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ABSTRACT: Objective: The study examines the role of obsessive-compulsive symptoms (OCS) as a part of the psychopathology of children with chronic tic disorders (CTD) and/or attention-deficit hyperactivity disorder (ADHD). Method: We assessed the psychopathology of four large patient groups without further psychiatric disorders: CTD (n = 112), CTD + ADHD (n = 82), ADHD (n = 129), and controls (n = 144)) by implementing the Child Behavior Checklist (CBCL). We compared the main effects for CTD and ADHD with and without including OCS as covariates. Results: Including OCS led to substantially different main effects for CTD on seven out of eight CBCL subscales. Slightly different main effects for ADHD were determined with respect to ADHD, mainly on the subscale withdrawn. Conclusions: OCS are closely related to CTD-associated psychopathology and - to a lesser extent, but nevertheless of importance in daily clinical practice - on ADHD-related symptoms. This information can be helpful in implementing more precise diagnostics and treatment in daily routine care.
Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie 05/2013; 41(3):163-71. · 0.99 Impact Factor
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Marian L Hamshere,
Kate Langley,
Joanna Martin,
Sharifah Shameem Agha,
Evangelia Stergiakouli,
Richard J L Anney,
Jan Buitelaar,
Stephen V Faraone,
Klaus-Peter Lesch,
Benjamin M Neale, [......], Aribert Rothenberger,
Tobias Banaschewski,
Robert D Oades,
James J McGough,
Lindsey Kent,
Nigel Williams,
Michael J Owen,
Peter Holmans,
Michael C O'Donovan,
Anita Thapar
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ABSTRACT: OBJECTIVE Although attention deficit hyperactivity disorder (ADHD) is highly heritable, genome-wide association studies (GWAS) have not yet identified any common genetic variants that contribute to risk. There is evidence that aggression or conduct disorder in children with ADHD indexes higher genetic loading and clinical severity. The authors examine whether common genetic variants considered en masse as polygenic scores for ADHD are especially enriched in children with comorbid conduct disorder. METHOD Polygenic scores derived from an ADHD GWAS meta-analysis were calculated in an independent ADHD sample (452 case subjects, 5,081 comparison subjects). Multivariate logistic regression analyses were employed to compare polygenic scores in the ADHD and comparison groups and test for higher scores in ADHD case subjects with comorbid conduct disorder relative to comparison subjects and relative to those without comorbid conduct disorder. Association with symptom scores was tested using linear regression. RESULTS Polygenic risk for ADHD, derived from the meta-analysis, was higher in the independent ADHD group than in the comparison group. Polygenic score was significantly higher in ADHD case subjects with conduct disorder relative to ADHD case subjects without conduct disorder. ADHD polygenic score showed significant association with comorbid conduct disorder symptoms. This relationship was explained by the aggression items. CONCLUSIONS Common genetic variation is relevant to ADHD, especially in individuals with comorbid aggression. The findings suggest that the previously published ADHD GWAS meta-analysis contains weak but true associations with common variants, support for which falls below genome-wide significance levels. The findings also highlight the fact that aggression in ADHD indexes genetic as well as clinical severity.
American Journal of Psychiatry 04/2013; · 12.54 Impact Factor
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European Child & Adolescent Psychiatry 04/2013; · 2.82 Impact Factor
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ABSTRACT: Among the different neuromodulation techniques, neurofeedback (NF) is gaining increasing interest in the treatment of children with attention-deficit/hyperactivity disorder (ADHD). In this article, a methodological framework is summarised considering the training as a neuro-behavioural treatment. Randomised controlled trials are selectively reviewed. Results from two smaller-scale studies are presented with the first study comprising a tomographic analysis over the course of a slow cortical potential (SCP) training and a correlational analysis of regulation skills and clinical outcome in children with ADHD. In the second study, ADHD-related behaviour was studied in children with tic disorder who either conducted a SCP training or a theta/low-beta (12-15 Hz) training (single-blind, randomised design). Both studies provide further evidence for the specificity of NF effects in ADHD. Based on these findings, a refined model of the mechanisms contributing to the efficacy of SCP training is developed. Despite a number of open questions concerning core mechanisms, moderators and mediators, NF (theta/beta and SCP) training seems to be on its way to become a valuable and ethically acceptable module in the treatment of children with ADHD.
Brain Topography 04/2013; · 3.45 Impact Factor
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ABSTRACT: Motor and vocal tics are the core symptom of Tourette Syndrome (TS). Tic generation seems to develop throughout the known motor pathways. This review focuses on functional neuroimaging in order to check this assumption. Also it elucidates the alterations and interactions of motor networks in TS depending on different contexts and circumstances like resting state, spontaneous tic movements, suppression of tics and premonitory urges voluntary goal-oriented movements as well as electrophysiological neuronal stimulation. In general, the primary tic generating motor network uses the basic motor pathways differently, interacts with secondary sensorimotor networks and neuronal systems of cognitive behavioural control in a merely hierarchical manner, changing during neurodevelopment.
