Motivational incentives and methylphenidate enhance electrophysiological correlates of error monitoring in children with attention deficit/hyperactivity disorder

The Impact of Motivation on Sustained Attention in Very Preterm and Term-born Children: An ERP Study

OBJECTIVE

To compare the effect of motivational features on sustained attention in children born very preterm and at term.

METHOD

EEG was recorded while 34 8-to-11-year-old children born very preterm and 34 term-born peers completed two variants of a cued continuous performance task (CPT-AX); a standard CPT-AX with basic shape stimuli, and structurally similar motivating variant, with a storyline, familiar characters, and feedback.

RESULTS

Higher hit rates, quicker response times and larger event-related potential (ERP) amplitudes were observed during the motivating, compared with the standard, task. Although groups did not differ in task performance, between-task differences in ERPs associated with orienting were larger in term-born than very preterm children.

CONCLUSION

The findings add to previous evidence of disruption to the brain networks that support salience detection and selective attention in children born preterm. Manipulations that increase intrinsic motivation can promote sustained attention in both term-born and very preterm children.

Neural markers of methylphenidate response in children with attention deficit hyperactivity disorder and the impact on executive function

Background

Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. A core cognitive deficit in ADHD is executive function (EF) impairment, which significantly impacts daily life. Methylphenidate (MPH) is a widely used first-line treatment for ADHD, but objective biomarkers to assess treatment response are lacking. The aim of this study was to investigate the effects of MPH on executive function and identify potential neural biomarkers of response in children with ADHD using electroencephalogram (EEG).

Methods

A total of 26 boys with ADHD (mean age 8.64 ± 1.30 years) participated in the study. All participants were treated with 18 mg/day of oral extended-release MPH in the morning for 8 weeks. Executive function was assessed using the BRIEF2 and Digit Span Test (DST), and event-related potentials (ERP) were measured at baseline and after 8 weeks of MPH treatment.

Results

After 8 weeks of MPH treatment, significant improvements were observed in several executive function domains. BRIEF2 scores, including inhibition, self-monitoring, shifting, emotional control, initiation, working memory, planning/organization, task monitoring, and material organization, were significantly reduced (P < 0.05). Behavioral performance in the Go/NoGo task also improved, with shorter correct response times and higher accuracy rates (P = 0.002, P = 0.009). EEG results revealed a reduction in Nogo-P300 latency at Fz, Cz and Pz compared to baseline (P<0.05).

Conclusions

The normalization of P300 latency following MPH treatment appears to be a reliable neural biomarker of positive treatment response in children with ADHD. MPH was associated with improvements in executive function, particularly in inhibitory control and working memory.

Behavioral and neurophysiological signatures of cognitive control in humans and rats

BACKGROUND

Deficits in cognitive control are implicated in numerous neuropsychiatric disorders. However, relevant pharmacological treatments are limited, likely due to weak translational validity of applicable preclinical models used. Neural indices derived from electroencephalography may prove useful in comparing and translating the effects of cognition-enhancing drugs between species. In the current study, we aimed to extend our previous cross-species results by examining if methylphenidate (MPH) modulates behavioral and neural indices of cognitive control in independent cohorts of humans and rats.

METHODS

We measured continuous electroencephalography data from healthy adults (n = 25; 14 female) and Long Evans rats (n = 22; 8 female) and compared both stimulus- and response-locked event-related potentials and spectral power measures across species, and their MPH-related moderation following treatment with vehicle (placebo) or 1 of 2 doses of MPH.

RESULTS

Across both species, linear mixed effects modeling confirmed the expected Flanker interference effect on behavior (eg, accuracy) and response-related event-related potentials. Unexpectedly, in contrast to past work, we did not observe any task-related effects on the spectral power of rodents. Moreover, MPH generally did not modulate cognitive control of either species, although some species-specific patterns offer insight for future research.

CONCLUSIONS

Collectively, these findings in independent human and rodent subjects replicate some of our previously reported behavioral and neurophysiological patterns partly consistent with the notion that similar neural mechanisms may regulate cognitive control in both species. Nonetheless, these results showcase an approach to accelerate translation using a coordinated between-species platform to evaluate pro-cognitive treatments.

