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Andrikopoulos D, Vassiliou G, Fatouros P, Tsirmpas C, Pehlivanidis A, Papageorgiou C. Machine learning-enabled detection of attention-deficit/hyperactivity disorder with multimodal physiological data: a case-control study. BMC Psychiatry 2024; 24:547. [PMID: 39103819 DOI: 10.1186/s12888-024-05987-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 07/25/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Attention-Deficit/Hyperactivity Disorder (ADHD) is a multifaceted neurodevelopmental psychiatric condition that typically emerges during childhood but often persists into adulthood, significantly impacting individuals' functioning, relationships, productivity, and overall quality of life. However, the current diagnostic process exhibits limitations that can significantly affect its overall effectiveness. Notably, its face-to-face and time-consuming nature, coupled with the reliance on subjective recall of historical information and clinician subjectivity, stand out as key challenges. To address these limitations, objective measures such as neuropsychological evaluations, imaging techniques and physiological monitoring of the Autonomic Nervous System functioning, have been explored. METHODS The main aim of this study was to investigate whether physiological data (i.e., Electrodermal Activity, Heart Rate Variability, and Skin Temperature) can serve as meaningful indicators of ADHD, evaluating its utility in distinguishing adult ADHD patients. This observational, case-control study included a total of 76 adult participants (32 ADHD patients and 44 healthy controls) who underwent a series of Stroop tests, while their physiological data was passively collected using a multi-sensor wearable device. Univariate feature analysis was employed to identify the tests that triggered significant signal responses, while the Informative k-Nearest Neighbors (KNN) algorithm was used to filter out less informative data points. Finally, a machine-learning decision pipeline incorporating various classification algorithms, including Logistic Regression, KNN, Random Forests, and Support Vector Machines (SVM), was utilized for ADHD patient detection. RESULTS Results indicate that the SVM-based model yielded the optimal performance, achieving 81.6% accuracy, maintaining a balance between the experimental and control groups, with sensitivity and specificity of 81.4% and 81.9%, respectively. Additionally, integration of data from all physiological signals yielded the best results, suggesting that each modality captures unique aspects of ADHD. CONCLUSIONS This study underscores the potential of physiological signals as valuable diagnostic indicators of adult ADHD. For the first time, to the best of our knowledge, our findings demonstrate that multimodal physiological data collected via wearable devices can complement traditional diagnostic approaches. Further research is warranted to explore the clinical applications and long-term implications of utilizing physiological markers in ADHD diagnosis and management.
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Affiliation(s)
| | - Georgia Vassiliou
- First Department of Psychiatry, Eginition Hospital, Medical School National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Artemios Pehlivanidis
- First Department of Psychiatry, Eginition Hospital, Medical School National and Kapodistrian University of Athens, Athens, Greece
| | - Charalabos Papageorgiou
- First Department of Psychiatry, Eginition Hospital, Medical School National and Kapodistrian University of Athens, Athens, Greece
- Neurosciences and Precision Medicine Research Institute "Costas Stefanis", University Mental Health, Athens, Greece
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Bucherbeam TR, Lovett BJ, Harrison AG. ADHD and Anxiety Symptoms: Does Construct or Assessment Type Matter More? J Atten Disord 2024; 28:1152-1157. [PMID: 38323532 DOI: 10.1177/10870547231220905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
OBJECTIVE This study examined the relationships between self-reported ADHD symptoms, self-reported anxiety, and continuous performance test (CPT) performance. METHOD 128 postsecondary students referred for clinical evaluation for possible ADHD and related conditions completed the Conners Adult ADHD Rating Scale, the Behavior Assessment Scale for Children, Third Edition, and either of two CPTs. RESULTS Multiple regression models found that when self-reported anxiety and CPT performance were used to simultaneously predict self-reported ADHD symptoms, CPT performance was not a significant predictor, whereas self-reported anxiety was. This finding was replicated across two different subsamples that took different CPTs. CONCLUSION Self-reported anxiety and ADHD symptoms are strongly related, but neither of these variables is significantly related to CPT performance. Implications for clinical practice and future research are discussed.
