Why am I overwhelmed by bright lights? The behavioural mechanisms of post-stroke visual hypersensitivity

After stroke, patients can experience visual hypersensitivity, an increase in their sensitivity for visual stimuli as compared to their state prior to the stroke. Candidate behavioural mechanisms for these subjective symptoms are atypical bottom-up sensory processing and impaired selective attention, but empirical evidence is currently lacking. In the current study, we aimed to investigate the relationship between post-stroke visual hypersensitivity and sensory thresholds, sensory processing speed, and selective attention using computational modelling of behavioural data. During a whole/partial report task, participants (51 stroke patients, 76 orthopedic patients, and 77 neurotypical adults) had to correctly identify a single target letter that was presented alone (for 17-100 ms) or along a distractor (for 83ms). Performance on this task was used to estimate the sensory threshold, sensory processing speed, and selective attention abilities of each participant. In the stroke population, both on a group and individual level, there was evidence for impaired selective attention and -to a lesser extent- lower sensory thresholds in patients with post-stroke visual hypersensitivity as compared to neurotypical adults, orthopedic patients, or stroke patients without post-stroke sensory hypersensitivity. These results provide a significant advancement in our comprehension of post-stroke visual hypersensitivity and can serve as a catalyst for further investigations into the underlying mechanisms of sensory hypersensitivity after other types of acquired brain injury as well as post-injury hypersensitivity for other sensory modalities.

Atypical neurocognitive functioning in children and adolescents with obsessive-compulsive disorder (OCD)

Atypical neurocognitive functioning has been found in adult patients with obsessive-compulsive disorder (OCD). However, little work has been done in children and adolescents with OCD. In this study, we investigated neurocognitive functioning in a large and representative sample of newly diagnosed children and adolescents with OCD compared to non-psychiatric controls. Children and adolescents with OCD (n = 119) and non-psychiatric controls (n = 90) underwent psychopathological assessment, intelligence testing, and a neurocognitive test battery spanning cognitive flexibility, planning and decision-making, working memory, fluency, and processing speed. The MANOVA main effect revealed that children and adolescents with OCD performed significantly worse than the control group (p < .001, [Formula: see text] = 0.256). Atypical patient performance was particularly found for indices of cognitive flexibility, decision-making, working memory, and processing speed. We found no evidence of differences in planning or fluency. Moreover, we found no significant associations between neurocognitive performance and OCD symptom severity or comorbidity status. Our results indicate that children and adolescents with OCD show selective atypical neurocognitive functioning. These difficulties do not appear to drive their OCD symptoms. However, they may contribute to lifespan difficulties and interfere with treatment efficacy, an objective of our research currently.

Adverse events in cognitive behavioral therapy and relaxation training for children and adolescents with obsessive-compulsive disorder: A mixed methods study and analysis plan for the TECTO trial

Background

Knowledge on adverse events in psychotherapy for youth with OCD is sparse. No official guidelines exist for defining or monitoring adverse events in psychotherapy. Recent recommendations call for more qualitative and quantitative assessment of adverse events in psychotherapy trials. This mixed methods study aims to expand knowledge on adverse events in psychotherapy for youth with OCD.

Methods

This is an analysis plan for a convergent mixed methods study within a randomized clinical trial (the TECTO trial). We include at least 128 youth aged 8-17 years with obsessive-compulsive disorder (OCD). Participants are randomized to either family-based cognitive behavioral therapy (FCBT) or family-based psychoeducation and relaxation training (FPRT). Adverse events are monitored quantitatively with the Negative Effects Questionnaire. Furthermore, we assess psychiatric symptoms, global functioning, quality of life, and family factors to investigate predictors for adverse events. We conduct semi-structured qualitative interviews with all youths and their parents on their experience of adverse events in FCBT or FPRT. For the mixed methods analysis, we will merge 1) a qualitative content analysis with descriptive statistics comparing the types, frequencies, and severity of adverse events; 2) a qualitative content analysis of the perceived causes for adverse events with prediction models for adverse events; and 3) a thematic analysis of the participants' treatment evaluation with a correlational analysis of adverse events and OCD severity.

Discussion

The in-depth mixed methods analysis can inform 1) safer and more effective psychotherapy for OCD; 2) instruments and guidelines for monitoring adverse events; and 3) patient information on potential adverse events. The main limitation is risk of missing data.

Trial registration

ClinicalTrials.gov identifier: NCT03595098. Registered on July 23, 2018.

Effects of methylphenidate on mismatch negativity and P3a amplitude of initially psychostimulant-naïve, adult ADHD patients

BACKGROUND

Deficient information processing in ADHD theoretically results in sensory overload and may underlie the symptoms of the disorder. Mismatch negativity (MMN) and P3a amplitude reflect an individual's detection and subsequent change in attention to stimulus change in their environment. Our primary aim was to explore MMN and P3a amplitude in adult ADHD patients and to examine the effects of methylphenidate (MPH) on these measures.

METHODS

Forty initially psychostimulant-naïve, adult ADHD patients without comorbid ASD and 42 matched healthy controls (HC) were assessed with an MMN paradigm at baseline. Both groups were retested after 6 weeks, in which patients were treated with MPH.

RESULTS

Neither significant group differences in MMN nor P3a amplitude were found at baseline. Although 6-week MPH treatment significantly reduced symptomatology and improved daily functioning of the patients, it did not significantly affect MMN amplitude; however, it did significantly reduce P3a amplitude compared to the HC. Furthermore, more severe ADHD symptoms were significantly associated with larger MMN amplitudes in the patients, both at baseline and follow-up.

CONCLUSION

We found no evidence for early information processing deficits in patients with ADHD, as measured with MMN and P3a amplitude. Six-week treatment with MPH decreased P3a but not MMN amplitude, although more severe ADHD-symptoms were associated with larger MMN amplitudes in the patients. Given that P3a amplitude represents an important attentional process and that glutamate has been linked to both ADHD and MMN amplitude, future research should investigate augmenting MPH treatment of less responsive adults with ADHD with glutamatergic antagonists.

