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Ben-Dor Cohen M, Nahum M, Traub Bar-Ilan R, Eldar E, Maeir A. Coping with emotional dysregulation among young adults with ADHD: A mixed-method study of self-awareness and strategies in daily life. Neuropsychol Rehabil 2024; 34:1161-1185. [PMID: 37971947 DOI: 10.1080/09602011.2023.2279181] [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: 12/28/2022] [Accepted: 10/29/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Emotional dysregulation (ED) impacts functional outcomes among individuals with attention-deficit hyperactivity disorder (ADHD). Self-awareness and strategies may enhance coping with ED yet are rarely studied in ADHD. OBJECTIVES To explore ED-related self-awareness and strategies in daily life of adults with ADHD, and to examine the interrelations between them and their association with symptoms. METHODS Sixty young adults with ADHD participated in a mixed-method study. At baseline, self-awareness and strategies were assessed using the Self-Regulation Skills Interview (SRSI); ADHD symptoms were self-rated using the ASRS symptom checklist. Then, symptoms were rated over 5-days using ecological momentary assessment (EMA). RESULTS Significant challenges in self-awareness and strategies were demonstrated quantitatively and qualitatively. Awareness of ED was associated with variability of ADHD symptoms on EMA yet not with symptom severity. Qualitative content analysis revealed a range of self-awareness levels, which were related to noticing ED-related cues and understanding contextual factors predictive of ED. Self-awareness and strategies were significantly associated. Strategies varied regarding effort, individual preference and temporality. CONCLUSIONS Variability of ADHD symptoms was negatively associated with self-awareness of ED. Strategy selection in daily-life among adults with ADHD may be affected by self-awareness and by a possible trade-off between short-term effort and long-term effectiveness.
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Affiliation(s)
- Maayan Ben-Dor Cohen
- School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mor Nahum
- School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ruthie Traub Bar-Ilan
- School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Eran Eldar
- Psychology Department, Faculty of Social Sciences, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Cognitive Sciences, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Adina Maeir
- School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Wiley K, Berger P, Friehs MA, Mandryk RL. Measuring the Reliability of a Gamified Stroop Task: Quantitative Experiment. JMIR Serious Games 2024; 12:e50315. [PMID: 38598265 PMCID: PMC11043929 DOI: 10.2196/50315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/29/2023] [Accepted: 01/31/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Few gamified cognitive tasks are subjected to rigorous examination of psychometric properties, despite their use in experimental and clinical settings. Even small manipulations to cognitive tasks require extensive research to understand their effects. OBJECTIVE This study aims to investigate how game elements can affect the reliability of scores on a Stroop task. We specifically investigated performance consistency within and across sessions. METHODS We created 2 versions of the Stroop task, with and without game elements, and then tested each task with participants at 2 time points. The gamified task used points and feedback as game elements. In this paper, we report on the reliability of the gamified Stroop task in terms of internal consistency and test-retest reliability, compared with the control task. We used a permutation approach to evaluate internal consistency. For test-retest reliability, we calculated the Pearson correlation and intraclass correlation coefficients between each time point. We also descriptively compared the reliability of scores on a trial-by-trial basis, considering the different trial types. RESULTS At the first time point, the Stroop effect was reduced in the game condition, indicating an increase in performance. Participants in the game condition had faster reaction times (P=.005) and lower error rates (P=.04) than those in the basic task condition. Furthermore, the game condition led to higher measures of internal consistency at both time points for reaction times and error rates, which indicates a more consistent response pattern. For reaction time in the basic task condition, at time 1, rSpearman-Brown=0.78, 95% CI 0.64-0.89. At time 2, rSpearman-Brown=0.64, 95% CI 0.40-0.81. For reaction time, in the game condition, at time 1, rSpearman-Brown=0.83, 95% CI 0.71-0.91. At time 2, rSpearman-Brown=0.76, 95% CI 0.60-0.88. Similarly, for error rates in the basic task condition, at time 1, rSpearman-Brown=0.76, 95% CI 0.62-0.87. At time 2, rSpearman-Brown=0.74, 95% CI 0.58-0.86. For error rates in the game condition, at time 1, rSpearman-Brown=0.76, 95% CI 0.62-0.87. At time 2, rSpearman-Brown=0.74, 95% CI 0.58-0.86. Test-retest reliability analysis revealed a distinctive performance pattern depending on the trial type, which may be reflective of motivational differences between task versions. In short, especially in the incongruent trials where cognitive conflict occurs, performance in the game condition reaches peak consistency after 100 trials, whereas performance consistency drops after 50 trials for the basic version and only catches up to the game after 250 trials. CONCLUSIONS Even subtle gamification can impact task performance albeit not only in terms of a direct difference in performance between conditions. People playing the game reach peak performance sooner, and their performance is more consistent within and across sessions. We advocate for a closer examination of the impact of game elements on performance.
