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Wiegers E, Garner A, Jusko M, Smith JN, Campez M, Greiner A, Gnagy E, Pelham WE, Raiker J. The Impact of Stimulant Medication on the Relation Between Working Memory and Activity Level in ADHD. Res Child Adolesc Psychopathol 2024:10.1007/s10802-024-01210-z. [PMID: 38836913 DOI: 10.1007/s10802-024-01210-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2024] [Indexed: 06/06/2024]
Abstract
There is a positive association between heightened activity levels and improved working memory performance (WM) in individuals with Attention-Deficit/Hyperactivity Disorder (ADHD). Recent research suggests that stimulant medications may have a simultaneous positive impact on WM and motor skills. Yet, it is unclear the specific connection between movement, WM, and stimulant use. We examined how visuospatial (VS) and phonological (PH) WM performance varied with children's stimulant medication usage and naturally occurring activity level. In a repeated measures design, children with ADHD (n = 43; 7-12 years old) completed WM tasks while wearing actigraphy watches to monitor activity level on and off stimulant medication. Significant large sized main effects were observed for medication condition on PH (p < .05, ηp2 = .14) and VS (p < .001, ηp2 = .30) WM. Activity level also had significant medium sized main effects on PH (p < .01, ηp2 = .09) and VS (p < .005, ηp2 = .10) WM. There was a significant medium sized interaction for VS WM (p < .005, ηp2 = .11), indicating that the effect of medication on performance was greatest in the highest activity level category. The findings suggest that a combination of stimulant medication and an "optimal" level of movement may be most effective for improving VS WM.
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Affiliation(s)
- Emily Wiegers
- Saint Louis University, Department of Psychology, St. Louis, MO, United States.
| | - Annie Garner
- Saint Louis University, Department of Psychology, St. Louis, MO, United States
| | - Morgan Jusko
- Florida International University, Department of Psychology, Miami, FL, United States
| | - Jessica N Smith
- Florida International University, Department of Psychology, Miami, FL, United States
| | - Mileini Campez
- Florida International University, Department of Psychology, Miami, FL, United States
| | - Andrew Greiner
- Florida International University, Department of Psychology, Miami, FL, United States
| | - Elizabeth Gnagy
- Florida International University, Department of Psychology, Miami, FL, United States
| | - William E Pelham
- Florida International University, Department of Psychology, Miami, FL, United States
| | - Joseph Raiker
- Florida International University, Department of Psychology, Miami, FL, United States
- Joon Health, Oakland, CA, United States
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Kofler MJ, Groves NB, Chan ESM, Marsh CL, Cole AM, Gaye F, Cibrian E, Tatsuki MO, Singh LJ. Working memory and inhibitory control deficits in children with ADHD: an experimental evaluation of competing model predictions. Front Psychiatry 2024; 15:1277583. [PMID: 38779551 PMCID: PMC11110569 DOI: 10.3389/fpsyt.2024.1277583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 03/07/2024] [Indexed: 05/25/2024] Open
Abstract
Introduction Children with ADHD demonstrate difficulties on many different neuropsychological tests. However, it remains unclear whether this pattern reflects a large number of distinct deficits or a small number of deficit(s) that broadly impact test performance. The current study is among the first experiments to systematically manipulate demands on both working memory and inhibition, with implications for competing conceptual models of ADHD pathogenesis. Method A clinically evaluated, carefully phenotyped sample of 110 children with ADHD, anxiety disorders, or co-occurring ADHD+anxiety (Mage=10.35, 44 girls; 69% White Not Hispanic/Latino) completed a counterbalanced, double dissociation experiment, with two tasks each per inhibition (low vs. high) x working memory (low vs. high) condition. Results Bayesian and frequentist models converged in indicating that both manipulations successfully increased demands on their target executive function (BF10>5.33x108, p<.001). Importantly, occupying children's limited capacity working memory system produced slower response times and reduced accuracy on inhibition tasks (BF10>317.42, p<.001, d=0.67-1.53). It also appeared to differentially reduce inhibition (and non-inhibition) accuracy for children with ADHD relative to children with anxiety (BF10=2.03, p=.02, d=0.50). In contrast, there was strong evidence against models that view working memory deficits as secondary outcomes of underlying inhibition deficits in ADHD (BF01=18.52, p=.85). Discussion This pattern indicates that working memory broadly affects children's ability to inhibit prepotent tendencies and maintain fast/accurate performance, and may explain the errors that children with ADHD make on inhibition tests. These findings are broadly consistent with models describing working memory as a causal mechanism that gives rise to secondary impairments. In contrast, these findings provide evidence against models that view disinhibition as a cause of working memory difficulties or view working memory as a non-causal correlate or epiphenomenon in ADHD.
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Affiliation(s)
- Michael J. Kofler
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Nicole B. Groves
- Department of Psychiatry, Seattle Children’s Hospital, Seattle, WA, United States
| | - Elizabeth S. M. Chan
- Graduate School of Applied and Professional Psychology, Rutgers University, New Brunswick, NJ, United States
| | - Carolyn L. Marsh
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Alissa M. Cole
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Fatou Gaye
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Enrique Cibrian
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Miho O. Tatsuki
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Leah J. Singh
- Department of Psychology, Florida State University, Tallahassee, FL, United States
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Friedman LM, Eckrich SJ, Rapport MD, Bohil CJ, Calub C. Working and short-term memory in children with ADHD: an examination of prefrontal cortical functioning using functional Near-Infrared Spectroscopy (fNIRS). Child Neuropsychol 2024; 30:462-485. [PMID: 37199502 DOI: 10.1080/09297049.2023.2213463] [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: 11/08/2022] [Accepted: 05/05/2023] [Indexed: 05/19/2023]
Abstract
Working memory impairments are an oft-reported deficit among children with ADHD, and complementary neuroimaging studies implicate reductions in prefrontal cortex (PFC) structure and function as a neurobiological explanation. Most imaging studies, however, rely on costly, movement-intolerant, and/or invasive methods to examine cortical differences. This is the first study to use a newer neuroimaging tool that overcomes these limitations, functional Near Infrared Spectroscopy (fNIRS), to investigate hypothesized prefrontal differences. Children (aged 8-12) with ADHD (N = 22) and typically developing (N = 18) children completed phonological working memory (PHWM) and short-term memory (PHSTM) tasks. Children with ADHD evinced poorer performance on both tasks, with greater differences observed in PHWM (Hedges' g = 0.67) relative to PHSTM (g = 0.39). fNIRS revealed reduced hemodynamic response among children with ADHD in the dorsolateral PFC while completing the PHWM task, but not within the anterior or posterior PFC. No between-group fNIRS differences were observed during the PHSTM task. Findings suggest that children with ADHD exhibit an inadequate hemodynamic response in a region of the brain that underlies PHWM abilities. The study also highlights the use of fNIRS as a cost-effective, noninvasive neuroimaging technique to localize/quantify neural activation patterns associated with executive functions.
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Affiliation(s)
| | - Samuel J Eckrich
- Department of Psychology, University of Central Florida, Orlando, FL, USA
- Department of Neuropsychology, Kennedy Krieger/Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mark D Rapport
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Corey J Bohil
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Catrina Calub
- Department of Psychiatry, University of California, Sacramento, CA, USA
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Bullard CC, Alderson RM, Roberts DK, Tatsuki MO, Sullivan MA, Kofler MJ. Social functioning in children with ADHD: an examination of inhibition, self-control, and working memory as potential mediators. Child Neuropsychol 2024:1-23. [PMID: 38269494 DOI: 10.1080/09297049.2024.2304375] [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: 04/18/2023] [Accepted: 11/24/2023] [Indexed: 01/26/2024]
Abstract
Children with attention-deficit/hyperactivity disorder (ADHD) experience a host of social problems, in addition to significant impairments in behavioral inhibition, working memory, and self-control. Behavioral inhibition and working memory difficulties have been linked with social functioning deficits, but to date, most studies have examined these neurocognitive problems either in isolation or as an aggregate measure in relation to social problems, and none has considered the role of self-control. Thus, it remains unclear whether all of these executive functions are linked with social problems or if the link can be more parsimoniously explained by construct overlap. Fifty-eight children with ADHD and 63 typically developing (TD) children completed tests assessing self-control, behavioral inhibition, and working memory; parents and teachers rated children's social functioning. Examination of potential indirect effects with the bootstrapping procedure indicated that working memory mediated the relation between group membership (ADHD, TD) and child social functioning based on teacher but not parent ratings. Behavioral inhibition and self-control did not have direct relations with either parent- or teacher-rated social functioning. These findings point to important differences regarding how executive functioning difficulties manifest at school compared to home, as well as the specific executive function components that predict ADHD-related social difficulties.
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Affiliation(s)
- Caitlin C Bullard
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - R Matt Alderson
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Delanie K Roberts
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
- Department of Psychology, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Miho O Tatsuki
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Maureen A Sullivan
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Michael J Kofler
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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Dipnall LM, Hourani D, Darling S, Anderson V, Sciberras E, Silk TJ. Fronto-parietal white matter microstructure associated with working memory performance in children with ADHD. Cortex 2023; 166:243-257. [PMID: 37406409 DOI: 10.1016/j.cortex.2023.03.015] [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: 12/01/2021] [Revised: 11/26/2022] [Accepted: 03/24/2023] [Indexed: 07/07/2023]
Abstract
INTRODUCTION Attention Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder with many functional impairments thought to be underpinned by difficulties in executive function domains such as working memory. The superior longitudinal fasciculus (SLF) plays an integral role in the development of working memory in neurotypical children. Neuroimaging research suggests reduced white matter organization of the SLF may contribute to working memory difficulties commonly seen in ADHD. This study aimed to examine the relationship between white matter organization of the SLF and working memory in children with ADHD. METHODS We examined the association of tract volume and apparent fibre density (AFD) of the SLF with working memory in children with ADHD (n = 64) and controls (n = 58) aged 9-11years. Children completed a computerized spatial n-back task and underwent diffusion magnetic resonance imaging (dMRI). Constrained spherical deconvolution-based tractography was used to construct the three branches of the SLF bilaterally and examine volume and AFD of the SLF. RESULTS Regression analyses revealed children with ADHD exhibited poorer working memory, and lower volume and AFD of the left SLF-II compared to healthy controls. There was also an association between reaction time and variability (RT and RT-V) and the left SLF-II. Further analyses revealed volume of the left SLF-II mediated the relationship between ADHD and working memory performance (RT and RT-V). DISCUSSION These findings add to the current body of ADHD literature, revealing the potential role of frontoparietal white matter in working memory difficulties in ADHD.
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Affiliation(s)
| | - Danah Hourani
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Simone Darling
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Australia; The Royal Children's Hospital, Melbourne, Australia
| | - Emma Sciberras
- School of Psychology, Deakin University, Geelong, Australia; Murdoch Children's Research Institute, Melbourne, Australia; The Royal Children's Hospital, Melbourne, Australia
| | - Timothy J Silk
- School of Psychology, Deakin University, Geelong, Australia; Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Australia
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A Cross-Sectional Study to Measure Physical Activity with Accelerometry in ADHD Children according to Presentations. CHILDREN (BASEL, SWITZERLAND) 2022; 10:children10010050. [PMID: 36670601 PMCID: PMC9856680 DOI: 10.3390/children10010050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022]
Abstract
(1) Background: Attention deficit hyperactivity disorder (ADHD) is a common mental disorder affecting 5-7% of school-aged children. Previous studies have looked at the effects of physical activity interventions on the symptoms of ADHD, although few have compared the motor behavior of children with ADHD versus those without. This exploratory study provides detailed information on the patterns and intensity of physical activity and sedentary behavior in children with ADHD as measured by Actigraph GT3X accelerometry, as well as the differences in physical activity in the different presentations of ADHD; (2) Methods: A cross-sectional design was used with a sample of 75 children, aged 6 to 12 years, with and without ADHD. The ADHD group had a previous diagnosis, determined by clinical assessment based on DSM-5 criteria; (3) Results: Physical activity levels were higher in children with ADHD compared to children without ADHD, but there was no difference in sedentary time between groups during weekdays or weekends. Physical activity decreased with age, with significant differences in the ADHD group, who exhibited more minutes of moderate Physical activity in 6-7 year-olds than 10-11 year-olds during weekdays and weekends; (4) Conclusions: Sedentary time increased by age in children without ADHD, and there was a decrease in moderate-intensity physical activity time in children with ADHD by age.