Effects of methylphenidate on subjective sleep parameters in adults with ADHD: a prospective, non-randomized, non-blinded 6-week trial

OBJECTIVE

Methylphenidate is a first-line treatment for ADHD; its contribution to sleep problems in adult ADHD is currently unclear. This study investigates (a) subjective sleep disturbances in a group of initially stimulant medication-naïve adults with ADHD and (b) reported changes in sleep problems after 6 weeks of methylphenidate treatment.

METHOD

A prospective, non-randomized, non-blinded, 6-week follow-up study utilising a self-report measure.

RESULTS

We found (1) a large difference in reported sleep quality between methylphenidate medication-naïve patients and controls at baseline, (2) a marked improvement in patients after methylphenidate medication, and (3) largest improvement for patients with the poorest reported sleep at baseline.

CONCLUSION

The study indicates that treatment with methylphenidate increases subjective sleep quality for at least some adults with ADHD.

Theory of visual attention (TVA) applied to rats performing the 5-choice serial reaction time task: differential effects of dopaminergic and noradrenergic manipulations

RATIONALE

Attention is compromised in many psychiatric disorders, including attention-deficit/hyperactivity disorder (ADHD). While dopamine and noradrenaline systems have been implicated in ADHD, their exact role in attentional processing is yet unknown.

OBJECTIVES

We applied the theory of visual attention (TVA) model, adapted from human research, to the rat 5-choice serial reaction time task (5CSRTT) to investigate catecholaminergic modulation of visual attentional processing in healthy subjects of high- and low-attention phenotypes.

METHODS

Rats trained on the standard 5CSRTT and tested with variable stimulus durations were treated systemically with noradrenergic and/or dopaminergic agents (atomoxetine, methylphenidate, amphetamine, phenylephrine and atipamezole). TVA modelling was applied to estimate visual processing speed for correct and incorrect visual perceptual categorisations, independent of motor reaction times, as measures of attentional capacity.

RESULTS

Atomoxetine and phenylephrine decreased response frequencies, including premature responses, increased omissions and slowed responding. In contrast, methylphenidate, amphetamine and atipamezole sped up responding and increased premature responses. Visual processing speed was also affected differentially. Atomoxetine and phenylephrine slowed, whereas methylphenidate and atipamezole sped up, visual processing, both for correct and incorrect categorisations. Amphetamine selectively improved visual processing for correct, though not incorrect, responses in high-attention rats only, possibly reflecting improved attention.

CONCLUSIONS

These data indicate that the application of TVA to the 5CSRTT provides an enhanced sensitivity to capturing attentional effects. Unexpectedly, we found overall slowing effects, including impaired visual processing, following drugs either increasing extracellular noradrenaline (atomoxetine) or activating the α1-adrenoceptor (phenylephrine), while also ameliorating premature responses (impulsivity). In contrast, amphetamine had potential pro-attentional effects by enhancing visual processing, probably due to central dopamine upregulation.

Family-based cognitive behavioural therapy versus family-based relaxation therapy for obsessive-compulsive disorder in children and adolescents (the TECTO trial): a statistical analysis plan for the randomised clinical trial

Background

Obsessive-compulsive disorder (OCD) is a debilitating psychiatric disorder which affects up to 3% of children and adolescents. OCD in children and adolescents is generally treated with cognitive behavioural therapy (CBT), which, in more severely affected patients, can be combined with antidepressant medication. The TECTO trial aims to compare the benefits and harms of family-based CBT (FCBT) versus family-based psychoeducation/relaxation training (FPRT) in children and adolescents aged 8 to 17 years. This statistical analysis plan outlines the planned statistical analyses for the TECTO trial.

Methods

The TECTO trial is an investigator-initiated, independently funded, single-centre, parallel-group, superiority randomised clinical trial. Both groups undergo 14 sessions of 75 min each during a period of 16 weeks with either FCBT or FPRT depending on the allocation. Participants are randomised stratified by age and baseline Children’s Yale–Brown Obsessive-Compulsive Scale (CY-BOCS) score. The primary outcome is the CY-BOCS score. Secondary outcomes are health-related quality of life assessed using KIDSCREEN-10 and adverse events assessed by the Negative Effects Questionnaire (NEQ). Primary and secondary outcomes are assessed at the end of the intervention. Continuous outcomes will be analysed using linear regression adjusted for the stratification variables and baseline value of the continuous outcome. Dichotomous outcomes will be analysed using logistic regression adjusted for the stratification variables. The statistical analyses will be carried out by two independent blinded statisticians.

Discussion

This statistical analysis plan includes a detailed predefined description of how data will be analysed and presented in the main publication before unblinding of study data. Statistical analysis plans limit selective reporting bias. This statistical analysis plan will increase the validity of the final trial results.

Trial registration

ClinicalTrials.gov NCT03595098. July 23, 2018

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-022-06799-4.

Emotion regulation in 7-year-old children with familial high risk for schizophrenia or bipolar disorder compared to controls - The Danish High Risk and Resilience Study - VIA 7, a population-based cohort study

OBJECTIVES

Emotion regulation is a predictor of overall life outcome. Problems of emotion regulation are associated with multiple psychiatric disorders and could be a potential treatment target for improving well-being and functioning. Children at familial high risk of severe mental illness have a markedly increased risk of various psychopathology and constitute a group at significant risk of emotion regulation problems. Investigations of emotion regulation in children at familial high risk of severe mental illness are sparse.

METHODS

We applied an instrument for assessing emotion regulation, the Tangram Emotion Coding Manual (TEC-M), to a population-based cohort of 522 7-year-old children born to parents diagnosed with either schizophrenia or bipolar disorder and matched controls. The TEC-M is an ecologically valid, clinician-rated observational test measure of spontaneous emotion regulation. We aimed to compare emotion regulation between risk groups and to investigate associations between emotion regulation and psychopathology and daily life functioning, and between emotion regulation and an acknowledged questionnaire-based dysregulation profile.

RESULTS

In this early developmental phase, we found no between group differences in emotion regulation. We found a significant but weak negative association between emotion regulation and both child psychopathology and the presence of a dysregulation profile on the Child Behavior Checklist and a weak positive association between emotion regulation and current level of functioning.

CONCLUSIONS

These findings contribute to the understanding of emotion regulation in familial high-risk children and further studies of emotion regulation in children at familial high risk of severe mental illness are warranted.