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Affiliation(s)
- Katelyn Wiley
- Department of Computer Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Phaedra Berger
- Department of Computer Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Maximilian Achim Friehs
- Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
- School of Psychology, University College Dublin, Dublin, Ireland
- Max-Planck-Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Regan Lee Mandryk
- Department of Computer Science, University of Victoria, Victoria, BC, Canada
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White E, Dalley JW. Brain mechanisms of temporal processing in impulsivity: Relevance to attention-deficit hyperactivity disorder. Brain Neurosci Adv 2024; 8:23982128241272234. [PMID: 39148691 PMCID: PMC11325328 DOI: 10.1177/23982128241272234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 06/25/2024] [Indexed: 08/17/2024] Open
Abstract
In this article, we critique the hypothesis that different varieties of impulsivity, including impulsiveness present in attention-deficit hyperactivity disorder, encompass an accelerated perception of time. This conceptualisation provides insights into how individuals with attention-deficit hyperactivity disorder have the capacity to maximise cognitive capabilities by more closely aligning themselves with appropriate environmental contexts (e.g. fast paced tasks that prevent boredom). We discuss the evidence for altered time perception in attention-deficit hyperactivity disorder alongside putative underlying neurobiological substrates, including a distributed brain network mediating time perception over multiple timescales. In particular, we explore the importance of temporal representations across the brain for time perception and symptom manifestation in attention-deficit hyperactivity disorder, including a prominent role of the hippocampus and other temporal lobe regions. We also reflect on how abnormalities in the perception of time may be relevant for understanding the aetiology of attention-deficit hyperactivity disorder and mechanism of action of existing medications.
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Affiliation(s)
- Eleanor White
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Jeffrey W Dalley
- Department of Psychology, University of Cambridge, Cambridge, UK
- Department of Psychiatry, Herschel Smith Building for Brain and Mind Sciences, Cambridge, UK
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Gallen CL, Schachtner JN, Anguera-Singla R, Anguera JA, Gazzaley A. Influence of game features on attention in adults. Front Psychol 2023; 14:1123306. [PMID: 37228349 PMCID: PMC10203248 DOI: 10.3389/fpsyg.2023.1123306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/06/2023] [Indexed: 05/27/2023] Open
Abstract
Introduction The incorporation of game features into cognitive tasks can inform us about the influence of reward and motivation on attention. Continuous performance tasks (CPTs), designed to assess attention abilities, are examples of cognitive tasks that have been targeted for the addition of game features. However, previous results have been mixed regarding how game elements affect attention abilities and task performance. Methods Here, we studied if there were factors that predict which individuals exhibit changes in attention from game features added to a CPT. Participants (N = 94, aged 21-71) played a traditional CPT and a game CPT with identical mechanics, but featured engaging game elements (aesthetics, storyline, competition, feedback, and reward). Results We first found corroborating evidence that game features have mixed effects on attention performance: most attention metrics of interest exhibited no overall difference between the traditional and game CPT, while game elements reduced performance for a few metrics. Importantly, we also found that specific behavioral and demographic profiles predicted individual differences in performance on the game CPT compared to the traditional CPT. Those with more attention difficulties (ADHD symptoms), more reward responsiveness, and younger adults performed better on the game CPT while, conversely, those with fewer ADHD symptoms, less reward responsiveness, and older adults performed better on the traditional CPT. Discussion These findings provide insights into how game features can influence attention in different individuals and have important implications for the use of game elements in cognitive tasks and training interventions.
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Affiliation(s)
- Courtney L. Gallen
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
- Neuroscape Center, University of California, San Francisco, San Francisco, CA, United States
| | - Jessica N. Schachtner
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
- Neuroscape Center, University of California, San Francisco, San Francisco, CA, United States
- Department of Psychology, University of Arizona, Tucson, AZ, United States
| | - Roger Anguera-Singla
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
- Neuroscape Center, University of California, San Francisco, San Francisco, CA, United States
| | - Joaquin A. Anguera
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
- Neuroscape Center, University of California, San Francisco, San Francisco, CA, United States
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Adam Gazzaley
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
- Neuroscape Center, University of California, San Francisco, San Francisco, CA, United States
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
- Department of Physiology, University of California, San Francisco, San Francisco, CA, United States
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Ben-Dor Cohen M, Maeir A, Eldar E, Nahum M. Everyday Cognitive Control and Emotion Dysregulation in Young Adults With and Without ADHD: An Ecological Momentary Assessment Study. J Atten Disord 2023; 27:539-553. [PMID: 36779529 PMCID: PMC9978869 DOI: 10.1177/10870547231153934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
OBJECTIVE This study examined the contribution of the temporal dynamics of two cognitive control mechanisms-inhibitory control (IC) and working memory (WM)-to emotion dysregulation (ED) in attention-deficit/hyperactivity disorder (ADHD) in ecological settings. METHOD One hundred twenty-two participants (age 18-33 years; 60 with ADHD) reported their ED at baseline, followed by a 5-day ecological momentary assessment (EMA) study, with short behavioral IC and WM tasks performed five times/day. RESULTS For IC, mean and lability of performance over EMA significantly accounted for differences in ED but not baseline performance. For WM, both baseline and mean of EMA, but not EMA lability, accounted for ED variance. ADHD status further contributed to the explained variance of ED. CONCLUSIONS Our results support the contribution of dynamic IC processes to ED in ADHD, in addition to WM performance level, and highlight the importance of dynamic and ecological investigation of different cognitive control components.
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Affiliation(s)
| | - Adina Maeir
- Hebrew University of Jerusalem,
Jerusalem, Israel
| | - Eran Eldar
- Hebrew University of Jerusalem,
Jerusalem, Israel
| | - Mor Nahum
- Hebrew University of Jerusalem,
Jerusalem, Israel,Mor Nahum, Faculty of Medicine, School of
Occupational Therapy, Hebrew University, Mt Scopus Campus, Jerusalem 9190501,
Israel.