Treatment biomarkers for ADHD: Taking stock and moving forward

The development of treatment biomarkers for psychiatric disorders has been challenging, particularly for heterogeneous neurodevelopmental conditions such as attention-deficit/hyperactivity disorder (ADHD). Promising findings are also rarely translated into clinical practice, especially with regard to treatment decisions and development of novel treatments. Despite this slow progress, the available neuroimaging, electrophysiological (EEG) and genetic literature provides a solid foundation for biomarker discovery. This article gives an updated review of promising treatment biomarkers for ADHD which may enhance personalized medicine and novel treatment development. The available literature points to promising pre-treatment profiles predicting efficacy of various pharmacological and non-pharmacological treatments for ADHD. These candidate predictive biomarkers, particularly those based on low-cost and non-invasive EEG assessments, show promise for the future stratification of patients to specific treatments. Studies with repeated biomarker assessments further show that different treatments produce distinct changes in brain profiles, which track treatment-related clinical improvements. These candidate monitoring/response biomarkers may aid future monitoring of treatment effects and point to mechanistic targets for novel treatments, such as neurotherapies. Nevertheless, existing research does not support any immediate clinical applications of treatment biomarkers for ADHD. Key barriers are the paucity of replications and external validations, the use of small and homogeneous samples of predominantly White children, and practical limitations, including the cost and technical requirements of biomarker assessments and their unknown feasibility and acceptability for people with ADHD. We conclude with a discussion of future directions and methodological changes to promote clinical translation and enhance personalized treatment decisions for diverse groups of individuals with ADHD.

Disentangling age and schooling effects on inhibitory control development: An fNIRS investigation

Children show marked improvements in executive functioning (EF) between 4 and 7 years of age. In many societies, this time period coincides with the start of formal school education, in which children are required to follow rules in a structured environment, drawing heavily on EF processes such as inhibitory control. This study aimed to investigate the longitudinal development of two aspects of inhibitory control, namely response inhibition and response monitoring and their neural correlates. Specifically, we examined how their longitudinal development may differ by schooling experience, and their potential significance in predicting academic outcomes. Longitudinal data were collected in two groups of children at their homes. At T1, all children were roughly 4.5 years of age and neither group had attended formal schooling. One year later at T2, one group (P1, n = 40) had completed one full year of schooling while the other group (KG, n = 40) had stayed in kindergarten. Behavioural and brain activation data (measured with functional near-infrared spectroscopy, fNIRS) in response to a Go/No-Go task and measures of academic achievement were collected. We found that P1 children, compared to KG children, showed a greater change over time in activation related to response monitoring in the bilateral frontal cortex. The change in left frontal activation difference showed a small positive association with math performance. Overall, the school environment is important in shaping the development of the brain functions underlying the monitoring of one own's performance.

Diminished error-related negativity and error positivity in children and adults with externalizing problems and disorders: a meta-analysis on error processing

BACKGROUND

Deficits in error processing are reflected in an inability of people with externalizing problems to adjust their problem behaviour. The present study contains 2 meta-analyses, testing whether error processing - indexed by the event-related potentials error-related negativity (ERN) and error positivity (Pe) - is reduced in children and adults with externalizing problems and disorders compared to healthy controls.

METHODS

We conducted a systematic search in PubMed (1980 to December 2018), PsycInfo (1980 to December 2018) and Scopus (1970 to December 2018), identifying 328 studies. We included studies that measured error processing using the Eriksen flanker task, the go/no-go task or the stop-signal task in healthy controls and in adults or children with clearly described externalizing behavioural problems (e.g., aggression) or a clinical diagnosis on the externalizing spectrum (e.g., addiction).

RESULTS

Random-effect models (ERN: 23 studies, 1739 participants; Pe: 27 studies, 1456 participants) revealed a reduced ERN amplitude (Hedges' g = 0.44, 95% confidence interval [CI] 0.29 to 0.58) and a reduced Pe amplitude (Hedges' g = -0.27, 95% CI -0.44 to -0.09) during error processing in people with externalizing problems or disorders compared to healthy controls. Type of diagnosis, age and the presence of performance feedback or comorbidity did not moderate the results. The employed cognitive task was a moderator for Pe but not for ERN. The go/no-go task generated a greater amplitude difference in Pe than the Eriksen flanker task. Small-sample assessment revealed evidence of publication bias for both event-related potentials. However, a p curve analysis for ERN showed that evidential value was present; for Pe, the p curve analysis was inconclusive.

LIMITATIONS

The moderators did not explain the potential heterogeneity in most of the analysis, suggesting that other disorder- and patient-related factors affect error processing.

CONCLUSION

Our findings indicate the presence of compromised error processing in externalizing psychopathology, suggesting diminished activation of the prefrontal cortex during performance monitoring.