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Wang XQ, Albitos PJ, Hao YF, Zhang H, Yuan LX, Zang YF. A review of objective assessments for hyperactivity in attention deficit hyperactivity disorder. J Neurosci Methods 2022; 370:109479. [PMID: 35038458 DOI: 10.1016/j.jneumeth.2022.109479] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/06/2022] [Indexed: 11/26/2022]
Abstract
Hyperactivity is one of the three core symptoms of attention deficit hyperactivity disorder (ADHD) that is a common childhood mental disorder. Objective assessments of hyperactivity are seldom utilized compared with measures of inattention and impulsivity during clinical diagnosis and evaluation. Acceleration-sensitive devices (e.g., Actigraph) and motion tracking systems (e.g., QbTest) are two main groups of devices that can be used to objectively measure hyperactivity. The Actigraph and QbTest have good discriminant validity, convergent validity, and sensitivity to the effects of stimulants. Furthermore, the assessment setting (i.e., research laboratory, school, or home) can greatly influence the presence and severity of hyperactivity. Nevertheless, objective assessments for hyperactivity have poor ability to distinguish ADHD from other disorders, or among the three types of ADHD. Thus, further studies are needed to assess objective measurements of hyperactivity in terms of discriminant and convergent validity, test-retest reliability in different settings, and correlations with brain activity.
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Affiliation(s)
- Xiu-Qin Wang
- Institute of Psychological Sciences, Hangzhou Normal University, Hangzhou, China; Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China
| | - Princess Jane Albitos
- Institute of Psychological Sciences, Hangzhou Normal University, Hangzhou, China; Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China
| | - Yong-Fu Hao
- Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China
| | - Hang Zhang
- Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China
| | - Li-Xia Yuan
- Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China.
| | - Yu-Feng Zang
- Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China.
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8
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Groves NB, Chan ESM, Marsh CL, Gaye F, Jaisle EM, Kofler MJ. Does central executive training and/or inhibitory control training improve emotion regulation for children with attention-deficit/hyperactivity disorder? A randomized controlled trial. Front Psychiatry 2022; 13:1034722. [PMID: 36561637 PMCID: PMC9763728 DOI: 10.3389/fpsyt.2022.1034722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Approximately 48-54% of children with attention-deficit/hyperactivity disorder (ADHD) have impairing difficulties with emotion regulation, and these difficulties are not ameliorated by first-line ADHD treatments. Working memory and inhibitory control represent promising intervention targets given their functional, if not causal, links with ADHD-related emotion dysregulation. METHODS This preregistered randomized controlled trial tested whether two digital therapeutic training protocols that have been previously shown to improve working memory (Central Executive Training [CET]) and inhibitory control (Inhibitory Control Training [ICT]) can improve emotion regulation in a sample of 94 children with ADHD aged 8-13 years (M = 10.22, SD = 1.43; 76% White/non-Hispanic; 29 girls). RESULTS Results of Bayesian mixed model ANOVAs indicated both treatment groups demonstrated significant decreases in emotion dysregulation relative to pre-treatment at immediate post-treatment (parent report; d = 1.25, BF10 = 8.04 × 1013, p < 0.001), at 1-2 months after completing treatment (teacher report; d = 0.99, BF10 = 1.22 × 106, p < 0.001), and at 2-4-months follow-up (parent report; d = 1.22, BF10 = 1.15 × 1014, p < 0.001). Contrary to our hypotheses, the CET and ICT groups demonstrated equivalent reductions in emotion dysregulation and maintenance of effects. Exploratory analyses revealed that results were robust to control for informant expectancies, ADHD medication status/changes, in-person vs. at-home treatment, child age, and time from treatment completion to post-treatment ratings. DISCUSSION To determine whether working memory and inhibitory control are causally linked with ADHD-related emotion dysregulation, future studies should include active control conditions that do not train executive functions prior to making decisions about the clinical utility of CET/ICT for the treatment of emotion dysregulation in ADHD. CLINICAL TRIAL REGISTRATION [https://clinicaltrials.gov/], identifier [NCT03324464].
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Affiliation(s)
- Nicole B Groves
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Elizabeth S M Chan
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Carolyn L Marsh
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Fatou Gaye
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Emma M Jaisle
- Department of Psychology, Florida International University, Miami, FL, United States
| | - Michael J Kofler
- Department of Psychology, Florida State University, Tallahassee, FL, United States
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Burley DT, Anning KL, van Goozen SHM. The association between hyperactive behaviour and cognitive inhibition impairments in young children. Child Neuropsychol 2021; 28:302-317. [PMID: 34505554 DOI: 10.1080/09297049.2021.1976128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Hyperactivity is one of the core features of attention-deficit hyperactivity disorder (ADHD), and yet there is evidence that hyperactive behavior in children with ADHD is not ubiquitous and could be a compensatory response to high cognitive demands. No research has yet objectively measured hyperactive behavior in young children who are demonstrating early signs of ADHD or examined the role of emotional state on hyperactivity levels.The current study measured motor activity using actigraphy during baseline, cognitive inhibition (Flanker task), and emotion arousing (Impossibly Perfect Circles task) conditions in 95 children aged 4-7 years old with developmental difficulties, including emerging symptoms of ADHD. We examined the relationship between objectively recorded activity, parent-rated hyperactivity problems, using the Strengths and Difficulties Questionnaire (SDQ), and cognitive inhibition task performance.Parent ratings of hyperactivity (but not inattention) symptoms were positively related to recorded hyperactivity, and this relationship was specific to activity measured during the cognitive inhibition task. Impaired cognitive inhibition performance was related to increased measured movement and this association was strongest in children who were rated as having the highest levels of hyperactive behavior.These findings confirm theoretically predicted associations between objectively recorded hyperactivity and impaired executive functioning and support the notion that hyperactivity in children emerges in response to high cognitive demands. The results encourage further investigation into the role of hyperactivity as a transdiagnostic dimension that can explain variation within and between different types of diagnostic classifications.
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Affiliation(s)
| | - Kate L Anning
- School of Psychology, Cardiff University, Cardiff, UK
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10
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Tan TX, Liu Y, Damjanovic V, Ledford E, Li G, Li Y. Inattention, hyperactivity/impulsivity, and academic competence: Findings from three cohorts. BRITISH JOURNAL OF EDUCATIONAL PSYCHOLOGY 2021; 92:82-104. [PMID: 34184249 DOI: 10.1111/bjep.12439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 06/09/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Attention-deficit hyperactivity disorder (ADHD) is a risk for learning. Because ADHD commonly includes behaviours of inattention and behaviours of hyperactivity/impulsivity, how the two types of behaviours independently affect children's academic competence remains poorly understood. AIMS To investigate the impact of behaviours of inattention and behaviours of hyperactivity/impulsivity on Chinese students' academic competence. SAMPLES Parents of 167 preschoolers (Cohort 1), parents of 313 first graders (Cohort 2), and 1,003 high school students (Cohort 3). METHODS The ADHD-RS-IV Preschool version (Cohort 1), ADHD-RS-IV Home version (Cohort 2), and BASC-SRP (Cohort 3) were used to measure behaviours of inattention and hyperactivity/impulsivity. Academic competence was operationalized as school readiness (Cohort 1), math and language arts scores at two time points provided by school (Cohort 2), and self-reported academic performance (Cohort 3). Multiple regressions were performed to investigate the relationship between academic performance and behaviours of inattention alone (Step 1), and behaviours of hyperactivity/impulsivity alone (Step 2), and behaviours of inattention together with behaviours of hyperactivity/impulsivity (Step 3). RESULTS For each cohort, both types of behaviours were negatively correlated with academic competence. However, regression analyses showed that in Step 3, behaviours of hyperactivity/impulsivity either failed to predict academic competence or predicted better academic competence. Overall, behaviours of inattention alone accounted for a similar amount of variance in academic competence as did behaviours of inattention and hyperactivity/impulsivity combined. CONCLUSIONS Behaviours of inattention presented a risk for academic competence but the effect of behaviours of hyperactivity/impulsivity varied. Implications for instructional strategies for behaviours of inattention were discussed.
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Affiliation(s)
- Tony Xing Tan
- Department of Educational and Psychological Studies, College of Education, University of South Florida, Tampa, Florida, USA
| | - Yanhong Liu
- Department of Counseling & Human Services, School of Education, Syracuse University, New York, USA
| | - Victoria Damjanovic
- Department of Teaching and Learning, College of Education, University of South Florida, Tampa, Florida, USA
| | - Elyse Ledford
- Department of Teaching and Learning, College of Education, University of South Florida, Tampa, Florida, USA
| | - Gen Li
- Department of Educational and Psychological Studies, College of Education, University of South Florida, Tampa, Florida, USA
| | - Yanzheng Li
- Department of Sociology, College of Humanities and Laws, Hebei University of Science and Technology, Shijiazhuang, Hebei, China
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11
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Using Fidget Spinners to Improve On-Task Classroom Behavior for Students With ADHD. Behav Anal Pract 2021; 15:454-465. [DOI: 10.1007/s40617-021-00588-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 11/26/2022] Open
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12
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Vogt C. Clinical Conundrums When Integrating the QbTest into a Standard ADHD Assessment of Children and Young People. Neuropediatrics 2021; 52:155-162. [PMID: 33445192 DOI: 10.1055/s-0040-1722674] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The uptake of the QbTest in clinical practice is increasing and has recently been supported by research evidence proposing its effectiveness in relation to clinical decision-making. However, the exact underlying process leading to this clinical benefit is currently not well established and requires further clarification. For the clinician, certain challenges arise when adding the QbTest as a novel method to standard clinical practice, such as having the skills required to interpret neuropsychological test information and assess for diagnostically relevant neurocognitive domains that are related to attention-deficit hyperactivity disorder (ADHD), or how neurocognitive domains express themselves within the behavioral classifications of ADHD and how the quantitative measurement of activity in a laboratory setting compares with real-life (ecological validity) situations as well as the impact of comorbidity on test results. This article aims to address these clinical conundrums in aid of developing a consistent approach and future guidelines in clinical practice.