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Gallagher R, Kessler K, Bramham J, Dechant M, Friehs MA. A proof-of-concept study exploring the effects of impulsivity on a gamified version of the stop-signal task in children. Front Psychol 2023; 14:1068229. [PMID: 36844283 PMCID: PMC9946965 DOI: 10.3389/fpsyg.2023.1068229] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/18/2023] [Indexed: 02/11/2023] Open
Abstract
This proof-of-concept study provides an appraisal of a remotely administered gamified Stop-Signal Task (gSST) for future use in studies using child sample. Performance on the standard Stop-Signal (SST) task has been shown previously to differentiate attention-deficit-hyperactivity-disorder groups from controls. As is the case with the SST, it was envisaged that those with greater impulsivity would perform worse than those with lower levels of impulsivity in the gSST. The potential advantage of the gSST is that it could be perceived as less monotonous than the original SST and has the potential to provide higher data quality in child samples, however future research will need to be conducted to determine this. The gSST was administered remotely via video chat to 30 child participants within a community sample aged 8-12 to investigate the effect of ADHD symptoms and intrinsic motivation on gSST performance. Qualitative data was collected based on feedback from participants to gain insight into how the gSST was received by participants. A positive correlation was observed between impulsive/hyperactivity and gSST performance, however there was insufficient evidence to suggest that impulsivity predicted performance. With regards to accuracy, results suggested that impulsivity level significantly predicted the rate of go-omission errors. No relationships were observed between intrinsic motivation inventory (IMI) subscales and performance or IMI and impulsivity. Nevertheless, mean IMI scores were overarchingly high for each of the IMI subscales, suggesting that regardless of performance and/or level of impulsive behaviour, the child sample obtained in this study demonstrated high levels of intrinsic motivation, which was supported by the predominantly positive subjective feedback provided by the child participants. The present study provides some evidence based on quantitative and qualitative results for the efficacy of gSST for use with children. Future research with a larger sample of children is warranted to examine how performance on the SST and gSST compare/differ.
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Affiliation(s)
- Ruth Gallagher
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Klaus Kessler
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Jessica Bramham
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Martin Dechant
- ZEISS Vision Science Lab, Institute for Ophthalmic Research, Tübingen University, Tübingen, Germany
- UCLIC, University College London, London, United Kingdom
| | - Maximilian A. Friehs
- School of Psychology, University College Dublin, Dublin, Ireland
- Lise-Meitner Research Group Cognition and Plasticity, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Department of Psychology of Conflict, Risk and Safety, University of Twente, Enschede, Netherlands
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7
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Roye S, Linck JF, Hoffmeister J, Copeland CT. OUP accepted manuscript. Arch Clin Neuropsychol 2022; 37:1555-1563. [PMID: 35596956 PMCID: PMC9582161 DOI: 10.1093/arclin/acac029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2022] [Indexed: 11/22/2022] Open
Abstract
Objective Attention, inhibition, and processing speed are related to functional decline among older adults. This study attempts to clarify the relationships between these cognitive factors and adaptive functioning. Method We examined relationships between attention, inhibition, and processing speed, with scores on the Texas Functional Living Scale (TFLS), a performance-based measure of daily functioning, in a mixed clinical sample of 530 older adults who were referred for an outpatient neuropsychological evaluation. Results The current study used a confirmatory factor analysis (CFA) to derive a three-factor cognitive model consisting of attention, inhibition, and processing speed. Results from a hierarchical regression, which included factor scores from the CFA, revealed that processing speed was the only significant predictor of TFLS performance when all three cognitive factors were included within a single model. Conclusion These results highlight the influence of processing speed as an important indicator of functional decline among a clinical population of older adults.
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Affiliation(s)
- Scott Roye
- Corresponding author at: Neuropsychology Services, Department of Psychiatry and Behavioral Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA. Tel.: (405) 271-4468; Fax: (405) 271-8802. E-mail address: (Scott Roye)
| | - John F Linck
- Neuropsychology Service, Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jordan Hoffmeister
- Neuropsychology Service, Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Christopher T Copeland
- Neuropsychology Service, Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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8
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Toschi C, Hervig MES, Moazen P, Parker MG, Dalley JW, Gether U, Robbins TW. Adaptive aspects of impulsivity and interactions with effects of catecholaminergic agents in the 5-choice serial reaction time task: implications for ADHD. Psychopharmacology (Berl) 2021; 238:2601-2615. [PMID: 34104987 PMCID: PMC8373759 DOI: 10.1007/s00213-021-05883-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 05/21/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Work in humans has shown that impulsivity can be advantageous in certain settings. However, evidence for so-called functional impulsivity is lacking in experimental animals. AIMS This study investigated the contexts in which high impulsive (HI) rats show an advantage in performance compared with mid- (MI) and low impulsive (LI) rats. We also assessed the effects of dopaminergic and noradrenergic agents to investigate underlying neurotransmitter mechanisms. METHODS We tested rats on a variable inter-trial interval (ITI) version of the 5-choice serial reaction time task (5CSRTT). Rats received systemic injections of methylphenidate (MPH, 1 mg/kg and 3 mg/kg), atomoxetine (ATO, 0.3 mg/kg and 1 mg/kg), amphetamine (AMPH, 0.2 mg/kg), the alpha-2a adrenoceptor antagonist atipamezole (ATI, 0.3 mg/kg) and the alpha-1 adrenoceptor agonist phenylephrine (PHEN, 1 mg/kg) prior to behavioural testing. RESULTS Unlike LI rats, HI rats exhibited superior performance, earning more reinforcers, on short ITI trials, when the task required rapid responding. MPH, AMPH and ATI improved performance on short ITI trials and increased impulsivity in long ITI trials, recapitulating the behavioural profile of HI. In contrast, ATO and PHEN impaired performance on short ITI trials and decreased impulsivity, thus mimicking the behavioural profile of LI rats. The effects of ATO were greater on MI rats and LI rats. CONCLUSIONS These findings indicate that impulsivity can be advantageous when rapid focusing and actions are required, an effect that may depend on increased dopamine neurotransmission. Conversely, activation of the noradrenergic system, with ATO and PHEN, led to a general inhibition of responding.