Heart Rate Variability in Children and Adolescents with Autism, ADHD and Co-occurring Autism and ADHD, During Passive and Active Experimental Conditions

Despite overlaps in clinical symptomatology, autism and ADHD may be associated with opposite autonomic arousal profiles which might partly explain altered cognitive and global functioning. We investigated autonomic arousal in 106 children/adolescents with autism, ADHD, co-occurring autism/ADHD, and neurotypical controls. Heart rate variability was recorded during resting-state, a 'passive' auditory oddball task and an 'active' response conflict task. Autistic children showed hyper-arousal during the active task, while those with ADHD showed hypo-arousal during resting-state and the passive task. Irrespective of diagnosis, children characterised by hyper-arousal showed more severe autistic symptomatology, increased anxiety and reduced global functioning than those displaying hypo-arousal, suggesting the importance of considering individual autonomic arousal profiles for differential diagnosis of autism/ADHD and when developing personalised interventions.

A systematic review and meta-analysis of altered electrophysiological markers of performance monitoring in Obsessive-Compulsive Disorder (OCD), Gilles de la Tourette Syndrome (GTS), Attention-Deficit/Hyperactivity disorder (ADHD) and Autism

Altered performance monitoring is implicated in obsessive-compulsive disorder (OCD), Gilles de la Tourette syndrome (GTS), attention-deficit/hyperactivity disorder (ADHD) and autism. We conducted a systematic review and meta-analysis of electrophysiological correlates of performance monitoring (error-related negativity, ERN; error positivity, Pe; feedback-related negativity, FRN; feedback-P3) in individuals with OCD, GTS, ADHD or autism compared to control participants, or associations between correlates and symptoms/traits of these conditions. Meta-analyses on 97 studies (5890 participants) showed increased ERN in OCD (Hedge's g = 0.54[CIs:0.44,0.65]) and GTS (g = 0.99[CIs:0.05,1.93]). OCD also showed increased Pe (g = 0.51[CIs:0.21,0.81]) and FRN (g = 0.50[CIs:0.26,0.73]). ADHD and autism showed reduced ERN (ADHD: g=-0.47[CIs:-0.67,-0.26]; autism: g=-0.61[CIs:-1.10,-0.13]). ADHD also showed reduced Pe (g=-0.50[CIs:-0.69,-0.32]). These findings suggest overlap in electrophysiological markers of performance monitoring alterations in four common neurodevelopmental conditions, with increased amplitudes of the markers in OCD and GTS and decreased amplitudes in ADHD and autism. Implications of these findings in terms of shared and distinct performance monitoring alterations across these neurodevelopmental conditions are discussed. PROSPERO pre-registration code: CRD42019134612.

Sensory processing and P300 event-related potential correlates of stimulant response in children with attention-deficit/hyperactivity disorder: A critical review

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder associated with considerable impairment in psychiatric and functional domains. Although stimulant medication can reduce core symptoms of inattention, hyperactivity, and impulsivity, a subgroup of patients does not respond to this intervention. A precision medicine approach has been proposed, whereby biomarkers are used to identify an effective treatment approach for a given individual. This review synthesizes the existing literature on event-related potential (ERP) correlates of stimulant response in children diagnosed with ADHD, with the goal of evaluating the potential for ERP to inform precision medicine care in this population. Forty-three articles were examined and results tentatively suggest that stimulant medications normalize the amplitude of the P300 component, and this is also associated with behavioral improvement. In contrast, results generally indicate that stimulants do not significantly alter early processing components, although there are some exceptions to this finding. Implications for research, theory, and clinical work are considered and concrete recommendations for future directions are provided. While recognizing limitations of existing literature (e.g., homogenous samples, variable methodologies), we conclude that ERP methods represent a promising approach for precision medicine care of patients with ADHD.

Error and post-error processing in children with attention-deficit/hyperactivity disorder: An electrical neuroimaging study

OBJECTIVE

Inaccurate and inconsistent response styles in attention-deficit/hyperactivity disorder (ADHD) have been observed in a wide variety of cognitive tasks, in line with regulatory deficit models of ADHD. Event-related potential (ERP) studies of error processing have provided evidence for these models, but are limited in specificity. We aimed to improve the isolation, localization and identification of error (self-monitoring and adaptive control) and post-error (implementation of cognitive control) processing in ADHD.

METHODS

ERPs were obtained for 46 ADHD and 51 typically developing (TD) children using the stop-signal task. Response-locked error (Ne and Pe) and stimulus-locked post-error (N2) components were compared between groups. Ne/Pe were corrected for preceding stimulus overlap and group differences were localized.