Decomposing the attentional blink

The Attentional Blink (AB) refers to a deficit in reporting a second target (T2) embedded in a stream of distractors when presented 200-500 ms after a preceding target (T1). Several theories about the origin of the AB have been proposed; filter-based theories claim that the AB is the result of a temporarily closing of an attentional gate to avoid featural confusion for targets and distractors, while bottleneck theories propose that the AB is caused by a reduction in the capacity to either encode into or maintain information in visual short-term memory. In three experiments, we systematically vary the exposure duration and composition of the T2 display allowing us to decompose the T2 deficit into well-established parameter estimates based on the Theory of Visual Attention (TVA). As the different AB theories make specific predictions regarding which parameters should be affected during the AB, we are able to test their plausibility. All three experiments consistently show a lower capacity to process T2 during the AB, supporting theories hypothesizing a bottleneck at the encoding stage. No evidence is found supporting filter-based theories or theories placing the bottleneck at the maintenance stage. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Family-based cognitive behavioural therapy versus family-based relaxation therapy for obsessive-compulsive disorder in children and adolescents: protocol for a randomised clinical trial (the TECTO trial)

BACKGROUND

Cognitive behavioural therapy (CBT) is the recommended first-line treatment for children and adolescents with obsessive-compulsive disorder (OCD), but evidence concerning treatment-specific benefits and harms compared with other interventions is limited. Furthermore, high risk-of-bias in most trials prevent firm conclusions regarding the efficacy of CBT. We investigate the benefits and harms of family-based CBT (FCBT) versus family-based psychoeducation and relaxation training (FPRT) in youth with OCD in a trial designed to reduce risk-of-bias.

METHODS

This is an investigator-initiated, independently funded, single-centre, parallel group superiority randomised clinical trial (RCT). Outcome assessors, data managers, statisticians, and conclusion drawers are blinded. From child and adolescent mental health services we include patients aged 8-17 years with a primary OCD diagnosis and an entry score of ≥16 on the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS). We exclude patients with comorbid illness contraindicating trial participation; intelligence quotient < 70; or treatment with CBT, PRT, antidepressant or antipsychotic medication within the last 6 months prior to trial entry. Participants are randomised 1:1 to the experimental intervention (FCBT) versus the control intervention (FPRT) each consisting of 14 75-min sessions. All therapists deliver both interventions. Follow-up assessments occur in week 4, 8 and 16 (end-of-treatment). The primary outcome is OCD symptom severity assessed with CY-BOCS at end-of-trial. Secondary outcomes are quality-of-life and adverse events. Based on sample size estimation, a minimum of 128 participants (64 in each intervention group) are included.

DISCUSSION

In our trial design we aim to reduce risk-of-bias, enhance generalisability, and broaden the outcome measures by: 1) conducting an investigator-initiated, independently funded RCT; 2) blinding investigators; 3) investigating a representative sample of OCD patients; 3) using an active control intervention (FPRT) to tease apart general and specific therapy effects; 4) using equal dosing of interventions and therapist supervision in both intervention groups; 5) having therapists perform both interventions decided by randomisation; 6) rating fidelity of both interventions; 7) assessing a broad range of benefits and harms with repeated measures. The primary study limitations are the risk of missing data and the inability to blind participants and therapists to the intervention.

TRIAL REGISTRATION

ClinicalTrials.gov : NCT03595098, registered July 23, 2018.

An observational study of emotion regulation in children with Tourette syndrome

BACKGROUND

Explosive outbursts occur in 25%-70% of children with Tourette syndrome (TS) and may cause more distress than the tics themselves. Previous studies have indicated that a comorbid diagnosis of attention-deficit/hyperactivity disorder (ADHD) is associated with emotional dysregulation in TS; however, this relationship has almost exclusively been studied using parent-reported questionnaires.

METHODS

We examined emotion regulation (ER) with an observational measure in 150 medication-naïve children aged 7-12 allocated to four groups: Forty-nine children with TS, 23 children with ADHD, 16 children with TS + ADHD, and 62 typically developing controls. We assessed participants' ER ability, as well as parent-child interactions in the context of a complex puzzle task, and coded the observed behavior with the Tangram Emotion Coding Manual (TEC-M). We examined group differences in ER, as well as associations between ER and severity of symptoms pertaining to TS and ADHD.

RESULTS

Children with TS did not differ from controls in their ER ability. However, children with ADHD and TS + ADHD had more problems with ER than those with TS only and controls. Finally, parents of children with ADHD displayed more tension during the experimental task. ER ability was not associated with tic severity nor premonitory urges; however, better ER ability was associated with less severe symptoms of ADHD.

CONCLUSIONS

This study is the first to evaluate ER with an observational, clinician-rated measure in a controlled social setting in children with TS. Our findings support earlier questionnaire-based studies by showing impaired ER in children with TS + ADHD, but not in children with TS without comorbidity. These findings inform our understanding of the phenomenology of emotional dysregulation in TS and the role of comorbid disorders.

Post-error adjustment among children aged 7 years with a familial high risk of schizophrenia or bipolar disorder: A population-based cohort study

The cognitive control system matures gradually with age and shows age-related sex differences. To gain knowledge concerning error adaptation in familial high-risk groups, investigating error adaptation among the offspring of parents with severe mental disorders is important and may contribute to the understanding of cognitive functioning in at-risk individuals. We identified an observational cohort through Danish registries and measured error adaptation using an Eriksen flanker paradigm. We tested 497 7-year-old children with a familial high risk of schizophrenia (N = 192) or bipolar disorder (N = 116) for deficits in error adaptation compared with a control group (N = 189). We investigated whether error adaptation differed between high-risk groups compared with controls and sex differences in the adaptation to errors, irrespective of high-risk status. Overall, children exhibited post-error slowing (PES), but the slowing of responses did not translate to significant improvements in accuracy. No differences were detected between either high-risk group compared with the controls. Boys showed less PES and PES after incongruent trials than girls. Our results suggest that familial high risk of severe mental disorders does not influence error adaptation at this early stage of cognitive control development. Error adaptation behavior at age 7 years shows specific sex differences.