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Affiliation(s)
- Chiara Toschi
- Department of Psychology and Behavioural and Clinical Neuroscience Institute, University of Cambridge, Downing St., CB2 3EB, Cambridge, UK.
| | - Mona El-Sayed Hervig
- Department of Psychology and Behavioural and Clinical Neuroscience Institute, University of Cambridge, Downing St., CB2 3EB, Cambridge, UK
- Department of Neuroscience, University of Copenhagen, DK-2200, Copenhagen, Denmark
| | - Parisa Moazen
- Department of Psychology and Behavioural and Clinical Neuroscience Institute, University of Cambridge, Downing St., CB2 3EB, Cambridge, UK
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Maximilian G Parker
- Department of Psychology and Behavioural and Clinical Neuroscience Institute, University of Cambridge, Downing St., CB2 3EB, Cambridge, UK
| | - Jeffrey W Dalley
- Department of Psychology and Behavioural and Clinical Neuroscience Institute, University of Cambridge, Downing St., CB2 3EB, Cambridge, UK
- Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Ulrik Gether
- Department of Neuroscience, University of Copenhagen, DK-2200, Copenhagen, Denmark
| | - Trevor W Robbins
- Department of Psychology and Behavioural and Clinical Neuroscience Institute, University of Cambridge, Downing St., CB2 3EB, Cambridge, UK
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Wiley K, Robinson R, Mandryk RL. The Making and Evaluation of Digital Games Used for the Assessment of Attention: Systematic Review. JMIR Serious Games 2021; 9:e26449. [PMID: 34383674 PMCID: PMC8386381 DOI: 10.2196/26449] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/16/2021] [Accepted: 05/20/2021] [Indexed: 12/19/2022] Open
Abstract
Background Serious games are now widely used in many contexts, including psychological research and clinical use. One area of growing interest is that of cognitive assessment, which seeks to measure different cognitive functions such as memory, attention, and perception. Measuring these functions at both the population and individual levels can inform research and indicate health issues. Attention is an important function to assess, as an accurate measure of attention can help diagnose many common disorders, such as attention-deficit/hyperactivity disorder and dementia. However, using games to assess attention poses unique problems, as games inherently manipulate attention through elements such as sound effects, graphics, and rewards, and research on adding game elements to assessments (ie, gamification) has shown mixed results. The process for developing cognitive tasks is robust, with high psychometric standards that must be met before these tasks are used for assessment. Although games offer more diverse approaches for assessment, there is no standard for how they should be developed or evaluated. Objective To better understand the field and provide guidance to interdisciplinary researchers, we aim to answer the question: How are digital games used for the cognitive assessment of attention made and measured? Methods We searched several databases for papers that described a digital game used to assess attention that could be deployed remotely without specialized hardware. We used Rayyan, a systematic review software, to screen the records before conducting a systematic review. Results The initial database search returned 49,365 papers. Our screening process resulted in a total of 74 papers that used a digital game to measure cognitive functions related to attention. Across the studies in our review, we found three approaches to making assessment games: gamifying cognitive tasks, creating custom games based on theories of cognition, and exploring potential assessment properties of commercial games. With regard to measuring the assessment properties of these games (eg, how accurately they assess attention), we found three approaches: comparison to a traditional cognitive task, comparison to a clinical diagnosis, and comparison to knowledge of cognition; however, most studies in our review did not evaluate the game’s properties (eg, if participants enjoyed the game). Conclusions Our review provides an overview of how games used for the assessment of attention are developed and evaluated. We further identified three barriers to advancing the field: reliance on assumptions, lack of evaluation, and lack of integration and standardization. We then recommend the best practices to address these barriers. Our review can act as a resource to help guide the field toward more standardized approaches and rigorous evaluation required for the widespread adoption of assessment games.
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Affiliation(s)
- Katelyn Wiley
- Department of Computer Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Raquel Robinson
- Department of Computer Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Regan L Mandryk
- Department of Computer Science, University of Saskatchewan, Saskatoon, SK, Canada
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10
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Kallweit C, Paucke M, Strauß M, Exner C. Adult ADHD: Influence of Physical Activation, Stimulation, and Reward on Cognitive Performance and Symptoms. J Atten Disord 2021; 25:809-819. [PMID: 31096844 PMCID: PMC7897786 DOI: 10.1177/1087054719845050] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Models of ADHD consider the influence of situational factors on cognitive performance and symptoms. Method: The influence of acute physical exercise, stimulation through continuous fine motor movement, and performance-related reward on performance and ADHD symptoms was assessed. Thirty-six adults with ADHD and 36 healthy controls performed executive function tasks (EF-tasks) of inhibition, selective attention, and working memory with material close to daily life. Experimental manipulations aimed at increasing cognitive performance. Results: No significant effects were found, but there were indicators for ADHD-specific impacts: Reward resulted in higher reported hyperactivity. Acute physical exercise slightly tended to improve attention performance and subjective inattention. Conclusion: The manipulations may affect performance and especially symptoms in different ways. Potential symptom interactions and identification of factors that determine whether symptoms may be functional or detrimental for task performance could be future research interests.