RESULTS

Ne was intact, while Pe amplitude was markedly reduced in children with ADHD (ηp² = 0.14). Pe differences were localized in the dorsal posterior/midcingulate (BA31/24) cortex. While the TD group showed increased N2 amplitude in post-error trials (ηp² = 0.24), localized in the left ventrolateral prefrontal cortex (VLPFC) and angular gyrus, the ADHD group did not.

CONCLUSIONS

Self-regulation deficits in ADHD are associated with later stages of error processing and subsequent implementation of cognitive control.

SIGNIFICANCE

We contribute to the literature by further specifying error processing deficits in ADHD.

Increased left inferior fronto-striatal activation during error monitoring after fMRI neurofeedback of right inferior frontal cortex in adolescents with attention deficit hyperactivity disorder

Attention Deficit/Hyperactivity Disorder (ADHD) is a self-regulation disorder, with impairments in error monitoring associated with underactivation of the related brain network(s). Psychostimulant medication improves ADHD symptoms and can upregulate brain function, but has side effects, with limited evidence for longer-term effects. Real-time functional magnetic resonance neurofeedback (fMRI-NF) has potential longer-term neuroplastic effects. We previously reported the effects of 11 runs of 8.5 min of fMRI-NF of the right inferior frontal cortex (rIFC) in adolescents with ADHD. This resulted in improvement of clinical symptom and enhanced rIFC activation post-pre treatment during response inhibition, when compared to a control group receiving fMRI-NF of the left parahippocampal gyrus (lPHG). In the current study we applied a novel analysis to the existing data by investigating the effects of fMRI-NF of rIFC in 16 adolescents with ADHD compared to fMRI-NF of lPHG in 11 adolescents with ADHD on the neurofunctional correlates of error monitoring during the same fMRI tracking stop task and potential associations with cognitive and clinical measures. We found stronger performance adjustment to errors in the rIFC-NF compared to the control lPHG-NF group. At the brain function level, fMRI-NF of rIFC compared to that of lPHG was associated with increased activation in error monitoring regions of the left IFC, premotor cortex, insula and putamen. The increased activation in left IFC-insular-striatal error monitoring regions in the rIFC-NF relative to the lPHG-NF group was furthermore trend-wise correlated with NF-induced ADHD symptom improvements. The findings of this study show, that during error monitoring, fMRI-NF training of rIFC upregulation elicited improvement in post-error behavioural adjustments and concomitant increased activation in left hemispheric fronto-insular-striatal and premotor regions mediating self-control and self-monitoring functions. This suggests that the administration of fMRI-NF of the rIFC may have had an impact on wider networks of self-regulation and self-monitoring in adolescents with ADHD.

Patients with mutations of the Thyroid hormone beta-receptor show an ADHD-like phenotype for performance monitoring: an electrophysiological study

Resistance to thyroid hormone beta (RTHβ) is a syndrome of reduced responsiveness of peripheral tissue to thyroid hormone, caused by mutations in the thyroid hormone receptor beta (THRB). Its cognitive phenotype has been reported to be similar to attention deficit hyperactivity disorder (ADHD). This study used electrophysiological biomarkers of performance monitoring in RTHβ to contribute further evidence on its phenotypical similarity to ADHD. Twenty-one participants with RTHβ aged 18-67 years and 21 matched healthy controls performed a modified flanker task during EEG recording. The RTHβ and control groups were compared on behavioural measures and components of event related potentials (ERPs), i.e. the error related negativity (ERN), the error positivity (Pe) and P3 component. There were no significant group differences with regard to behaviour. RTHβ subjects displayed significantly reduced ERN and Pe amplitudes compared to the controls in the response-locked ERPs. In addition, we observed reduced P3 amplitudes in both congruent and incongruent trials, as well as prolonged P3 latencies in RTHβ subjects in the stimulus-locked ERPs. Our findings reveal alterations in error detection and performance monitoring of RTHβ patients, likely indicating reduced error awareness. The electrophysiological phenotype of RTHß subjects with regard to action monitoring is indistinguishable from ADHD.

Neural mechanism underlying self-controlled feedback on motor skill learning

The present study investigated the neural mechanisms of self-controlled (SC) feedback underlying its learning advantages. Forty-two participants, including 24 females (16.43 ± 2.61 years) and 18 males (17.56 ± 0.86 years), were randomly assigned to a SC or yoked (YK) group. The 6-key-pressing task with a goal movement time was adopted as the experimental task. The behavioral results showed that the SC group demonstrated superior performance in transfer; however, the differences in retention did not reach statistical significance. Event-related potential analyses revealed that the SC group exhibited larger post-stimulus and post-feedback P3 amplitudes than the YK group in the frontal regions; these amplitudes were larger in the YK group in the parietal regions. The post-response error positivity amplitude was found to be larger in the YK group than in the SC group. These results suggest that SC feedback may allow the learner to more actively process the task stimuli and feedback information, and contributes to enhancing the learner's motivation and attachment to the task being practiced. The present study provides a neurophysiological explanation for why SC feedback is effective in learning a new motor skill.