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Affiliation(s)
- Carsten Vogt
- Child and Adolescent Mental Health Services (CAMHS), Children Young People and Families Services (CYPF), Berkshire Healthcare NHS Foundation Trust, United Kingdom
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13
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Brandt V, Patalay P, Kerner Auch Koerner J. Predicting ADHD symptoms and diagnosis at age 14 from objective activity levels at age 7 in a large UK cohort. Eur Child Adolesc Psychiatry 2021; 30:877-884. [PMID: 32506264 PMCID: PMC8140967 DOI: 10.1007/s00787-020-01566-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 05/01/2020] [Indexed: 12/16/2022]
Abstract
Hyperactivity is one of the three core symptoms in children with attention deficit hyperactivity disorder (ADHD). Diagnosing ADHD typically involves self-report, third party report and observations. Objective activity data can make a valuable contribution to the diagnostic process. Small actigraphy studies in clinical samples have shown that children with ADHD move more than children without ADHD. However, differences in physical activity between children with and without ADHD have not been assessed in large community samples or longitudinally. This study used data from the Millennium Cohort Study to test whether symptoms of ADHD (parent-rating Strengths and Difficulties Questionnaire) and ADHD diagnosis at age 14 (reported by parents) could be predicted from objective activity data (measured with actigraphs) at age 7 in N = 6675 children (final N = 5251). Regressions showed that less sedentary behavior at age 7 predicted more ADHD symptoms at age 14 (β = - 0.002, CI - 0.004 to - 0.001). The result remained significant when controlled for ADHD symptoms at age 7, sex, BMI, month of birth, SES and ethnicity (β = - 0.001, CI - 0.003 to - 0.0003). ADHD diagnosis at age 14 was also significantly predicted by less sedentary behavior at age 7 (β = - 0.008). Our findings show that symptoms of ADHD can be predicted by objective activity data 5 years in advance and suggest that actigraphy could be a useful instrument aiding an ADHD diagnosis. Interestingly, the results indicate that the key difference between children with and without ADHD lies in reduced sedentary activity, i.e., times of rest.
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Affiliation(s)
- Valerie Brandt
- Department of Psychology, Center for Innovation in Mental Health, University of Southampton, Southampton, Hampshire, UK
| | - Praveetha Patalay
- Centre for Longitudinal Studies, Institute of Social Research, UCL, London, UK
- Faculty of Population Health Sciences, MRC Unit of Lifelong Health and Ageing, UCL, London, UK
| | - Julia Kerner Auch Koerner
- Educational Psychology, Helmut-Schmidt-University Hamburg, Holstenhofweg 85, 22043, Hamburg, Germany.
- Center for Individual Development and Adaptive Education of Children at Risk (IDeA), Frankfurt, Germany.
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14
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Kofler MJ, Wells EL, Singh LJ, Soto EF, Irwin LN, Groves NB, Chan ESM, Miller CE, Richmond KP, Schatschneider C, Lonigan CJ. A randomized controlled trial of central executive training (CET) versus inhibitory control training (ICT) for ADHD. J Consult Clin Psychol 2020; 88:738-756. [PMID: 32700955 DOI: 10.1037/ccp0000550] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Executive function deficits are well-established in ADHD. Unfortunately, replicated evidence indicates that executive function training for ADHD has been largely unsuccessful. We hypothesized that this may reflect insufficient targeting, such that extant protocols do not sufficiently and specifically target the neurocognitive systems associated with phenotypic ADHD behaviors/impairments. METHOD Children with ADHD ages 8-12 (M = 10.41, SD = 1.46; 12 girls; 74% Caucasian/Non-Hispanic) were randomized with allocation concealment to either central executive training (CET; n = 25) or newly developed inhibitory control training (ICT; n = 29). Detailed data analytic plans were preregistered. RESULTS Both treatments were feasible/acceptable based on training duration, child-reported ease of use, and parent-reported high satisfaction. CET was superior to ICT for improving its primary intervention targets: phonological and visuospatial working memory (d = 0.70-0.84). CET was also superior to ICT for improving go/no-go (d = 0.84) but not stop-signal inhibition. Mechanisms of change analyses indicated that CET-related working memory improvements produced significant reductions in the primary clinical endpoints (objectively assessed hyperactivity) during working memory and inhibition testing (indirect effects: β ≥ -.11; 95% CIs exclude 0.0). CET was also superior to ICT on 3 of 4 secondary clinical endpoints (blinded teacher-rated ADHD symptoms; d = 0.46-0.70 vs. 0.16-0.42) and 2 of 4 feasibility/acceptability clinical endpoints (parent-reported ADHD symptoms; d = 0.96-1.42 vs. 0.45-0.65). CET-related gains were maintained at 2-4 month follow-up; ICT-related gains were maintained for attention problems but not hyperactivity/impulsivity per parent report. CONCLUSIONS Results support the use of CET for treating executive function deficits and targeting ADHD behavioral symptoms in children with ADHD. Findings for ICT were mixed at best and indicate the need for continued development/study. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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15
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Fasmer OB, Fasmer EE, Mjeldheim K, Førland W, Syrstad VEG, Jakobsen P, Berle JØ, Henriksen TEG, Sepasdar Z, Hauge ER, Oedegaard KJ. Diurnal variation of motor activity in adult ADHD patients analyzed with methods from graph theory. PLoS One 2020; 15:e0241991. [PMID: 33166350 PMCID: PMC7652335 DOI: 10.1371/journal.pone.0241991] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/25/2020] [Indexed: 02/07/2023] Open
Abstract
Attention-deficit /hyperactivity disorder (ADHD) is a common neurodevelopmental syndrome characterized by age-inappropriate levels of motor activity, impulsivity and attention. The aim of the present study was to study diurnal variation of motor activity in adult ADHD patients, compared to healthy controls and clinical controls with mood and anxiety disorders. Wrist-worn actigraphs were used to record motor activity in a sample of 81 patients and 30 healthy controls. Time series from registrations in the morning and evening were analyzed using measures of variability, complexity and a newly developed method, the similarity algorithm, based on transforming time series into graphs. In healthy controls the evening registrations showed higher variability and lower complexity compared to morning registrations, however this was evident only in the female controls. In the two patient groups the same measures were not significantly different, with one exception, the graph measure bridges. This was the measure that most clearly separated morning and evening registrations and was significantly different both in healthy controls and in patients with a diagnosis of ADHD. These findings suggest that actigraph registrations, combined with mathematical methods based on graph theory, may be used to elucidate the mechanisms responsible for the diurnal regulation of motor activity.
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Affiliation(s)
- Ole Bernt Fasmer
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- * E-mail:
| | | | | | | | - Vigdis Elin Giæver Syrstad
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Petter Jakobsen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Jan Øystein Berle
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Tone E. G. Henriksen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Division of Mental Health Care, Valen Hospital, Fonna Local Health Authority, Valen, Norway
| | - Zahra Sepasdar
- School of Electrical and Computer Engineering, Shiraz University, Shiraz, Iran
| | - Erik R. Hauge
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Ketil J. Oedegaard
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
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16
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Irwin LN, Groves NB, Soto EF, Kofler MJ. Is There a Functional Relation Between Set Shifting and Hyperactivity in Children with Attention-Deficit/Hyperactivity Disorder (ADHD)? J Int Neuropsychol Soc 2020; 26:1019-1027. [PMID: 32456747 PMCID: PMC7658020 DOI: 10.1017/s1355617720000545] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Replicated evidence indicates that children with attention-deficit/hyperactivity disorder (ADHD) show disproportionate increases in hyperactivity/physical movement when their underdeveloped executive functions are taxed. However, our understanding of hyperactivity's relation with set shifting is limited, which is surprising given set shifting's importance as the third core executive function alongside working memory and inhibition. The aim of this study was to experimentally examine the effect of imposing set shifting and inhibition demands on objectively measured activity level in children with and without ADHD. METHOD The current study used a validated experimental manipulation to differentially evoke set shifting, inhibition, and general cognitive demands in a carefully phenotyped sample of children aged 8-13 years with ADHD (n = 43) and without ADHD (n = 34). Activity level was sampled during each task using multiple, high-precision actigraphs; total hyperactivity scores (THS) were calculated. RESULTS Results of the 2 × 5 Bayesian ANOVA for hyperactivity revealed strong support for a main effect of task (BF10 = 1.79 × 1018, p < .001, ω2 = .20), such that children upregulated their physical movement in response to general cognitive demands and set shifting demands specifically, but not in response to increased inhibition demands. Importantly, however, this manipulation did not disproportionally increase hyperactivity in ADHD as demonstrated by significant evidence against the task × group interaction (BF01 = 18.21, p = .48, ω2 = .002). CONCLUSIONS Inhibition demands do not cause children to upregulate their physical activity. Set shifting produces reliable increases in children's physical movement/hyperactivity over and above the effects of general cognitive demands but cannot specifically explain hyperactivity in children with ADHD.
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Affiliation(s)
| | | | - Elia F. Soto
- Florida State University, Department of Psychology
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17
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Dekkers TJ, Rapport MD, Calub CA, Eckrich SJ, Irurita C. ADHD and hyperactivity: The influence of cognitive processing demands on gross motor activity level in children. Child Neuropsychol 2020; 27:63-82. [PMID: 32662360 DOI: 10.1080/09297049.2020.1793924] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Excessive gross motor activity is a prominent feature of children with ADHD, and accruing evidence indicates that their gross motor activity is significantly higher in situations associated with high relative to low working memory processing demands. It remains unknown, however, whether children's gross motor activity rises to an absolute level or accelerates incrementally as a function of increasingly more difficult cognitive processing demands imposed on the limited capacity working memory (WM) system - a question of both theoretical and applied significance. The present investigation examined the activity level of 8- to 12-year-old children with ADHD (n = 36) and Typically Developing (TD) children (n = 24) during multiple experimental conditions: a control condition with no storage and negligible WM processing demands; a short-term memory (STM) storage condition; and a sequence of WM conditions that required both STM and incrementally more difficult higher-order cognitive processing. Relative to the control condition, all children, regardless of diagnostic status, exhibited higher levels of gross motor activity while engaged in WM tasks that required STM alone and STM combined with upper level cognitive processing demands, and children with ADHD were motorically more active under all WM conditions relative to TD children. The increase in activity as a consequence of cognitive demand was similar for all experimental conditions. Findings suggest that upregulation of physical movement rises and remains relatively stable to promote arousal related mechanisms when engaged in cognitive activities involving WM for all children, and to a greater extent for children with ADHD.
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Affiliation(s)
- Tycho J Dekkers
- Department of Psychology, University of Central Florida , Orlando, FL, USA.,Department of Psychology, University of Amsterdam , Amsterdam, The Netherlands.,Academic Center for Child and Adolescent Psychiatry, de Bascule , Amsterdam, The Netherlands.,Department of Child and Adolescent Psychiatry, Free University Medical Center, Amsterdam UMC , Amsterdam, The Netherlands
| | - Mark D Rapport
- Department of Psychology, University of Central Florida , Orlando, FL, USA
| | - Catrina A Calub
- Department of Psychology, University of Central Florida , Orlando, FL, USA
| | - Samuel J Eckrich
- Department of Psychology, University of Central Florida , Orlando, FL, USA
| | - Carolina Irurita
- Department of Psychology, University of Central Florida , Orlando, FL, USA
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18
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Executive Functioning and Activity in Children: a Multimethod Examination of Working Memory, Inhibition, and Hyperactivity. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 48:1143-1153. [PMID: 32557161 DOI: 10.1007/s10802-020-00665-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Two primary methods of quantifying executive functioning include self- or other-reports (i.e., questionnaire-based EF) and cognitive test performance (i.e., task-based EF). Despite their lack of concordance with one another and relatively inconsistent associations with attention-deficit/hyperactivity disorder (ADHD) symptoms, both approaches have been utilized in attempts to advance our understanding of the role of EF in symptoms of ADHD. The current study is the first to incorporate a direct assessment of behavior (i.e., actigraphy) to further clarify the relation between EF and hyperactivity using a multi-method approach in a sample of children with a range of ADHD symptoms. Fifty-two children between the ages of 8 and 12 completed a testing session during which performance on working memory and inhibition computerized tasks, as well as actigraphy data, were collected. Additionally, parent reports of hyperactivity/impulsivity, working memory, and inhibition were obtained. As expected, questionnaire-based measures of working memory and inhibition were strongly associated with parent-reported hyperactivity/impulsivity, whereas only the latter was associated significantly with mechanically assessed movement. In contrast, task-based working memory performance was more strongly associated with parent-reported hyperactivity/impulsivity relative to task-based inhibition. Further, both task-based working memory and task-based inhibition were similarly associated with mechanically-assessed movement. Finally, compared to questionnaire-based EF, both measures of task-based EF accounted for more variance in objectively-assessed movement. Collectively, these results highlight the measurement issues in the present literature, the importance of careful task and questionnaire design, and the value that alternative approaches (e.g., actigraphy) may provide with respect to advancing our understanding of EF.