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Affiliation(s)
- Claudia Kallweit
- Department of Psychology, Clinical Psychology and Psychotherapy Unit, University of Leipzig, Germany,Claudia Kallweit, Clinical Psychology and Psychotherapy Unit, Department of Psychology, University of Leipzig, Leipzig 04081, Germany.
| | - Madlen Paucke
- Department of Psychiatry and Psychotherapy, Leipzig University Hospital, Germany
| | - Maria Strauß
- Department of Psychiatry and Psychotherapy, Leipzig University Hospital, Germany
| | - Cornelia Exner
- Department of Psychology, Clinical Psychology and Psychotherapy Unit, University of Leipzig, Germany
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Onandia-Hinchado I, Pardo-Palenzuela N, Diaz-Orueta U. Cognitive characterization of adult attention deficit hyperactivity disorder by domains: a systematic review. J Neural Transm (Vienna) 2021; 128:893-937. [PMID: 33620582 DOI: 10.1007/s00702-021-02302-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/06/2021] [Indexed: 02/06/2023]
Abstract
Attention deficit hyperactivity disorder (ADHD) is reportedly the most frequent neurodevelopmental disorder diagnosed during childhood, and it is recognized as a common condition in adulthood. We review the evidence to help identify cognitive domains associated to deficits in adult ADHD. A systematic review with narrative synthesis was performed, assessing studies on adult ADHD, neuropsychology and research on involved cognitive domains in adults 18+ years old with an established diagnosis of ADHD, in seven electronic databases (PubMed, PsychInfo, WebOfScience, Embase, Scopus, OvidSPMedline, and Teseo), and Worldcat and OpenGrey grey literature databases. 93 studies were included for this review, encompassing findings from a total 5574 adults diagnosed only with ADHD, medication-naïve or non-medicated at the moment of the assessment and 4880 healthy controls. Adults diagnosed with ADHD may show, when compared to healthy controls, a cognitive profile characterized by deficits across all attention modalities, processing speed, executive function (mainly working memory and inhibition with emphasis on reward delay and interference control), verbal memory, reading skills, social cognition and arithmetic abilities. A cognitive characterization of adult ADHD by domains is established beyond the sole consideration of attention and executive function problems. Along with these, verbal memory, language (mainly reading), social cognition and arithmetic abilities may also contribute to a more comprehensive characterization of the cognitive profile in adult ADHD.
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Affiliation(s)
| | | | - Unai Diaz-Orueta
- Department of Psychology, Maynooth University, Room 3.11, John Hume Building, North Campus, Maynooth, Co. Kildare, Ireland.
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Friehs MA, Dechant M, Vedress S, Frings C, Mandryk RL. Effective Gamification of the Stop-Signal Task: Two Controlled Laboratory Experiments. JMIR Serious Games 2020; 8:e17810. [PMID: 32897233 PMCID: PMC7509611 DOI: 10.2196/17810] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 06/16/2020] [Accepted: 06/25/2020] [Indexed: 02/07/2023] Open
Abstract
Background A lack of ability to inhibit prepotent responses, or more generally a lack of impulse control, is associated with several disorders such as attention-deficit/hyperactivity disorder and schizophrenia as well as general damage to the prefrontal cortex. A stop-signal task (SST) is a reliable and established measure of response inhibition. However, using the SST as an objective assessment in diagnostic or research-focused settings places significant stress on participants as the task itself requires concentration and cognitive effort and is not particularly engaging. This can lead to decreased motivation to follow task instructions and poor data quality, which can affect assessment efficacy and might increase drop-out rates. Gamification—the application of game-based elements in nongame settings—has shown to improve engaged attention to a cognitive task, thus increasing participant motivation and data quality. Objective This study aims to design a gamified SST that improves participants’ engagement and validate this gamified SST against a standard SST. Methods We described the design of our gamified SST and reported on 2 separate studies that aim to validate the gamified SST relative to a standard SST. In study 1, a within-subject design was used to compare the performance of the SST and a stop-signal game (SSG). In study 2, we added eye tracking to the procedure to determine if overt attention was affected and aimed to replicate the findings from study 1 in a between-subjects design. Furthermore, in both studies, flow and motivational experiences were measured. Results In contrast, the behavioral performance was comparable between the tasks (P<.87; BF01=2.87), and the experience of flow and intrinsic motivation were rated higher in the SSG group, although this difference was not significant. Conclusions Overall, our findings provide evidence that the gamification of SST is possible and that the SSG is enjoyed more. Thus, when participant engagement is critical, we recommend using the SSG instead of the SST.
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Affiliation(s)
| | - Martin Dechant
- Human-Computer-Interaction Lab, Department of Computer Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Sarah Vedress
- Human-Computer-Interaction Lab, Department of Computer Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Christian Frings
- Department of Cognitive Psychology and Methodology, Trier University, Trier, Germany
| | - Regan Lee Mandryk
- Human-Computer-Interaction Lab, Department of Computer Science, University of Saskatchewan, Saskatoon, SK, Canada
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Kallweit C, Paucke M, Strauß M, Exner C. Cognitive deficits and psychosocial functioning in adult ADHD: Bridging the gap between objective test measures and subjective reports. J Clin Exp Neuropsychol 2020; 42:569-583. [PMID: 32757704 DOI: 10.1080/13803395.2020.1779188] [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: 10/23/2022]
Abstract
INTRODUCTION Self-reported cognitive deficits in adult Attention-Deficit/Hyperactivity-Disorder (ADHD) are often not corroborated by standardized tests. Tests and reports also differ in their correspondence to aspects of psychosocial functioning. Executive function tasks (EF-tasks) using material close to daily life, may provide a more ecologically-valid assessment of cognitive deficits. METHOD 36 adults with ADHD and 36 healthy controls performed standardized EF-tasks and corresponding EF-tasks using material close to daily life and gave self-reports on cognitive functioning. The study investigated performance differences and the predictive utility of cognitive measures for psychosocial functioning. RESULTS While all the self-reports showed substantial cognitive impairments for the ADHD group, this was only shown in some of task measures. For two domains, the deficits in EF-tasks with material close to daily life were similar or smaller than assessed with traditional measures. However, three tasks, which used material of daily life, revealed more deficits than the corresponding more standardized tasks. Beyond cognitive self-reports the new tasks did not contribute substantial to psychosocial functioning, similar to the standardized tasks. CONCLUSIONS Tasks using material close to daily life have the potential to objectify reported everyday life deficits better than more standardized tests, at least in single EF-domains. When relevant methodical aspects of these tasks will be more targeted and considered systematically in future research, the tasks might contribute to assessments of psychosocial functioning. Then they could also be used as outcome measures in intervention studies.