Effects of methylphenidate on sensory and sensorimotor gating of initially psychostimulant-naïve adult ADHD patients

Deficient information processing in ADHD theoretically results in sensory overload, which in turn may underlie its symptoms. If this sensory overload is caused by deficient filtering of environmental stimuli, then one would expect finding deficits in P50 gating and prepulse inhibition of the startle reflex (PPI). Previous reports on these measures in ADHD have shown inconsistent findings, which may have been caused by either medication use or comorbidity (e.g. ASD). The primary aim of this study was therefore to explore P50 suppression and PPI in adult, psychostimulant-naïve patients with ADHD without major comorbidity, and to examine the effects of 6 weeks treatment with methylphenidate (MPH) on these measures. A total of 42 initially psychostimulant-naive, adult ADHD patients without major comorbidity and 42 matched healthy controls, were assessed for their P50 gating, PPI, and habituation/sensitization abilities at baseline and after 6 weeks of treatment with methylphenidate. Although six weeks of treatment with MPH significantly reduced symptomatology as well as improved daily life functioning in our patients, it neither significantly affected PPI, P50 suppression nor sensitization, but habituation unexpectedly decreased. The absence of PPI and P50 suppression deficits in our patients in the psychostimulant-naïve state indicates no gating deficits. In turn, this suggests that the difficulties to inhibit distraction of attention by irrelevant stimuli that many patients with (adult) ADHD report, have a different origin than the theoretical causes of sensory overload frequently reported in studies on patients with schizophrenia.

Encouraging Digital Technology in Neuropsychology: The Theory of Visual Attention on Tablet Devices

OBJECTIVE

Visual attention helps us to selectively process relevant information and is crucial in our everyday interactions with the environment. Not surprisingly, it is one of the cognitive domains that is most frequently affected by acquired brain injury. Reliable assessment of attention deficits is pivotal to neuropsychological examination and helps to optimize individual rehabilitation plans. Compared with conventional pen-and-paper tests, computerized tasks borrowed from the field of experimental psychology bring many benefits, but lab-based experimental setups cannot be easily incorporated in clinical practice. Light-weight and portable mobile tablet devices may facilitate the translation of computerized tasks to clinical settings. One such task is based on the Theory of Visual Attention (TVA), a mathematical model of visual attention. TVA-based paradigms have been widely used to investigate several aspects of visual attention in both fundamental and clinical research, and include measures for general processing capacity as well as stimulus-specific attentional parameters.

METHODS

This article discusses the benefits of TVA-based assessments compared with frequently used neuropsychological tests of visual attention, and examines the reliability of a tablet-based TVA-based assessment in 59 neurologically healthy participants.

RESULTS

Pearson's correlations indicate that the tablet-based TVA assessment and the conventional lab-based TVA assessment have a comparable parallel-form (range: .67-.93), test-retest (range: .61-.78), and internal reliability (range: .56-.97).

CONCLUSION

Our results suggest that tablet-based TVA assessment may be a promising tool to acquire clinical measures of visual attention at low cost at the bedside of the patient.

Development of visual attention from age 7 to age 12 in children with familial high risk for schizophrenia or bipolar disorder

BACKGROUND

Children with familial high risk of schizophrenia (FHR-SZ) or bipolar disorder (FHR-BP) are at increased risk of developing similar disorders and show cognitive deficits during childhood. The aim of this paper is to investigate visual attention and its developmental trajectories in children with FHR-SZ and with FHR-BP to increase our knowledge about potential cognitive endophenotypes of these two disorders.

METHODS

We compared the performance of 89 children with FHR-SZ (N = 32), FHR-BP (N = 22), and population-based controls (PBC, N = 35) at age 7 to that at age 12 as well as including 133 12-year-old children with FHR-SZ (N = 50), FHR-BP (N = 43) and PBC (N = 40) to investigate visual attention, as part of the Danish High Risk and Resilience Study. We used the TVA-based whole report paradigm, based on the Bundesen's Theory of Visual Attention (TVA) to investigate visual attention.

RESULTS

Children with FHR-SZ that showed deficits in visual processing speed at age 7 improved to a level that was not significantly different from controls at age 12. All children improved over time. We found no attentional deficits in FHR children at age 12.

CONCLUSIONS

On visual attention, children with FHR-SZ did not show developmental deficits or lags and, together with children with FHR-BP, they develop similarly to control children between age 7 to age 12. This emphasizes the potential of beneficial neuroplastic changes in cognitive deficits found at younger ages in children with FHR-SZ. It also highlights the importance of identifying and characterizing cognitive developmental trajectories of high-risk children and provides hope that visual attention may develop appropriately in these groups.

Dr. Uhre et al. Reply

In a recent letter to the editor, a group of clinician-researchers posit that the conclusions in our published systematic review¹ on cognitive-behavioral therapy (CBT) for pediatric obsessive-compulsive disorder (OCD) are based on inappropriate methodology. In this reply, we address the concerns expressed by Storch et al.².

Gabor patterns as stimuli in a rodent visual attention task

BACKGROUND

Gabor patterns are defined as the product of a sinusoid function and a Gaussian envelope and are commonly used in visual and attentional research due to their ability to selectively stimulate the primary visual cortex. The aim of this study was to investigate whether Gabor patterns can be used as visual stimuli in the rodent continuous performance test (rCPT), a newly developed task to study attentional function and impulsivity.

METHODS

Sixteen male C57BL/6 J mice were trained in the rCPT using Gabor patterns as visual stimuli and their performance was compared to sixteen mice that were trained using traditional high-contrast pattern stimuli. Mice were compared during training, baseline, and a variable stimulus duration probe.

RESULTS

The Gabor pattern group required more training sessions to reach criteria than the group with high-contrast patterns. At baseline, the Gabor pattern group showed a higher false alarm rate and a lower discriminability index. As task difficulty increased during the variable stimulus duration probe, differences between groups became more pronounced. Specifically, the Gabor pattern group showed decreased hit rate and discriminability index, as well as increased false alarm rate and premature responses compared to the high-contrast pattern group.

CONCLUSION

This feasibility study showed that it is possible to use Gabor patterns as visual stimuli in the rCPT, although it increases task demands. We discuss the differences between Gabor patterns and high-contrast patterns in the context of translatability of animal models in visual and cognitive research and give two examples of applicability.