Cognitive Control Over Visual Motion Processing - Are Children With ADHD Especially Compromised? A Pilot Study of Flanker Task Event-Related Potentials

Performance deficits and diminished brain activity during cognitive control and error processing are frequently reported in attention deficit/hyperactivity disorder (ADHD), indicating a “top-down” deficit in executive attention. So far, these findings are almost exclusively based on the processing of static visual forms, neglecting the importance of visual motion processing in everyday life as well as important attentional and neuroanatomical differences between processing static forms and visual motion. For the current study, we contrasted performance and electrophysiological parameters associated with cognitive control from two Flanker-Tasks using static stimuli and moving random dot patterns. Behavioral data and event-related potentials were recorded from 16 boys with ADHD (combined type) and 26 controls (aged 8–15 years). The ADHD group showed less accuracy especially for moving stimuli, and prolonged response times for both stimulus types. Analyses of electrophysiological parameters of cognitive control revealed trends for diminished N2-enhancements and smaller error-negativities (indicating medium effect sizes), and we detected significantly lower error positivities (large effect sizes) compared to controls, similarly for both static and moving stimuli. Taken together, the study supports evidence that motion processing is not fully developed in childhood and that the cognitive control deficit in ADHD is of higher order and independent of stimulus type.

ERP indices of performance monitoring and feedback processing in psychosis: A meta-analysis

BACKGROUND

Although individuals with, or at risk for, psychotic disorders often show difficulties with performance monitoring and feedback processing, findings from studies using event-related potentials (ERPs) to index these processes are not consistent. This meta-analytic review focused on studies of two different indexes of performance monitoring, the early error-related negativity (ERN; n = 25) and the later error positivity (Pe; n = 17), and one index of feedback processing, the feedback negativity (FN; n = 6).

METHODS

We evaluated whether individuals (1) with psychotic disorders, or (2) at heightened risk for these disorders differ from healthy controls in available studies of the ERN, Pe, and FN.

RESULTS

There was a significant, large ERN reduction in those with psychosis (g = -0.96) compared to controls, and a significant, moderate ERN reduction in those at-risk (g = -0.48). In contrast, there were uniformly non-significant, small between-group differences for Pe and FN (gs ≤ |0.16|).

CONCLUSIONS

The results reveal a differential pattern of impairment in psychosis. Early performance monitoring (ERN) impairments are substantial among those with psychotic disorders in general and may be a useful vulnerability indicator for these disorders. However, later performance monitoring (Pe) and basic feedback processing (FN) appear to be relatively spared in psychosis.

Social influences of error monitoring in adolescent girls

Adolescence is a developmental period characterized by increased social motivation and a heightened concern of peer evaluation. However, little research has examined social influences on neural functioning in adolescence. One psychophysiological measure of motivation, the error-related negativity (ERN), is an ERP following an error. In adults, the ERN is enhanced by contextual factors that influence motivation, such as social observation and evaluation. The current study examined relations among age and neural responses in social contexts in adolescence. Seventy-six adolescent girls (9-17 years old) completed a flanker task under two different conditions. In the social condition, adolescent girls were informed that two other adolescents would be observing and providing feedback about their performance. In the nonsocial condition, adolescent girls completed a flanker task alone and were told feedback was computer generated. Results revealed that younger adolescents exhibited a larger ERN in social contexts than nonsocial contexts. In contrast, there were no differences in the ERN between contexts among older adolescents. In addition, enhancements of the ERN in social contexts among younger adolescents diminished the relation between the ERN and age. These findings suggest that the ERN is sensitive to social contexts in early adolescence, and developmental changes in the ERN may be partially explained by contextual factors that influence motivation.