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Affiliation(s)
- Claudia Kallweit
- Department of Psychology, Clinical Psychology and Psychotherapy Unit, University of Leipzig , Leipzig, Germany
| | - Madlen Paucke
- Department of Psychiatry and Psychotherapy, Leipzig University Hospital , Leipzig, Germany
| | - Maria Strauß
- Department of Psychiatry and Psychotherapy, Leipzig University Hospital , Leipzig, Germany
| | - Cornelia Exner
- Department of Psychology, Clinical Psychology and Psychotherapy Unit, University of Leipzig , Leipzig, Germany
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Abstract
Objective: Neuropsychological performance patterns associated with adult ADHD subtypes are unknown. The aim of the current systematic review was to identify and synthesize available literature regarding neuropsychological performance associated with adult ADHD subtypes. Method: Searches were completed using the databases PsycINFO and PubMed for studies published before March 2017 addressing adult ADHD subtypes and neuropsychological performance. Data characterizing the neuropsychological tests utilized in each study were obtained and sorted into eight domains. To summarize the results of all comparisons (ADHD subtype compared with control, or to each other), we counted the proportion of tests within each domain with significant group differences. Results/Conclusion: We deemed four domains informative in differentiating ADHD subtypes from controls. Of these, memory was the only domain that held promise in distinguishing ADHD-Inattentive and ADHD-Combined. Limitations of the available literature are highlighted and recommendations for future research are provided.
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Affiliation(s)
- Amy LeRoy
- 1 Pacific University, Hillsboro, OR, USA
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15
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Lumsden J, Skinner A, Coyle D, Lawrence N, Munafo M. Attrition from Web-Based Cognitive Testing: A Repeated Measures Comparison of Gamification Techniques. J Med Internet Res 2017; 19:e395. [PMID: 29167090 PMCID: PMC5719230 DOI: 10.2196/jmir.8473] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 09/25/2017] [Accepted: 10/09/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The prospect of assessing cognition longitudinally and remotely is attractive to researchers, health practitioners, and pharmaceutical companies alike. However, such repeated testing regimes place a considerable burden on participants, and with cognitive tasks typically being regarded as effortful and unengaging, these studies may experience high levels of participant attrition. One potential solution is to gamify these tasks to make them more engaging: increasing participant willingness to take part and reducing attrition. However, such an approach must balance task validity with the introduction of entertaining gamelike elements. OBJECTIVE This study aims to investigate the effects of gamelike features on participant attrition using a between-subjects, longitudinal Web-based testing study. METHODS We used three variants of a common cognitive task, the Stop Signal Task (SST), with a single gamelike feature in each: one variant where points were rewarded for performing optimally; another where the task was given a graphical theme; and a third variant, which was a standard SST and served as a control condition. Participants completed four compulsory test sessions over 4 consecutive days before entering a 6-day voluntary testing period where they faced a daily decision to either drop out or continue taking part. Participants were paid for each session they completed. RESULTS A total of 482 participants signed up to take part in the study, with 265 completing the requisite four consecutive test sessions. No evidence of an effect of gamification on attrition was observed. A log-rank test showed no evidence of a difference in dropout rates between task variants (χ22=3.0, P=.22), and a one-way analysis of variance of the mean number of sessions completed per participant in each variant also showed no evidence of a difference (F2,262=1.534, P=.21, partial η2=0.012). CONCLUSIONS Our findings raise doubts about the ability of gamification to reduce attrition from longitudinal cognitive testing studies.
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Affiliation(s)
- Jim Lumsden
- UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, Bristol, United Kingdom
- The MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
| | - Andy Skinner
- UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, Bristol, United Kingdom
- The MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
| | - David Coyle
- School of Computer Science, University College Dublin, Dublin, Ireland
| | - Natalia Lawrence
- School of Psychology, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
| | - Marcus Munafo
- UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, Bristol, United Kingdom
- The MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
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16
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Kallweit C, Exner C. Evaluation of an Executive Functioning Test Battery in Two Versions with Material Close to Daily Life. ZEITSCHRIFT FÜR NEUROPSYCHOLOGIE 2016. [DOI: 10.1024/1016-264x/a000191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract. The assessment of executive functions (EF) often yields conflicting results between standardized tests and self-ratings (e. g., in depression or adult ADHD). For the present investigation, standardized EF-tasks were enriched in order to better represent executive demands of daily life. In the future this may improve the assessment and prediction of reported performance deficits in daily life. An EF-test battery was designed with material close to daily life; tasks were matched to basic executive functions. Healthy students took part in two preliminary studies to evaluate the reliability, validity, and comparability of five tasks. In the end, four tasks seem suitable, whereas one task underlies several limitations. The tasks can reliably be used and should be re-evaluated in further studies with adult ADHD participants and healthy controls.