Visual attention in adults with attention-deficit/hyperactivity disorder before and after stimulant treatment

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder which frequently persists into adulthood. The primary goal of the current study was to (a) investigate attentional functions of stimulant medication-naïve adults with ADHD, and (b) investigate the effects of 6 weeks of methylphenidate treatment on these functions.

METHODS

The study was a prospective, non-randomized, non-blinded, 6-week follow-up design with 42 stimulant medication-naïve adult patients with ADHD, and 42 age and parental education-matched healthy controls. Assessments included measures of visual attention, based on Bundesen's Theory of Visual Attention (TVA), which yields five precise measures of aspects of visual attention; general psychopathology; ADHD symptoms; dyslexia screening; and estimates of IQ.

RESULTS

At baseline, significant differences were found between patients and controls on three attentional parameters: visual short-term memory capacity, threshold of conscious perception, and to a lesser extent visual processing speed. Secondary analyses revealed no significant correlations between TVA parameter estimates and severity of ADHD symptomatology. At follow-up, significant improvements were found specifically for visual processing speed; this improvement had a large effect size, and remained when controlling for re-test effects, IQ, and dyslexia screen performance. There were no significant correlations between changes in visual processing speed and changes in ADHD symptomatology.

CONCLUSIONS

ADHD in adults may be associated with deficits in three distinct aspects of visual attention. Improvements after 6 weeks of medication are seen specifically in visual processing speed, which could represent an improvement in alertness. Clinical symptoms and visual attentional deficits may represent separate aspects of ADHD in adults.

Visual attention in 7-year-old children at familial high risk of schizophrenia or bipolar disorder: The Danish high risk and resilience study VIA 7

BACKGROUND

Attention deficits are found in children at familial high risk of schizophrenia (FHR-SZ) and bipolar disorder (FHR-BP) using assessment methods relying on motor-based response latency. This study compares visual attention functions in children at FHR-SZ or FHR-BP with controls using an unspeeded task unconfounded by motor components.

METHODS

Visual attention was assessed in 133 7-year-old children at FHR-SZ (N = 56) or FHR-BP (N = 32), and controls (N = 45) using the unspeeded paradigm, TVA-based whole report. We compared four parameters of visual attention: visual processing speed, visual short-term memory, threshold for visual perception, and error rate. Further, we investigated their potential relationships with severity of psychopathology, adequacy of the home environment, and neurocognitive measures.

RESULTS

Children at FHR-SZ displayed significant deficits in perceptual processing speed of visual attention compared with controls (p < .001; d = 0.75) as did children at FHR-BP (p < .05; d = 0.54). Visual processing speed was significantly associated with spatial working memory (β = -0.23; t(68) = -3.34, p = .01) and psychomotor processing speed (β = 0.14, t(67) = 2.11, p < .05).

LIMITATIONS

Larger group sizes would have permitted inclusion of more predictors in the search for neurocognitive and other factors associated with the parameters of TVA-based whole report.

CONCLUSIONS

Young children at FHR-SZ and FHR-BP display significant deficits in processing speed of visual attention, which may reflect the effect of shared vulnerability risk genes. Early identification of children at FHR-SZ and FHR-BP with perceptual processing speed impairments may represent a low-cost basis for low-risk interventions.

Dissociable Catecholaminergic Modulation of Visual Attention: Differential Effects of Catechol-O-Methyltransferase and Dopamine Beta-Hydroxylase Genes on Visual Attention

Visual attention enables us to prioritise behaviourally relevant visual information while ignoring distraction. The neural networks supporting attention are modulated by two catecholamines, dopamine and noradrenaline. The current study investigated the effects of single nucleotide polymorphisms in two catecholaminergic genes – COMT (Val¹⁵⁸Met) and DBH (444 G/A) – on individual differences in attention functions. Participants (n = 125) were recruited from the Oxford Biobank by genotype-based recall. They were tested on a continuous performance task (sustained attention), a Go/No-Go task (response inhibition), and a task assessing attentional selection in accordance with the Theory of Visual Attention (TVA). We found a significant effect of DBH genotype status on the capacity to maintain attention over time (sustained attention) as measured by the continuous performance task. Furthermore, we demonstrated a significant association between COMT genotype status and effective threshold of visual perception in attentional selection as estimated based on the TVA task performance. No other group differences in attention function were found with respect to the studied genotypes. Overall, our findings provide novel experimental evidence that: (i) dopaminergic and noradrenergic genotypes have dissociable effects on visual attention; (ii) either insufficient or excessive catecholaminergic activity may have equally detrimental effects on sustained attention.

•

Catecholaminergic genotypes have dissociative cognitive effects on visual attention.

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DBH (444 G/A) polymorphism affects sustained attention.

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COMT Val¹⁵⁸Met polymorphism affects perceptual threshold in visual attention.

•

Both too little and too much catecholamines may detrimentally impact sustained attention.

The Puzzle of Emotion Regulation: Development and Evaluation of the Tangram Emotion Coding Manual for Children

The ability to regulate one's emotions is crucial to engaging successfully in social contexts. Difficulties in emotion regulation are seen in multiple psychiatric disorders, prompting an increased interest in the concept. Suitable methods for assessing emotion regulation, however, are lacking. In this study, we investigated the interrater and intrarater reliability, construct validity, and content validity of a new observational method for evaluating children's emotion regulation abilities (a complex puzzle task) in a sample of 62 children without psychiatric disorders and 23 children with attention-deficit/hyperactivity disorder (ADHD) aged 7-12, using intra-class correlation coefficients for the reliability analyses and Spearman's rank-order correlations for analyses of convergent and discriminant validity. A panel of experts examined the content validity of the test, and Mann-Whitney U-tests were used to investigate the ability of the test to differentiate the non-clinical group from the ADHD group. Results showed a high level of interrater and intrarater reliability of the test. There was mixed evidence for convergent and discriminant validity as expected due to the novelty and experimental nature of the test, making it difficult to compare with questionnaire-based measures. Content validity analysis was satisfactory, and the group comparison showed that the test differentiated the groups on the primary outcome measure. Overall, the measure demonstrated high feasibility and satisfactory psychometric properties. The generic nature of the test makes it suitable for use across psychiatric disorders and age groups with potential relevance in both research and clinical settings.