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Machado YDC, Oliveira M, Lima JLF, Bhargav H, Varambally S, de Miranda DM, Romano-Silva MA. Effects of yoga on impulsivity in patients with and without mental disorders: a systematic review. BMC Psychiatry 2024; 24:267. [PMID: 38594701 PMCID: PMC11003078 DOI: 10.1186/s12888-024-05608-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 02/14/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Yoga can be used as a complementary intervention to conventional treatments, whether pharmacological or non-pharmacological. Sustained practice of yoga can generate a series of benefits for individuals' quality of life and improve their physical fitness. OBJECTIVE To investigate the potential effects of yoga as an adjunct intervention in conditions involving impulse control issues, such as attention deficit hyperactivity disorder (ADHD), borderline personality disorder, bipolar affective disorder, and substance use disorders. METHODS We performed a systematic review of placebo-controlled, randomized trials of yoga in patients with impulsivity. PubMed, Web of Science, and Science Direct databases were searched for trials published up to January, 2023. Data were extracted from published reports and quality assessment was performed per Cochrane recommendations. RESULTS Out of 277 database results, 6 RCT were included in this systematic review. To assess the level of attention and impulsiveness, the following scales were analyzed: Barratt Impulsiveness, UPPS-P Impulsive Behavior scale, Conners' Continuous Performance Test IIª and Conners' Parent Rating Scale-Revised: Long. CONCLUSIONS Yoga didn't have a significant improvement in impulsivity when compared to placebo. There are many tools to assess impulsivity, but they mean different concepts and domains consisting in a weakness on comparison of yoga effects. PROSPERO REGISTRATION CRD42023389088.
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Affiliation(s)
| | - Mariana Oliveira
- Faculdade de Ensino Superior da Amazônia Reunida, Redenção, Brazil
| | | | - Hemant Bhargav
- National Institute of Mental Health and Neurosciences, Bengaluru, India
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Callan PD, Swanberg S, Weber SK, Eidnes K, Pope TM, Shepler D. Diagnostic Utility of Conners Continuous Performance Test-3 for Attention Deficit/Hyperactivity Disorder: A Systematic Review. J Atten Disord 2024; 28:992-1007. [PMID: 38317541 DOI: 10.1177/10870547231223727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
OBJECTIVE To review the literature on the utility of the Conners CPT-3 in persons with ADHD. METHODS A systematic review was conducted. Six databases were searched using inclusion criteria: research studies, year 2000+, English, and ages 8+. Two raters independently screened 1,480 title/abstracts and subsequently reviewed 399 full texts. Data extraction and critical appraisal were conducted. Reflective thematic analysis through inductive coding identified qualitative themes. RESULTS Thirteen studies met inclusion criteria with five themes identified. Five studies found CPT-3 was a weak or poor predictor of ADHD diagnosis while two found it was an adequate predictor. Two studies found CPT-3 could differentiate clients with comorbid ADHD/anxiety from ADHD or ADHD from obsessive-compulsive disorder. One found CPT-3 could not differentiate ADHD from ASD or comorbid ADHD/ASD. CONCLUSIONS Results revealed CPT-3 as a standalone measure is a weak or poor predictor of ADHD. Multiple measures for evaluating persons with ADHD are recommended.