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19
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Kofler MJ, Irwin LN, Soto EF, Groves NB, Harmon SL, Sarver DE. Executive Functioning Heterogeneity in Pediatric ADHD. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 47:273-286. [PMID: 29705926 DOI: 10.1007/s10802-018-0438-2] [Citation(s) in RCA: 114] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Neurocognitive heterogeneity is increasingly recognized as a valid phenomenon in ADHD, with most estimates suggesting that executive dysfunction is present in only about 33%-50% of these children. However, recent critiques question the veracity of these estimates because our understanding of executive functioning in ADHD is based, in large part, on data from single tasks developed to detect gross neurological impairment rather than the specific executive processes hypothesized to underlie the ADHD phenotype. The current study is the first to comprehensively assess heterogeneity in all three primary executive functions in ADHD using a criterion battery that includes multiple tests per construct (working memory, inhibitory control, set shifting). Children ages 8-13 (M = 10.37, SD = 1.39) with and without ADHD (N = 136; 64 girls; 62% Caucasian/Non-Hispanic) completed a counterbalanced series of executive function tests. Accounting for task unreliability, results indicated significantly improved sensitivity and specificity relative to prior estimates, with 89% of children with ADHD demonstrating objectively-defined impairment on at least one executive function (62% impaired working memory, 27% impaired inhibitory control, 38% impaired set shifting; 54% impaired on one executive function, 35% impaired on two or all three executive functions). Children with working memory deficits showed higher parent- and teacher-reported ADHD inattentive and hyperactive/impulsive symptoms (BF10 = 5.23 × 104), and were slightly younger (BF10 = 11.35) than children without working memory deficits. Children with vs. without set shifting or inhibitory control deficits did not differ on ADHD symptoms, age, gender, IQ, SES, or medication status. Taken together, these findings confirm that ADHD is characterized by neurocognitive heterogeneity, while suggesting that contemporary, cognitively-informed criteria may provide improved precision for identifying a smaller number of neuropsychologically-impaired subtypes than previously described.
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Affiliation(s)
- Michael J Kofler
- Department of Psychology, Florida State University, 1107 W. Call Street, Tallahassee, FL, 32306-4301, USA.
| | - Lauren N Irwin
- Department of Psychology, Florida State University, 1107 W. Call Street, Tallahassee, FL, 32306-4301, USA
| | - Elia F Soto
- Department of Psychology, Florida State University, 1107 W. Call Street, Tallahassee, FL, 32306-4301, USA
| | - Nicole B Groves
- Department of Psychology, Florida State University, 1107 W. Call Street, Tallahassee, FL, 32306-4301, USA
| | - Sherelle L Harmon
- Department of Psychology, Florida State University, 1107 W. Call Street, Tallahassee, FL, 32306-4301, USA
| | - Dustin E Sarver
- Departments of Pediatrics and Psychiatry, Center for Advancement of Youth, University of Mississippi Medical Center, Jackson, MS, USA
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20
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Kofler MJ, Groves NB, Singh LJ, Soto EF, Chan ESM, Irwin LN, Miller CE. Rethinking hyperactivity in pediatric ADHD: Preliminary evidence for a reconceptualization of hyperactivity/impulsivity from the perspective of informant perceptual processes. Psychol Assess 2020; 32:752-767. [PMID: 32478528 DOI: 10.1037/pas0000856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Hyperactivity is a core ADHD symptom that has been both positively and negatively associated with cognition and functional outcomes. The reason for these conflicting findings is unclear but may relate to subjective assessments that conflate excess physical movement (hyperactivity) with verbally intrusive/impulsive behaviors. The current study adopted a model-driven, rational-empirical approach to distinguish excess physical movement symptoms from other, auditorily perceived behaviors assessed under the "hyperactivity/impulsivity" umbrella. We then tested this alternative conceptualization's fit, reliability, replicability, convergent/divergent validity via actigraphy, and generalizability across informants (parents, teachers) in a well-characterized, clinically evaluated sample of 132 children ages 8-13 years (M = 10.34, SD = 1.51; 47 girls; 67% White/non-Hispanic). The current DSM hyperactivity/impulsivity item pool can be reliably reclassified by knowledgeable judges into items reflecting excess physical movement (visual hyperactivity) and auditory interruptions (verbal intrusion). This bifactor structure showed evidence for multidimensionality and superior model fit relative to traditional hyperactivity/impulsivity models. The resultant visual hyperactivity factor was reliable, replicable, and showed strong convergent validity evidence via associations with objectively assessed hyperactivity. The verbal intrusion factor also showed evidence for reliability and explained a substantive portion of reliable variance, but demonstrated lower estimated replicability. These findings provide preliminary support for conceptualizing ADHD symptoms from the perspective of their cognitive-perceptual impact on others, as well as differentiating excess physical movement (hyperactivity) from other behaviors assessed under the hyperactivity/impulsivity umbrella. "Verbal intrusion" appears to provide a better explanation than "impulsivity" for the reliable, non-hyperactivity variance assessed by these items, but the current item set appears insufficient for replicable measurement of this construct. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | | | - Leah J Singh
- Department of Psychology, Florida State University
| | - Elia F Soto
- Department of Psychology, Florida State University
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21
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Amado-Caballero P, Casaseca-de-la-Higuera P, Alberola-Lopez S, Andres-de-Llano JM, Villalobos JAL, Garmendia-Leiza JR, Alberola-Lopez C. Objective ADHD Diagnosis Using Convolutional Neural Networks Over Daily-Life Activity Records. IEEE J Biomed Health Inform 2020; 24:2690-2700. [PMID: 31905156 DOI: 10.1109/jbhi.2020.2964072] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Attention Deficit/Hyperactivity Disorder (ADHD) is the most common neurobehavioral disorder in children and adolescents. However, its etiology is still unknown, and this hinders the existence of reliable, fast and inexpensive standard diagnostic methods. OBJECTIVE This paper proposes an end-to-end methodology for automatic diagnosis of the combined type of ADHD. METHODS Diagnosis is based on the analysis of 24 hour-long activity records using Convolutional Neural Networks to classify spectrograms of activity windows. RESULTS We achieve up to [Formula: see text] average sensitivity, [Formula: see text] specificity and AUC values over [Formula: see text]. Overall, our figures overcome those obtained by actigraphy-based methods reported in the literature as well as others based on more expensive (and not so convenient) acquisition methods. CONCLUSION These results reinforce the idea that combining deep learning techniques together with actimetry can lead to a robust and efficient system for objective ADHD diagnosis. SIGNIFICANCE Reliance on simple activity measurements leads to an inexpensive and non-invasive objective diagn-ostic method, which can be easily implemented with daily devices.
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22
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Friedman LM, Rapport MD, Orban SA, Eckrich SJ, Calub CA. Applied Problem Solving in Children with ADHD: The Mediating Roles of Working Memory and Mathematical Calculation. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2019; 46:491-504. [PMID: 28597131 DOI: 10.1007/s10802-017-0312-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The difficulties children with ADHD experience solving applied math problems are well documented; however, the independent and/or interactive contributions of cognitive processes underlying these difficulties are not fully understood and warrant scrutiny. The current study examines two primary cognitive processes integral to children's ability to solve applied math problems: working memory (WM) and math calculation skills (i.e., the ability to utilize specific facts, skills, or processes related to basic math operations stored in long-term memory). Thirty-six boys with ADHD-combined presentation and 33 typically developing (TD) boys aged 8-12 years old were administered multiple counterbalanced tasks to assess upper (central executive [CE]) and lower level (phonological [PH STM] and visuospatial [VS STM] short-term memory) WM processes, and standardized measures of mathematical abilities. Bias-corrected, bootstrapped mediation analyses revealed that CE ability fully mediated between-group differences in applied problem solving whereas math calculation ability partially mediated the relation. Neither PH STM nor VS STM was a significant mediator. When modeled together via serial mediation analysis, CE in tandem with math calculation ability fully mediated the relation, explained 79% of the variance, and provided a more parsimonious explication of applied mathematical problem solving differences among children with ADHD. Results suggest that interventions designed to address applied math difficulties in children with ADHD will likely benefit from targeting basic knowledge of math facts and skills while simultaneously promoting the active interplay of these skills with CE processes.
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Affiliation(s)
- Lauren M Friedman
- Department of Psychology, University of Central Florida, 4111 Pictor Lane, Psychology Bldg 99, Orlando, FL, 32816, USA
| | - Mark D Rapport
- Department of Psychology, University of Central Florida, 4111 Pictor Lane, Psychology Bldg 99, Orlando, FL, 32816, USA.
| | - Sarah A Orban
- Department of Psychology, University of Central Florida, 4111 Pictor Lane, Psychology Bldg 99, Orlando, FL, 32816, USA
| | - Samuel J Eckrich
- Department of Psychology, University of Central Florida, 4111 Pictor Lane, Psychology Bldg 99, Orlando, FL, 32816, USA
| | - Catrina A Calub
- Department of Psychology, University of Central Florida, 4111 Pictor Lane, Psychology Bldg 99, Orlando, FL, 32816, USA
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23
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Inattentive Behavior in Boys with ADHD during Classroom Instruction: the Mediating Role of Working Memory Processes. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2019; 46:713-727. [PMID: 28825170 DOI: 10.1007/s10802-017-0338-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Children with ADHD exhibit clinically impairing inattentive behavior during classroom instruction and in other cognitively demanding contexts. However, there have been surprisingly few attempts to validate anecdotal parent/teacher reports of intact sustained attention during 'preferred' activities such as watching movies. The current investigation addresses this omission, and provides an initial test of how ADHD-related working memory deficits contribute to inattentive behavior during classroom instruction. Boys ages 8-12 (M = 9.62, SD = 1.22) with ADHD (n = 32) and typically developing boys (TD; n = 30) completed a counterbalanced series of working memory tests and watched two videos on separate assessment days: an analogue math instructional video, and a non-instructional video selected to match the content and cognitive demands of parent/teacher-described 'preferred' activities. Objective, reliable observations of attentive behavior revealed no between-group differences during the non-instructional video (d = -0.02), and attentive behavior during the non-instructional video was unrelated to all working memory variables (r = -0.11 to 0.19, ns). In contrast, the ADHD group showed disproportionate attentive behavior decrements during analogue classroom instruction (d = -0.71). Bias-corrected, bootstrapped, serial mediation revealed that 59% of this between-group difference was attributable to ADHD-related impairments in central executive working memory, both directly (ER = 41%) and indirectly via its role in coordinating phonological short-term memory (ER = 15%). Between-group attentive behavior differences were no longer detectable after accounting for ADHD-related working memory impairments (d = -0.29, ns). Results confirm anecdotal reports of intact sustained attention during activities that place minimal demands on working memory, and indicate that ADHD children's inattention during analogue classroom instruction is related, in large part, to their underdeveloped working memory abilities.