Decreased cingulo-opercular network functional connectivity mediates the impact of aging on visual processing speed

The neural factors that account for the visual processing speed reduction in aging are incompletely understood. Based on previous reports of age-related decreases in the intrinsic functional connectivity (iFC) within the cingulo-opercular network and its relevance for processing speed, we hypothesized that these decreases are associated with age-related reductions in visual processing speed. We used a whole-report task and modeling based on Bundesen's "theory of visual attention" to parameterize visual processing speed in 91 healthy participants aged from 20 to 77 years. iFC was estimated using independent component analysis of resting-state functional magnetic resonance imaging data. From the clusters within the cingulo-opercular network exhibiting age-related decreased iFC, we found a cluster in the left insula to be particularly associated with visual processing speed and to mediate the age effect on visual speed. This mediation was not observed for age-related decreased iFC in other networks or for other attentional parameters. Our results point to the iFC in the cingulo-opercular network, represented by the left insula, as being a relevant marker for visual processing speed changes in aging.

Delay Aversion and Executive Functioning in Adults With Attention-Deficit/Hyperactivity Disorder: Before and After Stimulant Treatment

BACKGROUND

Attention deficit hyperactivity disorder is a heterogeneous disorder, associated with deficits in motivation (e.g., delay aversion) and cognition. Methylphenidate is recommended as a first line treatment for attention deficit hyperactivity disorder symptoms, but little is known about its nonacute effects on motivational and cognitive deficits, particularly in adults with attention deficit hyperactivity disorder.

METHODS

We utilized a prospective, non-randomized, non-blinded, 6-week follow-up design with 42 initially stimulant medication-naïve adult patients with moderate to severe attention deficit hyperactivity disorder, and 42 age- and parental education-matched healthy controls. Delay aversion and executive functioning were assessed with 2 questionnaires and 5 performance-based tests.

RESULTS

At baseline, patients and controls differed significantly on performance-based measures (moderate to large effect sizes), and self-report of delay aversion and executive functioning (very large effect sizes). Treatment with methylphenidate medication (mean dose 65.54 mg/d, SD=10.39) was not associated with improvements in performance-based measures of delay aversion and executive functioning compared to controls, although improvements in self-report executive functioning and delay aversion were found. Self-reported delay aversion was most consistently associated with ADHD symptomatology at baseline and after medication.

CONCLUSION

Methylphenidate treatment does not have an effect on performance-based measures of delay aversion and executive functioning, but may have significant effects on self-reported delay aversion and executive functioning. The latter finding should be interpreted cautiously, given the subjective nature of these measures and design limitations. Self-reported delay aversion is most consistently associated with attention deficit hyperactivity disorder symptomatology.

EEG correlates of visual short-term memory in older age vary with adult lifespan cognitive development

Visual short-term memory (vSTM) is a cognitive resource that declines with age. This study investigated whether electroencephalography (EEG) correlates of vSTM vary with cognitive development over individuals' lifespan. We measured vSTM performance and EEG in a lateralized whole-report task in a healthy birth cohort, whose cognitive function (intelligence quotient) was assessed in youth and late-middle age. Higher vSTM capacity (K; measured by Bundesen's theory of visual attention) was associated with higher amplitudes of the contralateral delay activity (CDA) and the central positivity (CP). In addition, rightward hemifield asymmetry of vSTM (K_λ) was associated with lower CDA amplitudes. Furthermore, more severe cognitive decline from young adulthood to late-middle age predicted higher CDA amplitudes, and the relationship between K and the CDA was less reliable in individuals who show higher levels of cognitive decline compared to individuals with preserved abilities. By contrast, there was no significant effect of lifespan cognitive changes on the CP or the relationship between behavioral measures of vSTM and the CP. Neither the CDA, nor the CP, nor the relationships between K or K_λ and the event-related potentials were predicted by individuals' current cognitive status. Together, our findings indicate complex age-related changes in processes underlying behavioral and EEG measures of vSTM and suggest that the K-CDA relationship might be a marker of cognitive lifespan trajectories.

Adult attachment style and anxiety - The mediating role of emotion regulation

BACKGROUND

Although there is substantial evidence for the role of emotion regulation in the etiology and maintenance of anxiety disorders, knowledge about what contributes to emotion dysregulation is sparse. Attachment style is related to emotion regulation and anxiety symptoms, but these variables have rarely been examined together. Examining emotion dysregulation within the context of anxiety disorders through an attachment theory framework will lead to a better understanding of the etiology and maintenance of anxiety disorders. In the present study we combined theoretically and empirically derived knowledge to examine the mediating role of emotion regulation between attachment dimensions (avoidance and anxiety) and anxiety symptoms.

METHODS

A total of 147 individuals were assessed with Beck Anxiety Inventory (BAI), Experiences in Close Relationships-Revised (ECR-R) and Difficulties in Emotion Regulation Scale (DERS), and statistical mediation analyses were conducted.

RESULTS

Our results indicate that the significant association between anxiety and attachment anxiety was mediated by emotion dysregulation, whereas attachment avoidance was not significantly related to anxiety when covarying for attachment anxiety. The primary limitation of our study is that data is cross-sectional and so causation cannot be inferred. Secondly, all measures used in this study were derived from self-reported questionnaires, which may be more susceptible to bias.

CONCLUSIONS

Our results suggest that it is not insecure attachment in general that is important in anxiety disorders, but that attachment anxiety is specifically relevant. Thus, clinical interventions for anxiety disorders may improve by targeting attachment related difficulties.

Perceptual and response-dependent profiles of attention in children with ADHD

OBJECTIVE

Attention-deficit hyperactivity disorder (ADHD) is a complex developmental neuropsychiatric disorder, characterized by inattentiveness, impulsivity, and hyperactivity. Recent literature suggests a potential core deficit underlying these behaviors may involve inefficient processing when contextual stimulation is low. In order to specify this inefficiency, the aim of the present study was to disentangle perceptual and response-based deficits of attention by supplementing classic reaction time (RT) measures with an accuracy-only test. Moreover, it was explored whether ADHD symptom severity was systematically related to perceptual and response-based processes.

METHOD

We applied an RT-independent paradigm (Bundesen, 1990) and a sustained attention task (Dockree et al., 2006) to test visual attention in 24 recently diagnosed, medication-naïve children with ADHD, 14 clinical controls with pervasive developmental disorder, and 57 healthy controls. Outcome measures included perceptual processing speed, capacity of visual short-term memory, and errors of commission and omission.