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Affiliation(s)
| | | | - Sarah K Weber
- Michigan School of Psychology, Farmington Hills, MI, USA
| | - Kari Eidnes
- Michigan School of Psychology, Farmington Hills, MI, USA
| | - Tara M Pope
- Michigan School of Psychology, Farmington Hills, MI, USA
| | - Dustin Shepler
- Michigan School of Psychology, Farmington Hills, MI, USA
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Varela JL, Magnante AT, Miskey HM, Ord AS, Eldridge A, Shura RD. A systematic review of the utility of continuous performance tests among adults with ADHD. Clin Neuropsychol 2024:1-62. [PMID: 38424025 DOI: 10.1080/13854046.2024.2315740] [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: 08/14/2023] [Accepted: 12/16/2023] [Indexed: 03/02/2024]
Abstract
OBJECTIVE The clinical utility of continuous performance tests (CPTs) among adults with attention-deficit/hyperactivity disorder (ADHD) has increasingly been brought under question. Therefore, the objective of this study was to systematically review the literature to investigate the clinical utility of various commercially available CPTs, including the Conner's Continuous Performance Test (CCPT), Test of Variables of Attention (TOVA), Gordon Diagnostic System (GDS), and Integrated Visual and Auditory Continuous Performance Test (IVA) in the adult ADHD population. METHODS This systematic review followed the a priori PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Articles were gathered from PsycINFO, PsycARTICLES, Academic Search Complete, and Google Scholar on 11 April 2022. Sixty-nine articles were included in the final review. Risk of bias was assessed using the National Institute of Health Quality Assessment Took for Observational Cohort and Cross-Sectional Studies. RESULTS Most articles demonstrated high risk of bias, and there was substantial heterogeneity across studies. Overall, the reviewed CPTs appeared to have limited diagnostic utility and classification accuracy. Although many studies showed differing scores between adults with ADHD and comparison groups, findings were not consistent. Characteristics of CPT performances among adults with ADHD were mixed, with little consistency and no evidence of a clear profile of performances; however, CCPT commission errors appeared to have the most utility when used a treatment or experimental outcome measure, compared to other CCPT scores. CONCLUSION Overall, CPTs should not be used in isolation as a diagnostic test but may be beneficial when used as a component of a comprehensive assessment.
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Affiliation(s)
- Jacob L Varela
- College of Health and Behavioral Sciences, Regent University, Virginia Beach, VA, USA
| | - Anna T Magnante
- W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, USA
- Education, and Clinical Center, VA Mid-Atlantic Mental Illness Research, Durham, NC, USA
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Holly M Miskey
- W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, USA
- Education, and Clinical Center, VA Mid-Atlantic Mental Illness Research, Durham, NC, USA
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Anna S Ord
- College of Health and Behavioral Sciences, Regent University, Virginia Beach, VA, USA
| | - Adrienne Eldridge
- College of Health and Behavioral Sciences, Regent University, Virginia Beach, VA, USA
| | - Robert D Shura
- W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, USA
- Education, and Clinical Center, VA Mid-Atlantic Mental Illness Research, Durham, NC, USA
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Tolonen T, Roine T, Alho K, Leppämäki S, Tani P, Koski A, Laine M, Salmi J. Abnormal wiring of the structural connectome in adults with ADHD. Netw Neurosci 2023; 7:1302-1325. [PMID: 38144696 PMCID: PMC10631790 DOI: 10.1162/netn_a_00326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/19/2023] [Indexed: 12/26/2023] Open
Abstract
Current knowledge of white matter changes in large-scale brain networks in adult attention-deficit/hyperactivity disorder (ADHD) is scarce. We collected diffusion-weighted magnetic resonance imaging data in 40 adults with ADHD and 36 neurotypical controls and used constrained spherical deconvolution-based tractography to reconstruct whole-brain structural connectivity networks. We used network-based statistic (NBS) and graph theoretical analysis to investigate differences in these networks between the ADHD and control groups, as well as associations between structural connectivity and ADHD symptoms assessed with the Adult ADHD Self-Report Scale or performance in the Conners Continuous Performance Test 2 (CPT-2). NBS revealed decreased connectivity in the ADHD group compared to the neurotypical controls in widespread unilateral networks, which included subcortical and corticocortical structures and encompassed dorsal and ventral attention networks and visual and somatomotor systems. Furthermore, hypoconnectivity in a predominantly left-frontal network was associated with higher amount of commission errors in CPT-2. Graph theoretical analysis did not reveal topological differences between the groups or associations between topological properties and ADHD symptoms or task performance. Our results suggest that abnormal structural wiring of the brain in adult ADHD is manifested as widespread intrahemispheric hypoconnectivity in networks previously associated with ADHD in functional neuroimaging studies.