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24
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Time Effects on Resting EEG in Children With/Without AD/HD. Brain Topogr 2018; 32:286-294. [DOI: 10.1007/s10548-018-0690-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 11/27/2018] [Indexed: 11/26/2022]
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25
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Tarle SJ, Alderson RM, Patros CHG, Arrington EF, Roberts DK. Working memory and behavioral inhibition in children with attention-deficit/hyperactivity disorder (ADHD): an examination of varied central executive demands, construct overlap, and task impurity. Child Neuropsychol 2018; 25:664-687. [DOI: 10.1080/09297049.2018.1519068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Stephanie J. Tarle
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - R. Matt Alderson
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | | | | | - Delanie K. Roberts
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
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26
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Saudino KJ, Wang M, Flom M, Asherson P. Genetic and environmental links between motor activity level and attention problems in early childhood. Dev Sci 2018; 21:e12630. [PMID: 29119648 PMCID: PMC6693496 DOI: 10.1111/desc.12630] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 09/12/2017] [Indexed: 11/26/2022]
Abstract
Cross-lagged biometric models were used to examine genetic and environmental links between actigraph-assessed motor activity level (AL) and parent-rated attention problems (AP) in 314 same-sex twin pairs (MZ = 145, DZ = 169) at ages 2 and 3 years. At both ages, genetic correlations between AL and AP were moderate (ra2 = .35; ra3 = .39) indicating both overlap and specificity in genetic effects across the two domains. Within- and across-age phenotypic associations between AL and AP were entirely due to overlapping genetic influences. There was a unidirectional effect of AL at age 2 predicting later AP. For AP, genetic and environmental influences from age 2 were transmitted to age 3 via stability effects and from AL. For AL, across-age effects were transmitted only via stability. These results suggest that overactivity in late infancy may impact the later development of problems related to inattention, and that genetic factors explain the association between the two domains.
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Affiliation(s)
- Kimberly J. Saudino
- Department of Psychological and Brain Sciences, Boston University, 64 Cummington Mall, Boston, MA, 02215
| | - Manjie Wang
- Department of Psychological and Brain Sciences, Boston University, 64 Cummington Mall, Boston, MA, 02215
| | - Megan Flom
- Department of Psychological and Brain Sciences, Boston University, 64 Cummington Mall, Boston, MA, 02215
| | - Philip Asherson
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Kings College, London, SE5 8AF
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Working Memory and Motor Activity: A Comparison Across Attention-Deficit/Hyperactivity Disorder, Generalized Anxiety Disorder, and Healthy Control Groups. Behav Ther 2018; 49:419-434. [PMID: 29704970 DOI: 10.1016/j.beth.2017.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 08/28/2017] [Accepted: 08/30/2017] [Indexed: 11/20/2022]
Abstract
Converging findings from recent research suggest a functional relationship between attention-deficit/hyperactivity disorder (ADHD)-related hyperactivity and demands on working memory (WM) in both children and adults. Excessive motor activity such as restlessness and fidgeting are not pathognomonic symptoms of ADHD, however, and are often associated with other diagnoses such as generalized anxiety disorder (GAD). Further, previous research indicates that anticipatory processing associated with anxiety can directly interfere with storage and rehearsal processes of WM. The topographical similarity of excessive motor activity seen in both ADHD and anxiety disorders, as well as similar WM deficits, may indicate a common relationship between WM deficits and increased motor activity. The relationship between objectively measured motor activity (actigraphy) and PH and visuospatial WM demands in adults with ADHD (n = 21), adults with GAD (n = 21), and healthy control adults (n = 20) was examined. Although all groups exhibited significant increases in activity from control to WM conditions, the ADHD group exhibited a disproportionate increase in activity, while activity exhibited by the GAD and healthy control groups was not different. Findings indicate that ADHD-related hyperactivity is uniquely related to WM demands, and appear to suggest that adults with GAD are no more active relative to healthy control adults during a cognitively demanding laboratory task.
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28
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Leontyev A, Sun S, Wolfe M, Yamauchi T. Augmented Go/No-Go Task: Mouse Cursor Motion Measures Improve ADHD Symptom Assessment in Healthy College Students. Front Psychol 2018; 9:496. [PMID: 29695985 PMCID: PMC5905239 DOI: 10.3389/fpsyg.2018.00496] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 03/23/2018] [Indexed: 12/05/2022] Open
Abstract
Attention deficit/hyperactivity disorder (ADHD) is frequently characterized as a disorder of executive function (EF). However, behavioral tests of EF, such as go/No-go tasks, often fail to grasp the deficiency in EF revealed by questionnaire-based measures. This inability is usually attributed to questionnaires and behavioral tasks assessing different constructs of EFs. We propose an additional explanation for this discrepancy. We hypothesize that this problem stems from the lack of dynamic assessment of decision-making (e.g., continuous monitoring of motor behavior such as velocity and acceleration in choice reaching) in classical versions of behavioral tasks. We test this hypothesis by introducing dynamic assessment in the form of mouse motion in a go/No-go task. Our results indicate that, among healthy college students, self-report measures of ADHD symptoms become strongly associated with performance in behavioral tasks when continuous assessment (e.g., acceleration in the mouse-cursor motion) is introduced.
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Affiliation(s)
| | | | | | - Takashi Yamauchi
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, United States
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Friedman LM, Rapport MD, Raiker JS, Orban SA, Eckrich SJ. Reading Comprehension in Boys with ADHD: The Mediating Roles of Working Memory and Orthographic Conversion. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2017; 45:273-287. [PMID: 27356983 DOI: 10.1007/s10802-016-0171-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Reading comprehension difficulties in children with ADHD are well established; however, limited information exists concerning the cognitive mechanisms that contribute to these difficulties and the extent to which they interact with one another. The current study examines two broad cognitive processes known to be involved in children's reading comprehension abilities-(a) working memory (i.e., central executive processes [CE], phonological short-term memory [PH STM], and visuospatial short-term memory [VS STM]) and (b) orthographic conversion (i.e., conversion of visually presented text to a phonological code)-to elucidate their unique and interactive contribution to ADHD-related reading comprehension differences. Thirty-one boys with ADHD-combined type and 30 typically developing (TD) boys aged 8 to 12 years (M = 9.64, SD = 1.22) were administered multiple counterbalanced tasks assessing WM and orthographic conversion processes. Relative to TD boys, boys with ADHD exhibited significant deficits in PH STM (d = -0.70), VS STM (d = -0.92), CE (d = -1.58), and orthographic conversion (d = -0.93). Bias-corrected, bootstrapped mediation analyses revealed that CE and orthographic conversion processes modeled separately mediated ADHD-related reading comprehension differences partially, whereas PH STM and VS STM did not. CE and orthographic conversion modeled jointly mediated ADHD-related reading comprehension differences fully wherein orthographic conversion's large magnitude influence on reading comprehension occurred indirectly through CE's impact on the orthographic system. The findings suggest that adaptive cognitive interventions designed to improve reading-related outcomes in children with ADHD may benefit by including modules that train CE and orthographic conversion processes independently and interactively.
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Affiliation(s)
- Lauren M Friedman
- Department of Psychology, University of Central Florida, 4111 Pictor Lane Psychology Bldg 99, Orlando, FL, 32816, USA
| | - Mark D Rapport
- Department of Psychology, University of Central Florida, 4111 Pictor Lane Psychology Bldg 99, Orlando, FL, 32816, USA.
| | - Joseph S Raiker
- Department of Psychology, Florida International University, 11200 S.W. 8th St. AHC 1, Room 239, Miami, FL, 33199, USA
| | - Sarah A Orban
- Department of Psychology, University of Central Florida, 4111 Pictor Lane Psychology Bldg 99, Orlando, FL, 32816, USA
| | - Samuel J Eckrich
- Department of Psychology, University of Central Florida, 4111 Pictor Lane Psychology Bldg 99, Orlando, FL, 32816, USA
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Jiménez-Figueroa G, Ardila-Duarte C, Pineda DA, Acosta-López JE, Cervantes-Henríquez ML, Pineda-Alhucema W, Cervantes-Gutiérrez J, Quintero-Ibarra M, Sánchez-Rojas M, Vélez JI, Puentes-Rozo PJ. Prepotent response inhibition and reaction times in children with attention deficit/hyperactivity disorder from a Caribbean community. ACTA ACUST UNITED AC 2017; 9:199-211. [PMID: 28238028 DOI: 10.1007/s12402-017-0223-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 02/16/2017] [Indexed: 01/19/2023]
Abstract
Impairment in inhibitory control has been postulated as an underlying hallmark of attention deficit/hyperactivity disorder (ADHD), which can be utilized as a quantitative trait for genetic studies. Here, we evaluate whether inhibitory control, measured by simple automatized prepotent response (PR) inhibition variables, is a robust discriminant function for the diagnosis of ADHD in children and can be used as an endophenotype for future genetic studies. One hundred fifty-two school children (30.9% female, 67.8% with ADHD) were recruited. The ADHD checklist was used as the screening tool, whilst the DSM-IV Mini International Neuropsychiatry Interview, neurologic interview and neurologic examination, and the WISC III FSIQ test were administered as the gold standard procedure to assert ADHD diagnosis. A Go/No-Go task using a naturalistic and automatized visual signal was administered. A linear multifactor model (MANOVA) was fitted to compare groups including ADHD status, age, and gender as multiple independent factors. Linear discriminant analysis and the receiver operating characteristic curve were used to assess the predictive performance of PR inhibition variables for ADHD diagnosis. We found that four variables of prepotent response reaction time- and prepotent response inhibition established statistically significant differences between children with and without ADHD. Furthermore, these variables generated a strong discriminant function with a total classification capability of 73, 84% specificity, 68% sensitivity, and 90% positive predictive value for ADHD diagnosis, which support reaction times as a candidate endophenotype that could potentially be used in future ADHD genetic research.
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Affiliation(s)
- Giomar Jiménez-Figueroa
- Grupo de Neurociencias del Caribe, Laboratorio de Neurociencias Cognitivas, Unidad de Neurociencias Cognitivas, Universidad Simón Bolívar, Calle 54 # 59 -189, Sede 1, Bloque C, Barranquilla, Colombia
| | - Carlos Ardila-Duarte
- Grupo de Neurociencias del Caribe, Laboratorio de Neurociencias Cognitivas, Unidad de Neurociencias Cognitivas, Universidad Simón Bolívar, Calle 54 # 59 -189, Sede 1, Bloque C, Barranquilla, Colombia
| | - David A Pineda
- Neuroscience Research Group, University of Antioquia, Medellín, Colombia
- Neuropsychology and Conduct Research Group, University of Antioquia, Medellín, Colombia
| | - Johan E Acosta-López
- Grupo de Neurociencias del Caribe, Laboratorio de Neurociencias Cognitivas, Unidad de Neurociencias Cognitivas, Universidad Simón Bolívar, Calle 54 # 59 -189, Sede 1, Bloque C, Barranquilla, Colombia
| | - Martha L Cervantes-Henríquez
- Grupo de Neurociencias del Caribe, Laboratorio de Neurociencias Cognitivas, Unidad de Neurociencias Cognitivas, Universidad Simón Bolívar, Calle 54 # 59 -189, Sede 1, Bloque C, Barranquilla, Colombia
| | - Wilmar Pineda-Alhucema
- Grupo de Neurociencias del Caribe, Laboratorio de Neurociencias Cognitivas, Unidad de Neurociencias Cognitivas, Universidad Simón Bolívar, Calle 54 # 59 -189, Sede 1, Bloque C, Barranquilla, Colombia
| | - Jeimys Cervantes-Gutiérrez
- Grupo de Neurociencias del Caribe, Laboratorio de Neurociencias Cognitivas, Unidad de Neurociencias Cognitivas, Universidad Simón Bolívar, Calle 54 # 59 -189, Sede 1, Bloque C, Barranquilla, Colombia
| | - Marisol Quintero-Ibarra
- Grupo de Neurociencias del Caribe, Laboratorio de Neurociencias Cognitivas, Unidad de Neurociencias Cognitivas, Universidad Simón Bolívar, Calle 54 # 59 -189, Sede 1, Bloque C, Barranquilla, Colombia
| | - Manuel Sánchez-Rojas
- Grupo de Neurociencias del Caribe, Laboratorio de Neurociencias Cognitivas, Unidad de Neurociencias Cognitivas, Universidad Simón Bolívar, Calle 54 # 59 -189, Sede 1, Bloque C, Barranquilla, Colombia
| | - Jorge I Vélez
- Neuroscience Research Group, University of Antioquia, Medellín, Colombia
- Universidad del Norte, Barranquilla, Colombia
- Genomics and Predictive Medicine Group, John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia
| | - Pedro J Puentes-Rozo
- Grupo de Neurociencias del Caribe, Laboratorio de Neurociencias Cognitivas, Unidad de Neurociencias Cognitivas, Universidad Simón Bolívar, Calle 54 # 59 -189, Sede 1, Bloque C, Barranquilla, Colombia.