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Affiliation(s)
- Claudia Kallweit
- Psychologisches Institut, Arbeitsgruppe für Klinische Psychologie und Psychotherapie, Universität Leipzig, Leipzig, Germany
| | - Cornelia Exner
- Psychologisches Institut, Arbeitsgruppe für Klinische Psychologie und Psychotherapie, Universität Leipzig, Leipzig, Germany
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17
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Lumsden J, Edwards EA, Lawrence NS, Coyle D, Munafò MR. Gamification of Cognitive Assessment and Cognitive Training: A Systematic Review of Applications and Efficacy. JMIR Serious Games 2016; 4:e11. [PMID: 27421244 PMCID: PMC4967181 DOI: 10.2196/games.5888] [Citation(s) in RCA: 166] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 06/16/2016] [Accepted: 06/17/2016] [Indexed: 12/18/2022] Open
Abstract
Background Cognitive tasks are typically viewed as effortful, frustrating, and repetitive, which often leads to participant disengagement. This, in turn, may negatively impact data quality and/or reduce intervention effects. However, gamification may provide a possible solution. If game design features can be incorporated into cognitive tasks without undermining their scientific value, then data quality, intervention effects, and participant engagement may be improved. Objectives This systematic review aims to explore and evaluate the ways in which gamification has already been used for cognitive training and assessment purposes. We hope to answer 3 questions: (1) Why have researchers opted to use gamification? (2) What domains has gamification been applied in? (3) How successful has gamification been in cognitive research thus far? Methods We systematically searched several Web-based databases, searching the titles, abstracts, and keywords of database entries using the search strategy (gamif* OR game OR games) AND (cognit* OR engag* OR behavi* OR health* OR attention OR motiv*). Searches included papers published in English between January 2007 and October 2015. Results Our review identified 33 relevant studies, covering 31 gamified cognitive tasks used across a range of disorders and cognitive domains. We identified 7 reasons for researchers opting to gamify their cognitive training and testing. We found that working memory and general executive functions were common targets for both gamified assessment and training. Gamified tests were typically validated successfully, although mixed-domain measurement was a problem. Gamified training appears to be highly engaging and does boost participant motivation, but mixed effects of gamification on task performance were reported. Conclusions Heterogeneous study designs and typically small sample sizes highlight the need for further research in both gamified training and testing. Nevertheless, careful application of gamification can provide a way to develop engaging and yet scientifically valid cognitive assessments, and it is likely worthwhile to continue to develop gamified cognitive tasks in the future.
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Affiliation(s)
- Jim Lumsden
- UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, Bristol, United Kingdom.
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18
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Lasky AK, Weisner TS, Jensen PS, Hinshaw SP, Hechtman L, Arnold LE, W Murray D, Swanson JM. ADHD in context: Young adults' reports of the impact of occupational environment on the manifestation of ADHD. Soc Sci Med 2016; 161:160-8. [PMID: 27299978 DOI: 10.1016/j.socscimed.2016.06.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 05/25/2016] [Accepted: 06/01/2016] [Indexed: 01/03/2023]
Abstract
Does changing context play a role in the decline in ADHD symptoms in adulthood? Insufficient research has explored the functioning of adults with ADHD. As adults, individuals with ADHD have significantly more latitude to control aspects of their day-to-day environments. Do the new contexts young adults find themselves in alter their experience of ADHD? Are there particular occupational or educational contexts in which young adults report functioning better than others? To examine this issue, we conducted semi-structured interviews at four North American sites in 2010-11 with 125 young adults, originally diagnosed with ADHD as children, regarding their work and post-secondary educational environments. Many subjects describe their symptoms as context-dependent. In some contexts, participants report feeling better able to focus; in others, their symptoms-such as high energy levels-become strengths rather than liabilities. Modal descriptions included tasks that were stressful and challenging, novel and required multitasking, busy and fast-paced, physically demanding or hands-on, and/or intrinsically interesting. Consistent with a developmental psychopathology framework, ADHD is experienced as arising from an interaction between our subjects and their environments. These findings demonstrate the need to account for the role of context in our understanding of ADHD as a psychiatric disorder, especially as it manifests in young adulthood.
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Affiliation(s)
- Arielle K Lasky
- David Geffen School of Medicine and Department of Anthropology, University of California, Los Angeles, USA.
| | - Thomas S Weisner
- Departments of Psychiatry and Anthropology, University of California, Los Angeles, USA.
| | - Peter S Jensen
- Department of Psychiatry, University of Arkansas for Medical Sciences, USA.
| | | | - Lily Hechtman
- Department of Psychiatry, McGill University, Canada.
| | | | - Desiree W Murray
- Frank Porter Graham Child Development Institute, University of North Carolina, Chapel Hill, USA.
| | - James M Swanson
- Department of Pediatrics, University of California, Irvine, USA.
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Mowinckel AM, Pedersen ML, Eilertsen E, Biele G. A meta-analysis of decision-making and attention in adults with ADHD. J Atten Disord 2015; 19:355-67. [PMID: 25477020 DOI: 10.1177/1087054714558872] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Deficient reward processing has gained attention as an important aspect of ADHD, but little is known about reward-based decision-making (DM) in adults with ADHD. This article summarizes research on DM in adult ADHD and contextualizes DM deficits by comparing them to attention deficits. METHOD Meta-analytic methods were used to calculate average effect sizes for different DM domains and continuous performance task (CPT) measures. RESULTS None of the 59 included studies (DM: 12 studies; CPT: 43; both: 4) had indications of publication bias. DM and CPT measures showed robust, small to medium effects. Large effect sizes were found for a drift diffusion model analysis of the CPT. CONCLUSION The results support the existence of DM deficits in adults with ADHD, which are of similar magnitude as attention deficits. These findings warrant further examination of DM in adults with ADHD to improve the understanding of underlying neurocognitive mechanisms.