The Influence of Different Kinds of Incentives on Decision-Making and Cognitive Control in Adolescent Development: A Review of Behavioral and Neuroscientific Studies

A number of recent hypothetical models on adolescent development take a dual-systems perspective and propose an imbalance in the maturation of neural systems underlying reward-driven and control-related behavior. In particular, such models suggest that the relative dominance of the early emerging subcortical reward system over the later emerging prefrontal-guided control system leads to higher risk-taking and sensation-seeking behavior in mid-adolescents. Here, we will review recent empirical evidence from behavioral and neuroscientific studies examining interactions between these systems and showing that empirical evidence in support for the view of a higher sensitivity to rewards in mid-adolescents is rather mixed. One possible explanation for this may be the use of different kinds and amounts of incentives across studies. We will therefore include developmental studies comparing the differential influence of primary and secondary incentives, as well as those investigating within the class of secondary incentives the effects of monetary, cognitive, or social incentives. We hypothesized that the value of receiving sweets or sours, winning or losing small or large amounts of money, and being accepted or rejected from a peer group may also changes across development, and thereby might modulate age differences in decision-making and cognitive control. Our review revealed that although developmental studies directly comparing different kinds of incentives are rather scarce, results of various studies rather consistently showed only minor age differences in the impact of incentives on the behavioral level. In tendency, adolescents were more sensitive to higher amounts of incentives and larger uncertainty of receiving them, as well as to social incentives such as the presence of peers observing them. Electrophysiological studies showed that processing efficiency was enhanced during anticipation of incentives and receiving them, irrespective of incentive type. Again, we found no strong evidence for interactions with age across studies. Finally, functional brain imaging studies revealed evidence for overlapping brain regions activated during processing of primary and secondary incentives, as well as social and non-social incentives. Adolescents recruited similar reward-related and control-related brain regions as adults did, but to a different degree. Implications for future research will be discussed.

Electroencephalographic and cardiovascular markers of vulnerability within families of suicidal adolescents: A pilot study

Suicide, self-injury, and predisposing vulnerabilities aggregate in families. Those at greatest risk often show deficits in two biologically-mediated domains: behavioral control and emotion regulation. This pilot study explored electroencephalographic and cardiovascular indices of self-regulation among typical and suicidal adolescents (n = 30/group) and biological family members (mothers, fathers, and siblings). We measured event-related potentials during a flanker task designed to evoke impulsive responding and respiratory sinus arrhythmia (RSA) at rest and during social rejection. Multilevel models indicate control families' RSA was unaffected by social rejection (slope = 0.136, p = .097, d = 0.09), whereas clinical families demonstrated RSA withdrawal (slope = -0.191, p = .036, d = -0.13). Clinical families displayed weaker positive voltage (P_e) deflections following behavioral errors relative to controls (coefficient = -2.723, p = .017, d = -0.45), indicating risk for compromised cognitive control. Thus, families with suicidal adolescents showed autonomic and central nervous system differences in biological markers associated with suicide risk.

Functional coding variation in the presynaptic dopamine transporter associated with neuropsychiatric disorders drives enhanced motivation and context-dependent impulsivity in mice

Recent genetic analyses have provided evidence that clinical commonalities associated with different psychiatric diagnoses often have shared mechanistic underpinnings. The development of animal models expressing functional genetic variation attributed to multiple disorders offers a salient opportunity to capture molecular, circuit and behavioral alterations underlying this hypothesis. In keeping with studies suggesting dopaminergic contributions to attention-deficit hyperactivity disorder (ADHD), bipolar disorder (BPD) and autism spectrum disorder (ASD), subjects with these diagnoses have been found to express a rare, functional coding substitution in the dopamine (DA) transporter (DAT), Ala559Val. We developed DAT Val559 knock-in mice as a construct valid model of dopaminergic alterations that drive multiple clinical phenotypes, and here evaluate the impact of lifelong expression of the variant on impulsivity and motivation utilizing the 5- choice serial reaction time task (5-CSRTT) and Go/NoGo as well as tests of time estimation (peak interval analysis), reward salience (sucrose preference), and motivation (progressive ratio test). Our findings indicate that the DAT Val559 variant induces impulsivity behaviors that are dependent upon the reward context, with increased impulsive action observed when mice are required to delay responding for a reward, whereas mice are able to withhold responding if there is a probability of reward for a correct rejection. Utilizing peak interval and progressive ratio tests, we provide evidence that impulsivity is likely driven by an enhanced motivational phenotype that also may drive faster task acquisition in operant tasks. These data provide critical validation that DAT, and more generally, DA signaling perturbations can drive impulsivity that can manifest in specific contexts and not others, and may rely on motivational alterations, which may also drive increased maladaptive reward seeking.