RESULTS

Children with ADHD processed information abnormally slow (d = 0.92), and performed poorly on RT variability and response stability (d's ranging from 0.60 to 1.08). In the ADHD group only, slowed visual processing speed was significantly related to response lapses (omission errors). This correlation was not explained by behavioral ratings of ADHD severity.

CONCLUSIONS

Based on combined assessment of perceptual and response-dependent variables of attention, the present study demonstrates a specific cognitive profile in children with ADHD. This profile distinguishes the disorder at a basic level of attentional functioning, and may define subgroups of children with ADHD in a way that is more sensitive than clinical rating scales. (PsycINFO Database Record

Theory of Visual Attention (TVA) applied to mice in the 5-choice serial reaction time task

RATIONALE

The 5-choice serial reaction time task (5-CSRTT) is widely used to measure rodent attentional functions. In humans, many attention studies in healthy and clinical populations have used testing based on Bundesen's Theory of Visual Attention (TVA) to estimate visual processing speeds and other parameters of attentional capacity.

OBJECTIVES

We aimed to bridge these research fields by modifying the 5-CSRTT's design and by mathematically modelling data to derive attentional parameters analogous to human TVA-based measures.

METHODS

C57BL/6 mice were tested in two 1-h sessions on consecutive days with a version of the 5-CSRTT where stimulus duration (SD) probe length was varied based on information from previous TVA studies. Thereafter, a scopolamine hydrobromide (HBr; 0.125 or 0.25 mg/kg) pharmacological challenge was undertaken, using a Latin square design. Mean score values were modelled using a new three-parameter version of TVA to obtain estimates of visual processing speeds, visual thresholds and motor response baselines in each mouse.

RESULTS

The parameter estimates for each animal were reliable across sessions, showing that the data were stable enough to support analysis on an individual level. Scopolamine HBr dose-dependently reduced 5-CSRTT attentional performance while also increasing reward collection latency at the highest dose. Upon TVA modelling, scopolamine HBr significantly reduced visual processing speed at both doses, while having less pronounced effects on visual thresholds and motor response baselines.

CONCLUSIONS

This study shows for the first time how 5-CSRTT performance in mice can be mathematically modelled to yield estimates of attentional capacity that are directly comparable to estimates from human studies.

Heightened Olfactory Sensitivity in Young Females with Recent-Onset Anorexia Nervosa and Recovered Individuals

Introduction

Olfaction may be related to food restriction and weight loss. However, reports regarding olfactory function in individuals with anorexia nervosa (AN) have been inconclusive.

Objective

Characterize olfactory sensitivity and identification in female adolescents and young adults with first-episode AN and young females recovered from AN.

Methods

We used the Sniffin’ Sticks Odor Threshold Test and Odor Identification Test to assess 43 participants with first-episode AN, 27 recovered participants, and 39 control participants. Participants completed the Importance of Olfaction questionnaire, the Beck Youth Inventory and the Eating Disorder Inventory. We also conducted a psychiatric diagnostic interview and the Autism Diagnostic Observation Schedule with participants.

Results

Both clinical groups showed heightened olfactory sensitivity. After excluding participants with depression, participants with first-episode AN identified more odors than recovered participants.

Conclusion

Heightened olfactory sensitivity in AN may be independent of clinical status, whereas only individuals with current AN and without depression show more accurate odor identification.

Eccentricity effects in vision and attention

Stimulus eccentricity affects visual processing in multiple ways. Performance on a visual task is often better when target stimuli are presented near or at the fovea compared to the retinal periphery. For instance, reaction times and error rates are often reported to increase with increasing eccentricity. Such findings have been interpreted as purely visual, reflecting neurophysiological differences in central and peripheral vision, as well as attentional, reflecting a central bias in the allocation of attentional resources. Other findings indicate that in some cases, information from the periphery is preferentially processed. Specifically, it has been suggested that visual processing speed increases with increasing stimulus eccentricity, and that this positive correlation is reduced, but not eliminated, when the amount of cortex activated by a stimulus is kept constant by magnifying peripheral stimuli (Carrasco et al., 2003). In this study, we investigated effects of eccentricity on visual attentional capacity with and without magnification, using computational modeling based on Bundesen's (1990) theory of visual attention. Our results suggest a general decrease in attentional capacity with increasing stimulus eccentricity, irrespective of magnification. We discuss these results in relation to the physiology of the visual system, the use of different paradigms for investigating visual perception across the visual field, and the use of different stimulus materials (e.g. Gabor patches vs. letters).

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Visual capacity for letter stimuli decreases toward the visual periphery.

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The decrease in visual capacity is irrespective of cortical magnification.

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Peripheral performance might depend on the specific stimuli and task demands.

An investigation of general predictors for cognitive-behavioural therapy outcome for anxiety disorders in a routine clinical setting

INTRODUCTION

Cognitive-behavioural therapy (CBT) is effective for treating anxiety disorders and is offered in most mental health services around the world. However, a relatively large number of patients with anxiety disorders do not benefit from CBT, experience relapses or drop out. Reliable predictors of treatment effects are lacking. The aim of this study is to investigate the predictive value of emotion regulation and attentional control for CBT outcome in a routine setting.

METHODS AND ANALYSIS

In this prospective and practice-based study, 112 patients with anxiety disorders referred for manual-based group CBT at two psychiatric outpatient clinics will be recruited. Emotion regulation, severity of anxiety and attentional control will be assessed with self-report measures and with an experimental computer-based attentional control task at baseline, post-treatment and at a 6-month follow-up. Emotion regulation will be measured with Difficulties in Emotion Regulation Questionnaire, severity of anxiety will be assessed with Beck Anxiety Inventory and attentional control will be measured with the self-report questionnaire, Attention Control Scale, and with an experimental computer-based attentional control task based on theory of visual attention. Data will be analysed using multilevel mixed-effects modelling.

ETHICS AND DISSEMINATION

The study is approved by the Danish National Ethical Board, the Department of Psychology Ethical Board, University of Copenhagen and by the Danish Data Protection Agency. Study findings will be disseminated through peer-reviewed journal publications and conference presentations. The Danish Committee System on Health Research Ethics has been notified about the project.