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Affiliation(s)
| | | | | | - Guido Biele
- University of Oslo, Norway Norwegian Institute of Public Health, Oslo, Norway
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20
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McCrea SM, Penningroth SL, Radakovich MP. Implementation intentions forge a strong cue–response link and boost prospective memory performance. JOURNAL OF COGNITIVE PSYCHOLOGY 2014. [DOI: 10.1080/20445911.2014.975816] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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21
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Braun CMJ, Guimond A, Payette JF, Daigneault S. Specific early vulnerability of high-order executive function to focal brain lesions and long-term impact on educational persistence: Sparing of incidental episodic memory. Dev Neurorehabil 2013; 16:89-101. [PMID: 23477462 DOI: 10.3109/17518423.2012.723761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We investigated mental functions expected to remain impaired or not ain adulthood following childhood-onset brain lesions. METHODS Thirty unilaterally lesioned young adults were tested a decade after lesion onset with an effort-demanding complex executive function (EF) task as well as a task of incidental declarative retrospective episodic recognition memory (IRM). Thirty neurotypical participants were also tested. RESULTS The EF task was significantly impaired in the lesion group and significantly more so than the IRM task. Regarding the lesioned cases, performance on EF, but not IRM, was significantly positively correlated with long-term educational persistence (EP). Both EF and EP but not IRM were significantly positively correlated with the age of onset of the lesion. Severity of neurological impairment was unrelated to any variable. CONCLUSION Mental abilities acquired through early schooling remain impaired into adulthood when early schooling is disturbed, not everyday memory which does not depend on schooling.
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Affiliation(s)
- Claude M J Braun
- Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada.
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Braun CMJ, Delisle J, Suffren S, Bolduc M. Atypical left–right balance of visuomotor awareness in adult ADHD (combined type) on a test of executive function. Laterality 2013; 18:385-406. [DOI: 10.1080/1357650x.2012.695796] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Farr OM, Hu S, Zhang S, Li CSR. Decreased saliency processing as a neural measure of Barratt impulsivity in healthy adults. Neuroimage 2012; 63:1070-7. [PMID: 22885245 DOI: 10.1016/j.neuroimage.2012.07.049] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 06/27/2012] [Accepted: 07/23/2012] [Indexed: 11/13/2022] Open
Abstract
Cognitive control is necessary to navigating through an uncertain world. With the stop signal task (SST), we measure how cognitive control functions in a controlled environment. There has been conflicting evidence on whether trait impulsivity might reflect differences in cognitive control during the SST. While some studies find that trait impulsivity relates to measures of response inhibition, such as the stop signal reaction time (SSRT), other studies do not. Here, in 92 young adult participants (58 females; age 25 ± 4 years), we examined whether trait impulsivity, measured by the Barratt impulsivity scale (BIS-11), is associated with differences in performance and regional brain activations for the component processes of cognitive control during the SST. Across participants, trait impulsivity showed a trend-level correlation with SSRT (F(1.90)=3.18, p<.07; Pearson regression). In simple regressions, activation of the right anterior dorsal insula and middle frontal cortex (MFC) during stop as compared to go trials negatively correlated with motor and non-planning impulsivity score. Using the generalized form of psychophysiological interaction (gPPI), we showed that functional connectivity of the right insula and MFC with the left dorsolateral prefrontal cortex and bilateral visual areas were also negatively correlated with impulsivity. None of the other component processes of cognitive control, including response inhibition, error processing, post-error slowing, were significantly related to Barratt impulsivity. These results suggest that trait impulsivity as measured by BIS-11 may have distinct effects on saliency processing in adult individuals.
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Affiliation(s)
- Olivia M Farr
- Interdepartmental Neuroscience Program, Yale University School of Medicine, New Haven, CT 06520, USA.
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The negative impact of attention-deficit/hyperactivity disorder on occupational health in adults and adolescents. Int Arch Occup Environ Health 2012; 85:837-47. [PMID: 22752312 DOI: 10.1007/s00420-012-0794-0] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 06/18/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To review the negative effects of attention-deficit/hyperactivity disorder (ADHD) in adolescence and adulthood on work productivity and occupational health. METHODS A review of the MEDLINE database was carried out to identify direct and indirect effects of ADHD on work, employment and occupational health. RESULTS ADHD is associated with higher levels of unemployment versus controls. Adults with ADHD who are employed experience workplace impairment and reduced productivity, as well as behavioural issues such as irritability and low frustration tolerance. Adults with ADHD are also at increased risk of accidents, trauma and workplace injuries, particularly traffic accidents. Indirect effects of ADHD on occupational health include reduced educational achievement and increased rates of substance abuse and criminality. Overall, ADHD in adults has a substantial economic impact as a result of absenteeism and lost productivity. Psychoeducation, combined with stimulant medications if necessary, is recommended as first-line treatment for adults with ADHD. Limited data available suggest that stimulant treatment can improve work productivity and efficacy, and reduce the risks associated with driving, although further studies are necessary. CONCLUSIONS ADHD can affect the ability to gain and maintain employment and to work safely and productively. As ADHD is a treatable condition, patients, employers and physicians have a role to play in ensuring optimal occupational health.
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