A trans-diagnostic perspective on obsessive-compulsive disorder

Progress in understanding the underlying neurobiology of obsessive-compulsive disorder (OCD) has stalled in part because of the considerable problem of heterogeneity within this diagnostic category, and homogeneity across other putatively discrete, diagnostic categories. As psychiatry begins to recognize the shortcomings of a purely symptom-based psychiatric nosology, new data-driven approaches have begun to be utilized with the goal of solving these problems: specifically, identifying trans-diagnostic aspects of clinical phenomenology based on their association with neurobiological processes. In this review, we describe key methodological approaches to understanding OCD from this perspective and highlight the candidate traits that have already been identified as a result of these early endeavours. We discuss how important inferences can be made from pre-existing case-control studies as well as showcasing newer methods that rely on large general population datasets to refine and validate psychiatric phenotypes. As exemplars, we take 'compulsivity' and 'anxiety', putatively trans-diagnostic symptom dimensions that are linked to well-defined neurobiological mechanisms, goal-directed learning and error-related negativity, respectively. We argue that the identification of biologically valid, more homogeneous, dimensions such as these provides renewed optimism for identifying reliable genetic contributions to OCD and other disorders, improving animal models and critically, provides a path towards a future of more targeted psychiatric treatments.

Attention-Deficit/Hyperactivity Disorder Remission Is Linked to Better Neurophysiological Error Detection and Attention-Vigilance Processes

BACKGROUND

The processes underlying persistence and remission of attention-deficit/hyperactivity disorder (ADHD) are poorly understood. We examined whether cognitive and neurophysiological impairments on a performance-monitoring task distinguish between ADHD persisters and remitters.

METHODS

On average 6 years after initial assessment, 110 adolescents and young adults with childhood ADHD (87 persisters, 23 remitters) and 169 age-matched control participants were compared on cognitive-performance measures and event-related potentials of conflict monitoring (N2) and error processing (error-related negativity and positivity) from an arrow flanker task with low-conflict and high-conflict conditions. ADHD outcome was examined with parent-reported symptoms and functional impairment measures using a categorical (DSM-IV) and a dimensional approach.

RESULTS

ADHD persisters were impaired compared with controls on all cognitive-performance and event-related potential measures (all p < .05). ADHD remitters differed from persisters and were indistinguishable from control participants on the number of congruent (low-conflict) errors, reaction time variability, error-related negativity, and error-related positivity (all p ≤ .05). Remitters did not differ significantly from the other groups on incongruent (high-conflict) errors, mean reaction time, and N2. In dimensional analyses on all participants with childhood ADHD, ADHD symptoms and functional impairment at follow-up were significantly correlated with congruent errors, reaction time variability, and error-related positivity (r = .19-.23, p ≤ .05).

CONCLUSIONS

Cognitive and neurophysiological measures of attention-vigilance and error detection distinguished ADHD remitters from persisters. These results extend our previous findings with other tasks and indicate that such measures are markers of remission and candidates for the development of nonpharmacological interventions.

Error-related brain activity in the age of RDoC: A review of the literature

The ability to detect and respond to errors is critical to successful adaptation to a changing environment. The error-related negativity (ERN), an event-related potential (ERP) component, is a well-validated neural response to errors and reflects the error monitoring activity of the anterior cingulate cortex (ACC). Additionally, the ERN is implicated in several processes key to adaptive functioning. Abnormalities in error-related brain activity have been linked to multiple forms of psychopathology and individual differences. As such, the component is likely to be useful in NIMH's Research Domain Criteria (RDoC) initiative to establish biologically-meaningful dimensions of psychological dysfunction, and currently appears as a unit of measurement in three RDoC domains: Positive Valence Systems, Negative Valence Systems, and Cognitive Systems. In this review paper, we introduce the ERN and discuss evidence related to its psychometric properties, as well as important task differences. Following this, we discuss evidence linking the ERN to clinically diverse forms of psychopathology, as well as the implications of one unit of measurement appearing in multiple RDoC dimensions. And finally, we discuss important future directions, as well as research pathways by which the ERN might be leveraged to track the ways in which dysfunctions in multiple neural systems interact to influence psychological well-being.

Probabilistic reward learning in adults with Attention Deficit Hyperactivity Disorder--an electrophysiological study

Attention Deficit Hyperactivity Disorder (ADHD) is hypothesized to be characterized by altered reinforcement sensitivity. The main aim of the present study was to assess alterations in the electrophysiological correlates of monetary reward processing in adult patients with ADHD of the combined subtype. Fourteen adults with ADHD of the combined subtype and 14 healthy control participants performed an active and an observational probabilistic reward-based learning task while an electroencephalogramm (EEG) was recorded. Regardless of feedback valence, there was a general feedback-related negativity (FRN) enhancement in combination with reduced learning performance during both active and observational reward learning in patients with ADHD relative to healthy controls. Other feedback-locked potentials such as the P200 and P300 and response-locked potentials were unaltered in the patients. There were no significant correlations between learning performance, FRN amplitudes and clinical symptoms, neither in the overall group involving all participants, nor in patients or controls considered separately. This pattern of findings might reflect generally impaired reward prediction in adults with ADHD of the combined subtype. We demonstrated for the first time that patients with ADHD of the combined subtype show not only deficient active reward learning but are also impaired when learning by observing other people׳s outcomes.

