Identification of biotypes in Attention-Deficit/Hyperactivity Disorder, a report from a randomized, controlled trial

Quantifying attention span across the lifespan

Introduction

Studies examining sustained attention abilities typically utilize metrics that quantify performance on vigilance tasks, such as response time and response time variability. However, approaches that assess the duration that an individual can maintain their attention over time are lacking.

Methods

Here we developed an objective attention span metric that quantified the maximum amount of time that a participant continuously maintained an optimal "in the zone" sustained attention state while performing a continuous performance task.

Results

In a population of 262 individuals aged 7-85, we showed that attention span was longer in young adults than in children and older adults. Furthermore, declines in attention span over time during task engagement were related to clinical symptoms of inattention in children.

Discussion

These results suggest that quantifying attention span is a unique and meaningful method of assessing sustained attention across the lifespan and in populations with inattention symptoms.

Behavioral and biologic characteristics of cancer-related cognitive impairment biotypes

Psychiatric diagnosis is moving away from symptom-based classification and towards multi-dimensional, biologically-based characterization, or biotyping. We previously identified three biotypes of chemotherapy-related cognitive impairment based on functional brain connectivity. In this follow-up study of 80 chemotherapy-treated breast cancer survivors and 80 non-cancer controls, we evaluated additional factors to help explain biotype expression: neurofunctional stability, brain age, apolipoprotein (APOE) genotype, and psychoneurologic symptoms. We also compared the discriminative ability of a traditional, symptom-based cognitive impairment definition with that of biotypes. We found significant differences in cortical brain age (F = 10.50, p < 0.001), neurofunctional stability (F = 2.83, p = 0.041), APOE e4 genotype (X2 = 7.68, p = 0.050), and psychoneurological symptoms (Pillai = 0.378, p < 0.001) across the three biotypes. The more resilient Biotype 2 demonstrated significantly higher neurofunctional stability compared to the other biotypes. Symptom-based classification of cognitive impairment did not differentiate biologic or other behavioral variables, suggesting that traditional categorization of cancer-related cognitive effects may miss important characteristics which could inform targeted treatment strategies. Additionally, biotyping, but not symptom-typing, was able to distinguish survivors with cognitive versus psychological effects. Our results suggest that Biotype 1 survivors might benefit from first addressing symptoms of anxiety and fatigue, Biotype 3 might benefit from a treatment plan which includes sleep hygiene, and Biotype 2 might benefit most from cognitive skills training or rehabilitation. Future research should include additional demographic and clinical information to further investigate biotype expression related to risk and resilience and examine integration of more clinically feasible imaging approaches.

Impulsivity Classification Using EEG Power and Explainable Machine Learning

Impulsivity is a multidimensional construct often associated with unfavorable outcomes. Previous studies have implicated several electroencephalography (EEG) indices to impulsiveness, but results are heterogeneous and inconsistent. Using a data-driven approach, we identified EEG power features for the prediction of self-reported impulsiveness. To this end, EEG signals of 56 individuals (18 low impulsive, 20 intermediate impulsive, 18 high impulsive) were recorded during a risk-taking task. Extracted EEG power features from 62 electrodes were fed into various machine learning classifiers to identify the most relevant band. Robustness of the classifier was varied by stratified [Formula: see text]-fold cross validation. Alpha and beta band power showed best performance in the classification of impulsiveness (accuracy = 95.18% and 95.11%, respectively) using a random forest classifier. Subsequently, a sequential bidirectional feature selection algorithm was used to estimate the most relevant electrode sites. Results show that as little as 10 electrodes are sufficient to reliably classify impulsiveness using alpha band power ([Formula: see text]-measure = 94.50%). Finally, the Shapley Additive exPlanations (SHAP) analysis approach was employed to reveal the individual EEG features that contributed most to the model's output. Results indicate that frontal as well as posterior midline alpha power seems to be of most importance for the classification of impulsiveness.

Toward Precision Medicine in ADHD

Attention-Deficit Hyperactivity Disorder (ADHD) is a complex and heterogeneous neurodevelopmental condition for which curative treatments are lacking. Whilst pharmacological treatments are generally effective and safe, there is considerable inter-individual variability among patients regarding treatment response, required dose, and tolerability. Many of the non-pharmacological treatments, which are preferred to drug-treatment by some patients, either lack efficacy for core symptoms or are associated with small effect sizes. No evidence-based decision tools are currently available to allocate pharmacological or psychosocial treatments based on the patient's clinical, environmental, cognitive, genetic, or biological characteristics. We systematically reviewed potential biomarkers that may help in diagnosing ADHD and/or stratifying ADHD into more homogeneous subgroups and/or predict clinical course, treatment response, and long-term outcome across the lifespan. Most work involved exploratory studies with cognitive, actigraphic and EEG diagnostic markers to predict ADHD, along with relatively few studies exploring markers to subtype ADHD and predict response to treatment. There is a critical need for multisite prospective carefully designed experimentally controlled or observational studies to identify biomarkers that index inter-individual variability and/or predict treatment response.