Behavioural neurology 11/2012; · 1.77 Impact Factor
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ABSTRACT: Event-related EEG modulations, which are phase-locked to perceptual, cognitive, and motor processes, are often studied by means of event-related potentials (ERPs), although event-related oscillatory responses in different EEG frequency bands allow a more refined analysis, closer to brain physiology. This article introduces the basics of time-frequency methods, which are typically applied for the analysis of event-related oscillations, focusing on adaptive procedures (e.g., wavelet networks). The potential of these methods is illustrated. Findings about event-related oscillations (gamma responses, theta responses) in children performing an auditory selective attention task are reviewed. Both the neuronal substrates of gamma (30–70 Hz) networks and the ability to synchronize these networks in relation to task-specific processes are available in children and adolescents from 9 to 16 years of age. Developmental changes in the task reactivity of synchronized gamma oscillations may provide evidence for a transition in cognitive processing strategies emerging at the age of 12–13 years. Event-related theta (3–7.5 Hz) activity is enhanced in two latency ranges. The early event-related theta response occurring 0–200 ms after a stimulus may be associated with representations of relevant target features in working memory. The late fronto-central theta response (200–450 ms) could be related to the processing of task-irrelevant information. In summary, event-related oscillations can be analyzed using time-frequency methods like wavelet networks. This approach should be used intensively to study neurocognitive development in children. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Journal of Psychophysiology 10/2012; 23(4):199-207. · 1.54 Impact Factor
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ABSTRACT: Response processing may comprise multiple systems working in parallel at different functional levels of performance monitoring. In time-frequency decompositions of response-locked event-related potentials from adults, a subprocess operating in the delta frequency band was interpreted as an index of cognitive error monitoring, distinguishable from a process with theta frequency probably related to motor control. However, it remains unclear whether such subprocesses can also be distinguished in children. In the current study, error processing was assessed in 22 normal boys aged 8 to 15 years using an Erikson Flanker task. Performance data revealed the expected indices of conflicting task demands, such as increased reaction times and error rates. A clear error-negativity was found in the response-locked event-related potentials after incompatible stimuli, and correct responses show a slow negative deflection immediately preceding the button-press, which is absent in errors. Time-frequency decompositions disclosed that a subprocess in the lower delta band preceding correct responses may reflect a more general action monitoring process sensitive to conflicting task demands that, moreover, may prevent one from making an error if it is active early enough. Processes in the delta and theta bands are modulated specifically by errors and may index motor-related monitoring in children. Moreover, these processes occurred considerably earlier for correct responses compared to errors, suggesting that their timing reflects some performance capacity. These considerations may help to clarify response processing in tasks with conflicting demands. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Journal of Psychophysiology 10/2012; 23(4):183-190. · 1.54 Impact Factor
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ABSTRACT: OPINION STATEMENT: Within the last 2 years the bulk of information on evidence based treatments in ADHD was reviewed quite intensively and new empirical studies could be added. This update reports comprehensively about actual and essential facts in the field related to brain development and sensitive periods, predictors of treatment, safety of medication, value of naturalistic studies, new drugs and complementary medicine, behavioral interventions including neurofeedback and psychosocial treatment, treatment of comorbidity, and ethical considerations including preventive aspects. The updated combination of well selected evidence based treatments (ie, pharma plus non-pharma) seems to be clinically and ethically recommended as also suggested by the European and American guidelines on ADHD.