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Affiliation(s)
- Tuija Tolonen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Timo Roine
- Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
- Turku Brain and Mind Center, University of Turku, Turku, Finland
| | - Kimmo Alho
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
- AMI Centre, Aalto Neuroimaging, Aalto University, Espoo, Finland
| | | | - Pekka Tani
- Department of Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | - Anniina Koski
- Department of Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | - Matti Laine
- Turku Brain and Mind Center, University of Turku, Turku, Finland
- Department of Psychology, Åbo Akademi University, Turku, Finland
| | - Juha Salmi
- Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
- AMI Centre, Aalto Neuroimaging, Aalto University, Espoo, Finland
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Skalidou S, Anestis A, Bakolas N, Tsoulfa G, Papadimitriou K. Swimming Activity Alleviates the Symptoms of Attention: Deficit Hyperactivity Disorder (ADHD) a Case Report. Healthcare (Basel) 2023; 11:1999. [PMID: 37510440 PMCID: PMC10379488 DOI: 10.3390/healthcare11141999] [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: 05/18/2023] [Revised: 07/05/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is a neurobehavioral disorder characterized by inattention, hyperactivity, and impulsivity. Sport and physical activity have been shown to play a major role in the development of cognition, memory, selective attention, and motor reaction time, especially among adolescents with ADHD. In this context, the objective of this study was to investigate the effects of a swimming exercise program on the symptoms of ADHD in an adult with a diagnosis since childhood. The training intervention was performed for eight weeks, and the results demonstrated that the swimming-learning program significantly alleviated the symptoms of inattention and hyperactivity, as measured by the psychometric indices used in the study. Further studies are needed to establish and understand the association between physical activities and improved mental performance in adults with ADHD.
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Affiliation(s)
- Smaragda Skalidou
- Laboratory of Hygiene, Social-Preventive Medicine and Medical Statistics, Faculty of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Andreas Anestis
- Laboratory of Hygiene, Social-Preventive Medicine and Medical Statistics, Faculty of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
- Division of Technology and Sciences, The American College of Thessaloniki, 55535 Thessaloniki, Greece
| | | | - Georgia Tsoulfa
- Division of Technology and Sciences, The American College of Thessaloniki, 55535 Thessaloniki, Greece
| | - Konstantinos Papadimitriou
- Faculty of Health and Rehabilitation Sciences, University of East London, Metropolitan College of Thessaloniki, 54624 Thessaloniki, Greece
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Pagán AF, Huizar YP, Short TR, Gotcher Z, Schmidt AT. Adult Attention-Deficit/Hyperactivity Disorder: a Narrative Review of Biological Mechanisms, Treatments, and Outcomes. Curr Neurol Neurosci Rep 2023:10.1007/s11910-023-01280-4. [PMID: 37335460 DOI: 10.1007/s11910-023-01280-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE OF REVIEW Attention-deficit/hyperactivity disorder (ADHD) is a heterogeneous and complex neurodevelopmental disorder related to disruptions in various neuronal structures and pathways, dopamine (DA) transporter, and receptor genes, resulting in cognitive and regulation deficits. This article reviews recent research on the biological mechanisms and markers, clinical manifestations, treatments, and outcomes of adult ADHD as well as current controversies within the field. RECENT FINDINGS New research identifies white matter disruptions in multiple cortical pathways in adults with ADHD. New treatments for ADHD in adults such as viloxazine ER have shown preliminary effectiveness in addition to research showing transcranial direct current stimulation can be an effective treatment for adults with ADHD. Although questions exist about the effectiveness of current assessments of and treatments for adult ADHD, recent findings represent a step towards improving the quality of life and outcomes for individuals experiencing this life-long, chronic health condition.
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Affiliation(s)
- Antonio F Pagán
- Department of Psychological Sciences, Texas Tech University, Psychological Sciences Building, 2700 18th St, Lubbock, TX, 79410, USA.
| | - Yazmine P Huizar
- Department of Psychological Sciences, Texas Tech University, Psychological Sciences Building, 2700 18th St, Lubbock, TX, 79410, USA
| | - Tucker R Short
- Department of Psychological Sciences, Texas Tech University, Psychological Sciences Building, 2700 18th St, Lubbock, TX, 79410, USA
| | - Zoe Gotcher
- Department of Psychological Sciences, Texas Tech University, Psychological Sciences Building, 2700 18th St, Lubbock, TX, 79410, USA
| | - Adam T Schmidt
- Department of Psychological Sciences, Texas Tech University, Psychological Sciences Building, 2700 18th St, Lubbock, TX, 79410, USA
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