- Grupo de Neurociencias del Caribe, Universidad Simón Bolívar-Universidad del Atlántico, Barranquilla, Colombia.
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An evidenced-based perspective on the validity of attention-deficit/hyperactivity disorder in the context of high intelligence. Neurosci Biobehav Rev 2016; 71:21-47. [DOI: 10.1016/j.neubiorev.2016.08.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 06/14/2016] [Accepted: 08/27/2016] [Indexed: 01/22/2023]
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Azami S, Moghadas A, Sohrabi-Esmrood F, Nazifi M, Mirmohamad M, Hemmati F, Ahmadi A, Hamzeh-Poor P, Khari S, Lakes K. A pilot randomized controlled trial comparing computer-assisted cognitive rehabilitation, stimulant medication, and an active control in the treatment of ADHD. Child Adolesc Ment Health 2016; 21:217-224. [PMID: 32680341 DOI: 10.1111/camh.12157] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND This research aimed to compare computer-assisted cognitive rehabilitation (CACR) psychostimulants (MED) and placebo CACR (PCACR) in the treatment of ADHD using a multiarm parallel design. METHODS Thirty-four boys with ADHD, aged 7-12, were randomly assigned to either CACR (n = 12), MED (n = 11), or PCACR (n = 11). However, the study was not blinded and medication doses might be suboptimal given the lack of titration. Continuous performance test, Tower-of-London, forward/backward digit span, span board, Raven's progressive matrices, and SNAP-IV were completed at baseline, posttest, and follow-up. RESULTS Computer-assisted cognitive rehabilitation outperformed both MED and PCACR on backward digit span at posttest and PCACR at follow-up. CACR outperformed PCACR and MED on forward digit span at posttest and PCACR at follow-up. CACR outperformed MED on span board at posttest. CACR outperformed PCACR and MED on Raven's matrices at posttest. CACR and PCACR scored lower than MED on ADHD-PHI at posttest. CACR scored lower than MED on ADHD-C at posttest. CONCLUSIONS Immediately after interventions, CACR improved certain simple executive functions (EFs) as much as active stimulant medication. On complex EFs, CACR was superior to active stimulant medication and PCACR. CACR reduced behavioral symptoms of ADHD more than active stimulant medication. However, at 3-month follow-up, maintenance of the CACR gains was weak.
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Affiliation(s)
- Saeed Azami
- Department of Clinical and General Psychology, Allameh Tabatabai University, Tehran, Iran
| | - Alireza Moghadas
- Department of Clinical and General Psychology, Allameh Tabatabai University, Tehran, Iran
| | | | - Morteza Nazifi
- Department of Psychology, University of Bojnord, Bojnord, 9453155111, Iran
| | - Mahdieh Mirmohamad
- Institute for Brain and Cognitive Sciences, Shahid-Beheshti University, Tehran, Iran
| | - Fatemeh Hemmati
- Department of Psychology, Tarbiat Modares University, Tehran, Iran
| | - Ameneh Ahmadi
- Department of Clinical and General Psychology, Allameh Tabatabai University, Tehran, Iran
| | - Pariya Hamzeh-Poor
- Department of Clinical and General Psychology, Allameh Tabatabai University, Tehran, Iran
| | | | - Kimberley Lakes
- Department of Pediatrics, University of California, Irvine, CA, USA
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Patros CHG, Alderson RM, Hudec KL, Tarle SJ, Lea SE. Hyperactivity in boys with attention-deficit/hyperactivity disorder: The influence of underlying visuospatial working memory and self-control processes. J Exp Child Psychol 2016; 154:1-12. [PMID: 27776326 DOI: 10.1016/j.jecp.2016.09.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 09/26/2016] [Accepted: 09/27/2016] [Indexed: 10/20/2022]
Abstract
Changes in motor activity were examined across control and executive function (EF) tasks that differ with regard to demands placed on visuospatial working memory (VS-WM) and self-control processes. Motor activity was measured via actigraphy in 8- to 12-year-old boys with (n=15) and without (n=17) attention-deficit/hyperactivity disorder (ADHD) during the completion of VS-WM, self-control, and control tasks. Results indicated that boys with ADHD, relative to typically developing boys, exhibited greater motor activity across tasks, and both groups' activity was greater during EF tasks relative to control tasks. Lastly, VS-WM performance, relative to self-control performance, accounted for significantly more variance in activity across both VS-WM and self-control tasks. Collectively, findings suggest that ADHD-related hyperactivity is positively related to increased cognitive demands and appears to be better explained by deficient VS-WM rather than insufficient self-control.
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Affiliation(s)
- Connor H G Patros
- Department of Psychology, Oklahoma State University, Stillwater, OK 74078, USA
| | - R Matt Alderson
- Department of Psychology, Oklahoma State University, Stillwater, OK 74078, USA.
| | - Kristen L Hudec
- Department of Psychology, Oklahoma State University, Stillwater, OK 74078, USA
| | - Stephanie J Tarle
- Department of Psychology, Oklahoma State University, Stillwater, OK 74078, USA
| | - Sarah E Lea
- Department of Psychology, Oklahoma State University, Stillwater, OK 74078, USA
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Hall CL, Valentine AZ, Groom MJ, Walker GM, Sayal K, Daley D, Hollis C. The clinical utility of the continuous performance test and objective measures of activity for diagnosing and monitoring ADHD in children: a systematic review. Eur Child Adolesc Psychiatry 2016; 25:677-99. [PMID: 26620873 DOI: 10.1007/s00787-015-0798-x] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 11/14/2015] [Indexed: 11/25/2022]
Abstract
Attention-deficit hyperactivity disorder (ADHD) is typically diagnosed using clinical observation and subjective informant reports. Once children commence ADHD medication, robust monitoring is required to detect partial or non-responses. The extent to which neuropsychological continuous performance tests (CPTs) and objective measures of activity can clinically aid the assessment and titration process in ADHD is not fully understood. This review describes the current evidence base for the use of CPTs and objectively measured activity to support the diagnostic procedure and medication management for children with ADHD. Four databases (PsycINFO, Medline, Allied and Complementary Medicine (AMED), and PsycARTICLES) were systematically searched to understand the current evidence base for (1) the use of CPTs to aid clinical assessment of ADHD; (2) the use of CPTs to aid medication management; and (3) the clinical utility of objective measures of activity in ADHD. Sixty relevant articles were identified. The search revealed six commercially available CPTs that had been reported on for their clinical use. There were mixed findings with regard to the use of CPTs to assess and manage medication, with contrasting evidence on their ability to support clinical decision-making. There was a strong evidence base for the use of objective measures of activity to aid ADHD/non-ADHD group differentiation, which appears sensitive to medication effects and would also benefit from further research on their clinical utility. The findings suggest that combining CPTs and an objective measure of activity may be particularly useful as a clinical tool and worthy of further pursuit.
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Affiliation(s)
- Charlotte L Hall
- Division of Psychiatry and Applied Psychology, CLAHRC-EM, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK.
| | - Althea Z Valentine
- Division of Psychiatry and Applied Psychology, CLAHRC-EM, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
| | - Madeleine J Groom
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
| | - Gemma M Walker
- Division of Psychiatry and Applied Psychology, CLAHRC-EM, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
| | - Kapil Sayal
- Developmental Psychiatry, School of Medicine, University of Nottingham, Nottingham, UK
- Centre for ADHD and Neuro-developmental Disorders Across the Lifespan (CANDAL), Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
| | - David Daley
- Centre for ADHD and Neuro-developmental Disorders Across the Lifespan (CANDAL), Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Chris Hollis
- Division of Psychiatry and Applied Psychology, CLAHRC-EM, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
- Centre for ADHD and Neuro-developmental Disorders Across the Lifespan (CANDAL), University of Nottingham, Nottingham, UK
- MindTech, Developmental Psychiatry, Queen's Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
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Hyperactivity in Attention-Deficit/Hyperactivity Disorder (ADHD): Impairing Deficit or Compensatory Behavior? JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2016; 43:1219-32. [PMID: 25863472 DOI: 10.1007/s10802-015-0011-1] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Excess gross motor activity (hyperactivity) is considered a core diagnostic feature of childhood ADHD that impedes learning. This view has been challenged, however, by recent models that conceptualize excess motor activity as a compensatory mechanism that facilitates neurocognitive functioning in children with ADHD. The current study investigated competing model predictions regarding activity level's relation with working memory (WM) performance and attention in boys aged 8-12 years (M = 9.64, SD = 1.26) with ADHD (n = 29) and typically developing children (TD; n = 23). Children's phonological WM and attentive behavior were objectively assessed during four counterbalanced WM tasks administered across four separate sessions. These data were then sequenced hierarchically based on behavioral observations of each child's gross motor activity during each task. Analysis of the relations among intra-individual changes in observed activity level, attention, and performance revealed that higher rates of activity level predicted significantly better, but not normalized WM performance for children with ADHD. Conversely, higher rates of activity level predicted somewhat lower WM performance for TD children. Variations in movement did not predict changes in attention for either group. At the individual level, children with ADHD and TD children were more likely to be classified as reliably Improved and Deteriorated, respectively, when comparing their WM performance at their highest versus lowest observed activity level. These findings appear most consistent with models ascribing a functional role to hyperactivity in ADHD, with implications for selecting behavioral treatment targets to avoid overcorrecting gross motor activity during academic tasks that rely on phonological WM.