Voluntary modulation of anterior cingulate response to negative feedback

Anterior cingulate and medial frontal cortex (dACC/mFC) response to negative feedback represents the actions of a generalized error-monitoring system critical for the management of goal-directed behavior. Magnitude of dACC/mFC response to negative feedback correlates with levels of post-feedback behavioral change, and with proficiency of operant learning processes. With this in mind, it follows that an ability to alter dACC/mFC response to negative feedback may lead to representative changes in operant learning proficiency. To this end, the present study investigated the extent to which healthy individuals would show modulation of their dACC/mFC response when instructed to try to either maximize or minimize their neural response to the presentation of contingent negative feedback. Participants performed multiple runs of a standard time-estimation task, during which they received feedback regarding their ability to accurately estimate a one-second duration. On Watch runs, participants were simply instructed to try to estimate as closely as possible the one second duration. On Increase and Decrease runs, participants performed the same task, but were instructed to “try to increase [decrease] their brain's response every time they received negative feedback”. Results indicated that participants showed changes in dACC/mFC response under these differing instructional conditions: dACC/mFC activity following negative feedback was higher in the Increase condition, and dACC activity trended lower in the Decrease condition, compared to the Watch condition. Moreover, dACC activity correlated with post-feedback performance adjustments, and these adjustments were highest in the Increase condition. Potential implications for neuromodulation and facilitated learning are discussed.

Error-monitoring in response to social stimuli in individuals with higher-functioning Autism Spectrum Disorder

Error-monitoring, or the ability to recognize one's mistakes and implement behavioral changes to prevent further mistakes, may be impaired in individuals with Autism Spectrum Disorder (ASD). Children and adolescents (ages 9-19) with ASD (n = 42) and typical development (n = 42) completed two face processing tasks that required discrimination of either the gender or affect of standardized face stimuli. Post-error slowing and the difference in Error-Related Negativity amplitude between correct and incorrect responses (ERNdiff ) were used to index error-monitoring ability. Overall, ERNdiff increased with age. On the Gender Task, individuals with ASD had a smaller ERNdiff than individuals with typical development; however, on the Affect Task, there were no significant diagnostic group differences on ERNdiff . Individuals with ASD may have ERN amplitudes similar to those observed in individuals with typical development in more social contexts compared to less social contexts due to greater consequences for errors, more effortful processing, and/or reduced processing efficiency in these contexts. Across all participants, more post-error slowing on the Affect Task was associated with better social cognitive skills.

The attention deficit hyperactivity disorder phenotype as a summation of deficits in executive functioning and reward sensitivity: does this explain its relationship with oppositional defiant disorder?

OBJECTIVE

Attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) commonly coexist but the relationship between them has not been well explained. We present a view of the ADHD phenotype as a summation of deficits in executive functioning and reward sensitivity and apply this to explain its co-occurrence with ODD.

MODEL

ADHD relates to difficulty in sustaining concentration for completing tasks. This is associated with lack of reward due to lack of achievement. The unfavorable balance of effort to reward in ADHD is exacerbated in ODD, a condition in which lack of reward is responsible for an adverse effect on mood resulting in a negative attitude and oppositional behavior. We have called this model the "Mental effort-reward imbalances model".

CONCLUSION

This model predicts that oppositional symptoms would be highly prevalent in ADHD, to the extent that ODD would be a frequent co-morbidity.

The effects of performance-based rewards on neurophysiological correlates of stimulus, error, and feedback processing in children with ADHD

Rewards have been shown to improve behavior and cognitive processes implicated in attention-deficit hyperactivity disorder (ADHD), but the information-processing mechanisms by which these improvements occur remain unclear. We examined the effect of performance-based rewards on ERPs related to processing of the primary task stimuli, errors, and feedback in children with ADHD and typically developing controls. Participants completed a flanker task containing blocks with and without performance-based rewards. Children with ADHD showed reduced amplitude of ERPs associated with processing of the flanker stimuli (P3) and errors (ERN, Pe), but did not differ in feedback-processing (FRN). Rewards enhanced flanker-related P3 amplitude similarly across groups and error-related Pe amplitude differentially for children with ADHD. These findings suggest that rewards may improve cognitive deficits in children with ADHD through enhanced processing of relevant stimuli and increased error evaluation.