A Pilot Study of Behavioral, Physiological, and Subjective Responses to Varying Mental Effort Requirements in Attention-Deficit/Hyperactivity Disorder

Neurophysiological measures and correlates of cognitive load in attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and dyslexia: A scoping review and research recommendations

Working memory is integral to a range of critical cognitive functions such as reasoning and decision-making. Although alterations in working memory have been observed in neurodivergent populations, there has been no review mapping how cognitive load is measured in common neurodevelopmental conditions such as attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and dyslexia. This scoping review explores the neurophysiological measures used to study cognitive load in these specific populations. Our findings highlight that electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) are the most frequently used methods, with a limited number of studies employing functional near-infrared spectroscopy (fNIRs), magnetoencephalography (MEG) or eye-tracking. Notably, eye-related measures are less commonly used, despite their prominence in cognitive load research among neurotypical individuals. The review also highlights potential correlates of cognitive load, such as neural oscillations in the theta and alpha ranges for EEG studies, blood oxygenation level-dependent (BOLD) responses in lateral and medial frontal brain regions for fMRI and fNIRS studies and eye-related measures such as pupil dilation and blink rate. Finally, critical issues for future studies are discussed, including the technical challenges associated with multimodal approaches, the possible impact of atypical features on cognitive load measures and balancing data richness with participant well-being. These insights contribute to a more nuanced understanding of cognitive load measurement in neurodivergent populations and point to important methodological considerations for future neuroscientific research in this area.

ADHD and the avoidance of mental effort: the role of response inhibition and avoidance motivation

OBJECTIVE

The tendency of people with ADHD to avoid tasks that require mental effort impacts their academic achievement. Findings in the literature suggest that children with ADHD find cognitive tasks more effortful and uncomfortable than their typically developing peers. However, neuropsychological processes contributing to this remain unclear. The present study investigated whether the relationship between prepotent motor response inhibition and avoiding mental effort is mediated by the ability to resist avoidance motivation and whether this proposed mediation mechanism is contingent on ADHD diagnosis.

METHOD

40 children with ADHD and 40 gender and age-matched typically developing peers participated in the study. They completed the Cognitive Effort Avoidance Measure, the Go/No-go Task, and the Reinforcement Sensitivity Theory-Personality Questionnaire-Children. Mediation and moderated mediation analyses were employed to test the hypotheses.

RESULTS

Children with ADHD scored lower in response inhibition and resisting avoidance motivation. Poorer scores in these variables were associated with a higher avoidance rate. Moreover, the ability to resist avoidance motivation completely mediated the relationship between response inhibition and avoidance rate only among children with ADHD.

CONCLUSION

Findings imply that poorer response inhibition led to an increase in avoidance motivation among children with ADHD, which becomes challenging to regulate effectively due to an impairment in the ability to resist avoidance motivation. Theoretical and clinical implications are discussed.

Within-individual BOLD signal variability in the N-back task and its associations with vigilance and working memory

In a group of healthy adults (N = 48), this study evaluated how fMRI Blood Oxygen Level-Dependent (BOLD) signal variability differed across letter n-back task load and quantified the extent to which BOLD signal variability was associated with in-scanner accuracy and reaction time as well as out-of-scanner measures of vigilance and working memory (WM). Within-individual BOLD signal variability in regions of interest (ROIs, identified as peak coordinates in an attention/vigilance and WM network using Neurosynth) was differentially modulated across vigilance and WM trials. Within-individual BOLD signal variability was significantly greater across the majority of the ROIs in the working memory trials (2- and 3-back trials) compared to 0-back trials. Notably, this increased variability across the network was accompanied by significantly less variability in the left cingulate gyrus and left inferior temporal lobe during the working memory trials. Significantly fewer differences in within-individual BOLD signal variability were identified for vigilance trials (0- and 1-back trials) compared to crosshair. We hypothesized that increased BOLD signal variability would be associated with n-back task performance and with out-of-scanner measures of vigilance (Digit Span Forward) and WM (Auditory Consonant Trigrams and Digit Span Backward). These results were non-significant after correcting for multiple comparisons. Furthermore, using multivariate analyses (partial least squares regression; PLS-R), within-individual BOLD signal variability in regions associated with a WM-vigilance network did not significantly predict out-of-scanner test performance after appropriate cross validation, yet provided a promising trend for WM trials; greater within-individual BOLD signal variability during WM n-back trials was associated with decreased performance on all included neuropsychological measures, which provides partial support for previous findings. This study demonstrates that patterns of variability differ based on task load in the scanner and illustrates an intriguing association between within-individual BOLD signal variability and out-of-scanner behavioral performance that may be better explored in future studies with a larger sample size.

Identification of attention-deficit hyperactivity disorder based on the complexity and symmetricity of pupil diameter

Adult attention-deficit/hyperactivity disorder (ADHD) frequently leads to psychological/social dysfunction if unaddressed. Identifying a reliable biomarker would assist the diagnosis of adult ADHD and ensure that adults with ADHD receive treatment. Pupil diameter can reflect inherent neural activity and deficits of attention or arousal characteristic of ADHD. Furthermore, distinct profiles of the complexity and symmetricity of neural activity are associated with some psychiatric disorders. We hypothesized that analysing the relationship between the size, complexity of temporal patterns, and asymmetricity of pupil diameters will help characterize the nervous systems of adults with ADHD and that an identification method combining these features would ease the diagnosis of adult ADHD. To validate this hypothesis, we evaluated the resting state hippus in adult participants with or without ADHD by examining the pupil diameter and its temporal complexity using sample entropy and the asymmetricity of the left and right pupils using transfer entropy. We found that large pupil diameters and low temporal complexity and symmetry were associated with ADHD. Moreover, the combination of these factors by the classifier enhanced the accuracy of ADHD identification. These findings may contribute to the development of tools to diagnose adult ADHD.

Atypical alert state control in adult patients with ADHD: A pupillometry study

Although behavioral studies have repeatedly demonstrated that individuals with attention-deficit/hyperactivity disorder (ADHD) have deficits in alertness, little is known about its underlying neural basis. It is hypothesized that pupil diameter reflects the firing of norepinephrine (NE) neurons in the locus coeruleus (LC), and that the LC-NE neuromodulatory system for regulating alertness may be dysfunctional in ADHD. To clinically and non-invasively examine this hypothesis, we monitored the kinetics of pupil diameter in response to stimuli and compared them between adults with ADHD (n = 17) and typically developing (TD) adults (n = 23) during an auditory continuous performance task. Individuals in the ADHD group exhibited a significantly larger tonic pupil diameter, and a suppressed stimulus-evoked phasic pupil dilation, compared to those in the TD group. These findings provide support for the idea that the aberrant regulatory control of pupil diameter in adults with ADHD may be consistent with a compromised state of alertness resulting from a hyperactivated LC-NE system.