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Kofler MJ, Raiker JS, Sarver DE, Wells EL, Soto EF. Is hyperactivity ubiquitous in ADHD or dependent on environmental demands? Evidence from meta-analysis. Clin Psychol Rev 2016; 46:12-24. [PMID: 27131918 DOI: 10.1016/j.cpr.2016.04.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 03/22/2016] [Accepted: 04/11/2016] [Indexed: 12/20/2022]
Abstract
Hyperactivity, or excess gross motor activity, is considered a core and ubiquitous characteristic of ADHD. Alternate models question this premise, and propose that hyperactive behavior reflects, to a large extent, purposeful behavior to cope with environmental demands that interact with underlying neurobiological vulnerabilities. The present review critically evaluates the ubiquity and environmental modifiability of hyperactivity in ADHD through meta-analysis of 63 studies of mechanically measured activity level in children, adolescents, and adults with ADHD relative to typically developing groups. Random effects models corrected for publication bias confirmed elevated gross motor activity in ADHD (d=0.86); surprisingly, neither participant age (child vs. adult) nor the proportion of each ADHD sample diagnosed with the inattentive subtype/presentation moderated this effect. In contrast, activity level assessed during high cognitive load conditions in general (d=1.14) and high executive functioning demands in particular (d=1.39) revealed significantly higher effect sizes than activity level during low cognitive load (d=0.36) and in-class schoolwork (d=0.50) settings. Low stimulation environments, more rigorous diagnostic practices, actigraph measurement of movement frequency and intensity, and ADHD samples that included fewer females were also associated with larger effects. Overall, the results are inconsistent with DSM-5 and ADHD models that a) describe hyperactivity as ubiquitous behavior, b) predict a developmental decline in hyperactivity, or c) differentiate subtypes/presentations according to perceived differences in hyperactive behavior. Instead, results suggest that the presence and magnitude of hyperactive behavior in ADHD may be influenced to a considerable extent by environmental factors in general, and cognitive/executive functioning demands in particular.
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Affiliation(s)
- Michael J Kofler
- Florida State University, Department of Psychology, 1107 W. Call Street, Tallahassee, FL 32306-4301, United States.
| | - Joseph S Raiker
- Florida International University
- Department of Psychology Center for Children and Families 11200 SW 8th St.
- Miami, FL 33199, United States
| | - Dustin E Sarver
- University of Mississippi Medical CenterDepartment of Pediatrics, Division of Child Development Center for Advancement of Youth (CAY) 2500 North State Street Jackson, MS 39216, United States
| | - Erica L Wells
- Florida State University, Department of Psychology, 1107 W. Call Street, Tallahassee, FL 32306-4301, United States
| | - Elia F Soto
- Florida State University, Department of Psychology, 1107 W. Call Street, Tallahassee, FL 32306-4301, United States
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De Crescenzo F, Licchelli S, Ciabattini M, Menghini D, Armando M, Alfieri P, Mazzone L, Pontrelli G, Livadiotti S, Foti F, Quested D, Vicari S. The use of actigraphy in the monitoring of sleep and activity in ADHD: A meta-analysis. Sleep Med Rev 2016; 26:9-20. [DOI: 10.1016/j.smrv.2015.04.002] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 04/15/2015] [Accepted: 04/15/2015] [Indexed: 11/27/2022]
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Choice-impulsivity in children and adolescents with attention-deficit/hyperactivity disorder (ADHD): A meta-analytic review. Clin Psychol Rev 2016; 43:162-74. [DOI: 10.1016/j.cpr.2015.11.001] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 09/18/2015] [Accepted: 11/09/2015] [Indexed: 11/21/2022]
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Alderson RM, Patros CHG, Tarle SJ, Hudec KL, Kasper LJ, Lea SE. [Formula: see text]Working memory and behavioral inhibition in boys with ADHD: An experimental examination of competing models. Child Neuropsychol 2015; 23:255-272. [PMID: 26563880 DOI: 10.1080/09297049.2015.1105207] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Working memory (WM) and behavioral inhibition impairments have garnered significant attention as candidate core features, endophenotypes, and/or associated neurocognitive deficits of attention-deficit/hyperactivity disorder (ADHD). The relationship between ADHD-related WM and inhibition deficits remains relatively unclear, however, with inferences about the constructs' directional relationship stemming predominantly from correlational research. The current study utilized a dual-task paradigm to experimentally examine the relationship between ADHD-related WM and behavioral inhibition deficits. A total of 31 boys (15 ADHD and 16 typically developing [TD]) aged 8-12 years completed WM (1-back and 2-back), behavioral inhibition (stop-signal task [SST]), and dual-condition (1-back/SST and 2-back/SST) experimental tasks. Children with ADHD exhibited significant, large-magnitude WM deficits for the 1-back condition but were not significantly different from children in the TD group for the 2-back, 1-back/SST, and 2-back/SST conditions. Children with ADHD also exhibited significant inhibition deficits for the SST, 1-back/SST, and 2-back/SST conditions, but the within-group effect was not significant. The findings suggest that ADHD-related stop-signal demands are upstream, or compete for, resources involved in controlled-focused attention and/or other central executive (CE), WM processes.
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Affiliation(s)
- R Matt Alderson
- a Department of Psychology , Oklahoma State University , Stillwater , OK , USA
| | - Connor H G Patros
- a Department of Psychology , Oklahoma State University , Stillwater , OK , USA
| | - Stephanie J Tarle
- a Department of Psychology , Oklahoma State University , Stillwater , OK , USA
| | - Kristen L Hudec
- a Department of Psychology , Oklahoma State University , Stillwater , OK , USA
| | - Lisa J Kasper
- a Department of Psychology , Oklahoma State University , Stillwater , OK , USA
| | - Sarah E Lea
- a Department of Psychology , Oklahoma State University , Stillwater , OK , USA
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Fasmer OB, Mjeldheim K, Førland W, Hansen AL, Dilsaver S, Oedegaard KJ, Berle JØ. Motor Activity in Adult Patients with Attention Deficit Hyperactivity Disorder. Psychiatry Investig 2015; 12:474-82. [PMID: 26508958 PMCID: PMC4620304 DOI: 10.4306/pi.2015.12.4.474] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 03/18/2015] [Accepted: 03/18/2015] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Hyperactivity is a core symptom of attention-deficit hyperactivity disorder (ADHD), but limited information is available on analysis of activity patterns in this disorder. The aim of the study was to analyze motor activity during daily living in adult patients with ADHD. METHODS Patients (n=76) from the private psychiatric practice of two of the authors were recruited, and were compared to patients with other psychiatric disorders and to normal controls. Actigraphs were used to record motor activity for six days, with one minute intervals, and data were analysed using linear and non-linear mathematical methods. RESULTS For short recording periods (300 minutes) the activity levels of ADHD patients do not differ from normal controls, but the autocorrelation (lag 1) is lower and Fourier analysis shows higher power in the high frequency range, corresponding to the period from 2-8 min. During recordings for six days there are no significant differences between ADHD patients and the control groups. The combined and inattentive subgroups differ only in the six days recordings. The Fourier analyses show that the combined type has lower power in the high frequency range, corresponding to the period from 4-8 hours, and in the analysis of rhythms the intra-daily variability is lower, compared to the inattentive type. CONCLUSION Adult ADHD patients do not show evidence of hyperactivity, but have levels of activity similar to normal controls. However, on several measures ADHD patients display altered activity patterns, indicating that the regulation of motor activity in this disorder is different from controls.
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Affiliation(s)
- Ole Bernt Fasmer
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, Section for Psychiatry, University of Bergen, Bergen, Norway
- K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, Bergen, Norway
| | | | | | - Anita L. Hansen
- Department of Psychosocial Science, University of Bergen, Bergen, Norway/Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | | | - Ketil J. Oedegaard
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, Section for Psychiatry, University of Bergen, Bergen, Norway
- K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, Bergen, Norway
| | - Jan Øystein Berle
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
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Hudec KL, Alderson RM, Patros CHG, Lea SE, Tarle SJ, Kasper LJ. Hyperactivity in boys with attention-deficit/hyperactivity disorder (ADHD): The role of executive and non-executive functions. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 45-46:103-109. [PMID: 26232202 DOI: 10.1016/j.ridd.2015.07.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 07/01/2015] [Accepted: 07/13/2015] [Indexed: 06/04/2023]
Abstract
Motor activity of boys (age 8-12 years) with (n=19) and without (n=18) ADHD was objectively measured with actigraphy across experimental conditions that varied with regard to demands on executive functions. Activity exhibited during two n-back (1-back, 2-back) working memory tasks was compared to activity during a choice-reaction time (CRT) task that placed relatively fewer demands on executive processes and during a simple reaction time (SRT) task that required mostly automatic processing with minimal executive demands. Results indicated that children in the ADHD group exhibited greater activity compared to children in the non-ADHD group. Further, both groups exhibited the greatest activity during conditions with high working memory demands, followed by the reaction time and control task conditions, respectively. The findings indicate that large-magnitude increases in motor activity are predominantly associated with increased demands on working memory, though demands on non-executive processes are sufficient to elicit small to moderate increases in motor activity as well.
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Affiliation(s)
- Kristen L Hudec
- Department of Psychology, Oklahoma State University, United States
| | - R Matt Alderson
- Department of Psychology, Oklahoma State University, United States.
| | | | - Sarah E Lea
- Department of Psychology, Oklahoma State University, United States
| | | | - Lisa J Kasper
- Department of Psychology, Oklahoma State University, United States
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García Murillo L, Cortese S, Anderson D, Di Martino A, Castellanos FX. Locomotor activity measures in the diagnosis of attention deficit hyperactivity disorder: Meta-analyses and new findings. J Neurosci Methods 2015; 252:14-26. [PMID: 25770940 PMCID: PMC4522351 DOI: 10.1016/j.jneumeth.2015.03.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 02/19/2015] [Accepted: 03/02/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Our aim was to assess differences in movement measures in attention-deficit/hyperactivity disorder (ADHD) vs. typically developing (TD) controls. METHODS We performed meta-analyses of published studies on motion measures contrasting ADHD with controls. We also conducted a case-control study with children/adolescents (n = 61 TD, n = 62 ADHD) and adults (n = 30 TD, n = 19 ADHD) using the McLean motion activity test, semi-structured diagnostic interviews and the behavior rating inventory of executive function and Conners (parent, teacher; self) rating scales. RESULTS Meta-analyses revealed medium-to-large effect sizes for actigraph (standardized mean difference [SMD]: 0.64, 95% confidence interval (CI): 0.43, 0.85) and motion tracking systems (SDM: 0.92, 95% CI: 0.65, 1.20) measures in differentiating individuals with ADHD from controls. Effects sizes were similar in studies of children/adolescents ([SMD]: 0.75, 95% CI: 0.50, 1.01) and of adults ([SMD]: 0.73, 95% CI: 0.46, 1.00). In our sample, ADHD groups differed significantly in number of head movements (p = 0.02 in children; p = 0.002 in adults), displacement (p = 0.009/p < 0.001), head area (p = 0.03/p < 0.001), spatial complexity (p = 0.06/p = 0.02) and temporal scaling (p = 0.05/p = 0.04). Mean effect sizes were non-significantly larger (d = 0.83, 95% CI: 0.20, 1.45) in adults vs. children/adolescents with ADHD (d = 0.45, 95% CI: 0.08, 0.82). In the concurrent go/no-go task, reaction time variability was significantly greater in ADHD (p < 0.05 in both age groups) than controls. CONCLUSIONS Locomotor hyperactivity remains core to the construct of ADHD even in adults. Our results suggest that objective locomotion measures may be particularly useful in evaluating adults with possible ADHD.
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Affiliation(s)
| | - Samuele Cortese
- The Child Study Center at NYU Langone Medical Center, New York, USA; Developmental Brain-Behaviour Laboratory, Psychology, University of Southampton, UK; School of Medicine, University of Nottingham, UK; Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan, Institute of Mental Health, University of Nottingham, UK
| | - David Anderson
- The Child Study Center at NYU Langone Medical Center, New York, USA; Child Mind Institute, New York, NY, USA
| | | | - Francisco Xavier Castellanos
- The Child Study Center at NYU Langone Medical Center, New York, USA; Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA.
