discovery for neuropsychiatric diseases: focus on negative valence

Drug discovery, particularly in the field of central nervous system, has had very limited success in the last few decades. A likely contributor is the poor translation between preclinical and clinical phases. The Research Domain Criteria of the National Institutes of Mental Health is a framework which aims to identify new ways of classifying mental illnesses that are based on observable behaviour and neurobiological measures, and to provide a guiding and evolving framework to improve the translation from preclinical to clinical research. At the core of the Research Domain Criteria approach is the assumption that the dimensional constructs described can be assessed across different units of analysis, thus enabling a more precise quantitative understanding of their neurobiological underpinnings, increasing the likelihood of identifying new and effective therapeutic approaches. In the present review, we discuss how the Research Domain Criteria can be applied to drug discovery with the domain Negative Valence, construct Potential Threat (‘Anxiety’) as an example. We will discuss the evidence supporting the utility of the Research Domain Criteria approach and evaluate how close we are to achieving a common thread of translational research from gene to self-report.