TRIAL REGISTRATION NUMBER

NCT02638363.

A Componential Analysis of Visual Attention in Children With ADHD

OBJECTIVE

Inattentive behaviour is a defining characteristic of ADHD. Researchers have wondered about the nature of the attentional deficit underlying these symptoms. The primary purpose of the current study was to examine this attentional deficit using a novel paradigm based upon the Theory of Visual Attention (TVA).

METHOD

The TVA paradigm enabled a componential analysis of visual attention through the use of a mathematical model to estimate parameters relating to attentional selectivity and capacity. Children's ability to sustain attention was also assessed using the Sustained Attention to Response Task. The sample included a comparison between 25 children with ADHD and 25 control children aged 9-13.

RESULTS

Children with ADHD had significantly impaired sustained attention and visual processing speed but intact attentional selectivity, perceptual threshold and visual short-term memory capacity.

CONCLUSION

The results of this study lend support to the notion of differential impairment of attentional functions in children with ADHD.

Beyond trial types

Conventional wisdom on psychological experiments has held that when one or more independent variables are manipulated it is essential that all other conditions are kept constant such that confounding factors can be assumed negligible (Woodworth, 1938). In practice, the latter assumption is often questionable because it is generally difficult to guarantee that all other conditions are constant between any two trials. Therefore, the most common way to check for confounding violations of this assumption is to split the experimental conditions in terms of "trial types" to simulate a reduction of unintended trial-by-trial variation. Here, we pose a method which is more general than the use of trial types: use of mathematical models treating measures of potentially confounding factors and manipulated variables as equals on the single-trial level. We show how the method can be applied with models that subsume under the generalized linear item response theory (GLIRT), which is the case for most of the well-known psychometric models (Mellenbergh, 1994). As an example, we provide a new analysis of a single-letter recognition experiment using a nested likelihood ratio test that treats manipulated and measured variables equally (i.e., in exactly the same way) on the single-trial level. The test detects a confounding interaction with time-on-task as a single-trial measure and yields a substantially better estimate of the effect size of the main manipulation compared with an analysis made in terms of trial types.

Components of attention modulated by temporal expectation

By varying the probabilities that a stimulus would appear at particular times after the presentation of a cue and modeling the data by the theory of visual attention (Bundesen, 1990), Vangkilde, Coull, and Bundesen (2012) provided evidence that the speed of encoding a singly presented stimulus letter into visual short-term memory (VSTM) is modulated by the observer's temporal expectations. We extended the investigation from single-stimulus recognition to whole report (Experiment 1) and partial report (Experiment 2). Cue-stimulus foreperiods were distributed geometrically using time steps of 500 ms. In high expectancy conditions, the probability that the stimulus would appear on the next time step, given that it had not yet appeared, was high, whereas in low expectancy conditions, the probability was low. The speed of encoding the stimuli into VSTM was higher in the high expectancy conditions. In line with the Easterbrook (1959) hypothesis, under high temporal expectancy, the processing was also more focused (selective). First, the storage capacity of VSTM was lower, so that fewer stimuli were encoded into VSTM. Second, the distribution of attentional weights across stimuli was less even: The efficiency of selecting targets rather than distractors for encoding into VSTM was higher, as was the spread of the attentional weights of the target letters.

Temporal expectancy in the context of a theory of visual attention

Temporal expectation is expectation with respect to the timing of an event such as the appearance of a certain stimulus. In this paper, temporal expectancy is investigated in the context of the theory of visual attention (TVA), and we begin by summarizing the foundations of this theoretical framework. Next, we present a parametric experiment exploring the effects of temporal expectation on perceptual processing speed in cued single-stimulus letter recognition with unspeeded motor responses. The length of the cue-stimulus foreperiod was exponentially distributed with one of six hazard rates varying between blocks. We hypothesized that this manipulation would result in a distinct temporal expectation in each hazard rate condition. Stimulus exposures were varied such that both the temporal threshold of conscious perception (t0 ms) and the perceptual processing speed (v letters s(-1)) could be estimated using TVA. We found that the temporal threshold t0 was unaffected by temporal expectation, but the perceptual processing speed v was a strikingly linear function of the logarithm of the hazard rate of the stimulus presentation. We argue that the effects on the v values were generated by changes in perceptual biases, suggesting that our perceptual biases are directly related to our temporal expectations.

Don't words come easy? A psychophysical exploration of word superiority

Words are made of letters, and yet sometimes it is easier to identify a word than a single letter. This word superiority effect (WSE) has been observed when written stimuli are presented very briefly or degraded by visual noise. We compare performance with letters and words in three experiments, to explore the extents and limits of the WSE. Using a carefully controlled list of three letter words, we show that a WSE can be revealed in vocal reaction times even to undegraded stimuli. With a novel combination of psychophysics and mathematical modeling, we further show that the typical WSE is specifically reflected in perceptual processing speed: single words are simply processed faster than single letters. Intriguingly, when multiple stimuli are presented simultaneously, letters are perceived more easily than words, and this is reflected both in perceptual processing speed and visual short term memory (VSTM) capacity. So, even if single words come easy, there is a limit to the WSE.

Intensive video gaming improves encoding speed to visual short-term memory in young male adults

The purpose of this study was to measure the effect of action video gaming on central elements of visual attention using Bundesen's (1990) Theory of Visual Attention. To examine the cognitive impact of action video gaming, we tested basic functions of visual attention in 42 young male adults. Participants were divided into three groups depending on the amount of time spent playing action video games: non-players (<2h/month, N=12), casual players (4-8h/month, N=10), and experienced players (>15h/month, N=20). All participants were tested in three tasks which tap central functions of visual attention and short-term memory: a test based on the Theory of Visual Attention (TVA), an enumeration test and finally the Attentional Network Test (ANT). The results show that action video gaming does not seem to impact the capacity of visual short-term memory. However, playing action video games does seem to improve the encoding speed of visual information into visual short-term memory and the improvement does seem to depend on the time devoted to gaming. This suggests that intense action video gaming improves basic attentional functioning and that this improvement generalizes into other activities. The implications of these findings for cognitive rehabilitation training are discussed.