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Hartanto TA, Krafft CE, Iosif AM, Schweitzer JB. A trial-by-trial analysis reveals more intense physical activity is associated with better cognitive control performance in attention-deficit/hyperactivity disorder. Child Neuropsychol 2015; 22:618-26. [PMID: 26059476 DOI: 10.1080/09297049.2015.1044511] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Hyperactivity is a key symptom and the most observable manifestation of attention-deficit/hyperactivity disorder (ADHD). The over-activity associated with ADHD can cause specific challenges in academic settings, extracurricular activities and social relationships. Cognitive control challenges are also well established in ADHD. The current study included 44 children between the ages of 10 and 17 diagnosed with ADHD or who were typically developing (TD), all of whom had no psychiatric co-morbidity or significant learning disorders. Participants wore an actometer on their ankle while performing a flanker paradigm in order to objectively measure their rates of activity in association with cognitive control. Analyses assessed the relationship between frequency and intensity of activity to task accuracy on a trial-by-trial basis. A significant interaction effect between group and performance revealed that more intense movement was associated with better performance in the ADHD group but not in the TD group. The ADHD group demonstrated more intense activity than the TD group during correct (but not error) trials. Within-group, children with ADHD generated higher intensity movements in their correct trials compared to their error trials, whereas the TD group did not demonstrate any within-group differences. These findings suggest that excessive motoric activity associated with clinically significant ADHD symptoms may reflect compensatory efforts to modulate attention and alertness. Future research should systematically explore the relationship between motion in ADHD and how it might be used to improve cognitive performance.
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Affiliation(s)
- T A Hartanto
- a Department of Psychiatry and Behavioral Sciences and MIND Institute, Davis School of Medicine , University of California , Sacramento , USA
| | - C E Krafft
- a Department of Psychiatry and Behavioral Sciences and MIND Institute, Davis School of Medicine , University of California , Sacramento , USA
| | - A M Iosif
- a Department of Psychiatry and Behavioral Sciences and MIND Institute, Davis School of Medicine , University of California , Sacramento , USA
| | - J B Schweitzer
- a Department of Psychiatry and Behavioral Sciences and MIND Institute, Davis School of Medicine , University of California , Sacramento , USA
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Patros CHG, Alderson RM, Lea SE, Tarle SJ, Kasper LJ, Hudec KL. Visuospatial working memory underlies choice-impulsivity in boys with attention-deficit/hyperactivity disorder. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 38:134-144. [PMID: 25576877 DOI: 10.1016/j.ridd.2014.12.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 12/08/2014] [Accepted: 12/09/2014] [Indexed: 06/04/2023]
Abstract
The present study examined the directional relationship between choice-impulsivity and separate indices of phonological and visuospatial working memory performance in boys (aged 8-12 years) with (n=16) and without ADHD (n=19). Results indicated that high ratings of overall ADHD, inattention, and hyperactivity were significantly associated with increased impulsivity and poorer phonological and visuospatial working memory performance. Further, results from bias-corrected bootstrapped mediation analyses revealed a significant indirect effect of visuospatial working memory performance, through choice-impulsivity, on overall ADHD, inattention, and hyperactivity/impulsivity. Collectively, the findings suggest that deficits of visuospatial working memory underlie choice-impulsivity, which in turn contributes to the ADHD phenotype. Moreover, these findings are consistent with a growing body of literature that identifies working memory as a central neurocognitive deficit of ADHD.
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Affiliation(s)
- Connor H G Patros
- Department of Psychology, Oklahoma State University, 116 North Murray, Stillwater, OK 74078-3064, United States
| | - R Matt Alderson
- Department of Psychology, Oklahoma State University, 116 North Murray, Stillwater, OK 74078-3064, United States.
| | - Sarah E Lea
- Department of Psychology, Oklahoma State University, 116 North Murray, Stillwater, OK 74078-3064, United States
| | - Stephanie J Tarle
- Department of Psychology, Oklahoma State University, 116 North Murray, Stillwater, OK 74078-3064, United States
| | - Lisa J Kasper
- Department of Psychology, Oklahoma State University, 116 North Murray, Stillwater, OK 74078-3064, United States
| | - Kristen L Hudec
- Department of Psychology, Oklahoma State University, 116 North Murray, Stillwater, OK 74078-3064, United States
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Hudec KL, Alderson RM, Kasper LJ, Patros CHG. Working memory contributes to elevated motor activity in adults with ADHD: an examination of the role of central executive and storage/rehearsal processes. J Atten Disord 2014; 18:357-68. [PMID: 23900406 DOI: 10.1177/1087054713497398] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The relationship between working memory (WM) and objectively measured motor activity was examined in adults with ADHD and healthy controls (HCs). METHOD Thirty-five adults (ADHD = 20, HC = 15) were grouped using self-report and collateral-report measures in addition to a semistructured clinical interview. All participants completed control conditions with minimal WM demands, and separate phonological (PH) and visuospatial (VS) WM tasks with recall demands ranging from four to seven stimuli. RESULTS The ADHD group exhibited significantly more motor activity relative to the HC group, and both groups exhibited greater activity during PH and VS WM tasks, relative to control conditions. Finally, the central executive (CE) and PH storage/rehearsal subsystems were associated with large-magnitude between-group differences in activity. CONCLUSION Findings suggest that increased demands on WM, particularly the CE and PH storage/rehearsal, contribute to ADHD-related hyperactivity, though a portion of excessive motor activity in adults with ADHD may occur independently of WM demands.
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46
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Glass L, Graham DM, Deweese BN, Jones KL, Riley EP, Mattson SN. Correspondence of parent report and laboratory measures of inattention and hyperactivity in children with heavy prenatal alcohol exposure. Neurotoxicol Teratol 2014; 42:43-50. [PMID: 24512965 PMCID: PMC3989839 DOI: 10.1016/j.ntt.2014.01.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 12/20/2013] [Accepted: 01/29/2014] [Indexed: 11/29/2022]
Abstract
Clinical research and practice support a multi-method approach to validating behavioral problems in children. We examined whether parent-reported symptoms of hyperactivity and inattention (using the Disruptive Behavior Disorder Rating Scale) were substantiated by objective laboratory measures [hyperactivity measured by wrist-worn actigraphy (ACT) and inattention assessed using a 20-minute continuous performance task (CPT)] in three age- and demographically-matched groups of school-age children: children with prenatal alcohol exposure (AE), non-exposed children with idiopathic ADHD (ADHD), and controls (CON). Results indicated that the clinical groups (AE, ADHD) had significantly higher parent-reported levels for both domains compared to the CON group, and did not differ from each other. On the laboratory measures, the clinical groups were more inattentive than controls on the CPT, but did not differ from each other. In contrast, the ADHD group had higher objective activity on the ACT than AE and CON, which did not differ from each other. Thus, laboratory measures differentially validated parent reports in a group-dependent manner. Actigraphy substantiated parent-reported hyperactivity for children in the ADHD group but not for children in the AE group, while the CPT validated parent-reported inattention for both clinical groups. Although the majority of children in the AE group met the criteria for ADHD, objective activity levels were not different from controls, indicating that hyperactivity may be a less prominent feature in the AE group. Thus, while there is considerable overlap between the effects of prenatal alcohol exposure and ADHD, differences in behavioral profiles may be clinically useful in differential diagnosis. Further, these data indicate that objective measures should be used to validate parent reports.
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Affiliation(s)
- Leila Glass
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, 6330 Alvarado Court, Suite 100, San Diego, CA 92120, USA.
| | - Diana M Graham
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, 6330 Alvarado Court, Suite 100, San Diego, CA 92120, USA.
| | - Benjamin N Deweese
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, 6330 Alvarado Court, Suite 100, San Diego, CA 92120, USA.
| | - Kenneth Lyons Jones
- University of California, San Diego, School of Medicine, Department of Pediatrics, San Diego, CA 92093, USA.
| | - Edward P Riley
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, 6330 Alvarado Court, Suite 100, San Diego, CA 92120, USA.
| | - Sarah N Mattson
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, 6330 Alvarado Court, Suite 100, San Diego, CA 92120, USA.
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Rapport MD, Orban SA, Kofler MJ, Friedman LM. Do programs designed to train working memory, other executive functions, and attention benefit children with ADHD? A meta-analytic review of cognitive, academic, and behavioral outcomes. Clin Psychol Rev 2013; 33:1237-52. [PMID: 24120258 DOI: 10.1016/j.cpr.2013.08.005] [Citation(s) in RCA: 268] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 06/23/2013] [Accepted: 08/16/2013] [Indexed: 11/18/2022]
Abstract
Children with ADHD are characterized frequently as possessing underdeveloped executive functions and sustained attentional abilities, and recent commercial claims suggest that computer-based cognitive training can remediate these impairments and provide significant and lasting improvement in their attention, impulse control, social functioning, academic performance, and complex reasoning skills. The present review critically evaluates these claims through meta-analysis of 25 studies of facilitative intervention training (i.e., cognitive training) for children with ADHD. Random effects models corrected for publication bias and sampling error revealed that studies training short-term memory alone resulted in moderate magnitude improvements in short-term memory (d=0.63), whereas training attention did not significantly improve attention and training mixed executive functions did not significantly improve the targeted executive functions (both nonsignificant: 95% confidence intervals include 0.0). Far transfer effects of cognitive training on academic functioning, blinded ratings of behavior (both nonsignificant), and cognitive tests (d=0.14) were nonsignificant or negligible. Unblinded raters (d=0.48) reported significantly larger benefits relative to blinded raters and objective tests (both p<.05), indicating the likelihood of Hawthorne effects. Critical examination of training targets revealed incongruence with empirical evidence regarding the specific executive functions that are (a) most impaired in ADHD, and (b) functionally related to the behavioral and academic outcomes these training programs are intended to ameliorate. Collectively, meta-analytic results indicate that claims regarding the academic, behavioral, and cognitive benefits associated with extant cognitive training programs are unsupported in ADHD. The methodological limitations of the current evidence base, however, leave open the possibility that cognitive training techniques designed to improve empirically documented executive function deficits may benefit children with ADHD.
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Affiliation(s)
- Mark D Rapport
- Department of Psychology, University of Central Florida, Orlando, FL, USA; Co-first authors of the study.
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48
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Killeen PR, Russell VA, Sergeant JA. A behavioral neuroenergetics theory of ADHD. Neurosci Biobehav Rev 2013; 37:625-57. [PMID: 23454637 DOI: 10.1016/j.neubiorev.2013.02.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 02/02/2013] [Accepted: 02/18/2013] [Indexed: 02/02/2023]
Abstract
Energetic insufficiency in neurons due to inadequate lactate supply is implicated in several neuropathologies, including attention-deficit/hyperactivity disorder (ADHD). By formalizing the mechanism and implications of such constraints on function, the behavioral Neuroenergetics Theory (NeT) predicts the results of many neuropsychological tasks involving individuals with ADHD and kindred dysfunctions, and entails many novel predictions. The associated diffusion model predicts that response times will follow a mixture of Wald distributions from the attentive state, and ex-Wald distributions after attentional lapses. It is inferred from the model that ADHD participants can bring only 75-85% of the neurocognitive energy to bear on tasks, and allocate only about 85% of the cognitive resources of comparison groups. Parameters derived from the model in specific tasks predict performance in other tasks, and in clinical conditions often associated with ADHD. The primary action of therapeutic stimulants is to increase norepinephrine in active regions of the brain. This activates glial adrenoceptors, increasing the release of lactate from astrocytes to fuel depleted neurons. The theory is aligned with other approaches and integrated with more general theories of ADHD. Therapeutic implications are explored.
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Affiliation(s)
- Peter R Killeen
- Department of Psychology, Arizona State University, Tempe, AZ 85287-1104, USA.
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