Current Treatment Options in Neurology 09/2012; · 1.29 Impact Factor
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Tobias Banaschewski,
Christine Jennen-Steinmetz,
Daniel Brandeis,
Jan K Buitelaar,
Jonna Kuntsi,
Luise Poustka,
Joseph A Sergeant,
Edmund J Sonuga-Barke,
Alexis C Frazier-Wood,
Björn Albrecht, [......],
Michael Gill,
Iris Manor,
Ana Miranda,
Fernando Mulas,
Robert D Oades,
Herbert Roeyers, Aribert Rothenberger,
Hans-Christoph Steinhausen,
Stephen V Faraone,
Philip Asherson
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ABSTRACT: Background: Emotional lability (EL) is commonly seen in patients with attention-deficit/hyperactivity disorder (ADHD). The reasons for this association remain currently unknown. To address this question, we examined the relationship between ADHD and EL symptoms, and performance on a range of neuropsychological tasks to clarify whether EL symptoms are predicted by particular cognitive and/or motivational dysfunctions and whether these associations are mediated by the presence of ADHD symptoms. Methods: A large multi-site sample of 424 carefully diagnosed ADHD cases and 564 unaffected siblings and controls aged 6-18 years performed a broad neuropsychological test battery, including a Go/No-Go Task, a warned four-choice Reaction Time task, the Maudsley Index of Childhood Delay Aversion and Digit span backwards. Neuropsychological variables were aggregated as indices of processing speed, response variability, executive functions, choice impulsivity and the influence of energetic and/or motivational factors. EL and ADHD symptoms were regressed on each neuropsychological variable in separate analyses controlling for age, gender and IQ, and, in subsequent regression analyses, for ADHD and EL symptoms respectively. Results: Neuropsychological variables significantly predicted ADHD and EL symptoms with moderate-to-low regression coefficients. However, the association between neuropsychological parameters on EL disappeared entirely when the effect of ADHD symptoms was taken into account, revealing that the association between the neuropsychological performance measures and EL is completely mediated statistically by variations in ADHD symptoms. Conversely, neuropsychological effects on ADHD symptoms remained after EL symptom severity was taken into account. Conclusions: The neuropsychological parameters examined, herein, predict ADHD more strongly than EL. They cannot explain EL symptoms beyond what is already accounted for by ADHD symptom severity. The association between EL and ADHD cannot be explained by these cognitive or motivational deficits. Alternative mechanisms, including overlapping genetic influences (pleiotropic effects) and/or alternative neuropsychological processes need to be considered.
Journal of Child Psychology and Psychiatry 08/2012; 53(11):1139-1148. · 4.28 Impact Factor
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ABSTRACT: Sleep problems are a prominent feature in children with attention-deficit/hyperactivity disorder (ADHD) but their relationships to sleep structure are not consistent across studies. We aimed at further examining the sleep architecture in children with ADHD, while considering the role of the first-night effect (FNE) as a possible confounder. Twenty unmedicated children with ADHD combined type (8-15 years old; mean 11.24, SD 2.31) and 19 healthy controls, matched for age and gender, underwent polysomnography during an adaptation and a consecutive second night. ADHD and controls displayed a typical FNE without group differences. Independently of testing night, children with ADHD spent more time in sleep and had shortened rapid eye movement (REM) sleep latency and a greater amount of REM sleep relative to controls. However, the increased REM sleep amount in ADHD children was more expressed in the second night when it was also significantly related to scores of inattention and hyperactivity. Our results (1) document similar sleep adaptation processes in children with ADHD and typically developing children, (2) reveal that REM sleep changes in association with ADHD-specific psychopathology may characterize sleep in ADHD children, which is evident only when the FNE is accounted for, (3) indicate that ADHD psychopathology and adaptation night may exert opposite effects on REM sleep in children. These results may prompt the awareness of clinicians about the importance of actual sleep alterations and their precise evaluation in children with ADHD, which could significantly contribute to better diagnostic, treatment and early prevention strategies.
European Child & Adolescent Psychiatry 07/2012; · 2.82 Impact Factor
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ABSTRACT: Background: Disturbances of motor circuitry are commonly encountered in Tourette syndrome (TS). The aim of this study was to investigate simple motor performance differences between boys with TS and healthy controls. Methods: We attempted to provide insight into motor network alterations by studying a group of treatment-naïve patients suffering from 'pure' TS, i.e., without comorbid symptomatology at an early stage of disease. We used functional MRI to compare activation patterns during right (preferred) and left (nonpreferred) index finger tapping between 22 TS boys (12.6 ± 1.7 years) and 22 age-matched healthy control boys. Results: Boys with TS revealed altered motor network recruitment for right (dominant) and left (nondominant) index finger tapping. Brain activation patterns in response to index finger tapping of the nonpreferred left hand reflected the most prominent differences, including activation decrease in contralateral sensorimotor cortex while recruiting premotor and prefrontal regions along with the left inferior parietal lobule to a greater extent. Conclusions: This study demonstrates clear functional differences of simple index finger tapping in early-stage TS. We suggest that this reflects the requirement for additional brain networks to keep a normal performance level during the actual task and adaptive mechanisms due to continuous tic suppression and performance in TS.
Journal of Child Psychology and Psychiatry 07/2012; · 4.28 Impact Factor
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ABSTRACT: Tremendous progress has taken place in the last 8 years since the publication of our review on «Therapy of Tic Disorders» in the Zeitschrift für Kinder- und Jugendpsychiatrie. Several steps in treatment have been specified. For example, consensus-based indications for treatment have been published, and a detailed manual for a so-called habit-reversal training program has been developed and evaluated. In addition, new treatment options such as aripiprazole and deep-brain stimulation have been implemented. Increasing attention is being given to the disabling consequences of the commonly co-occurring psychiatric conditions known as ADHD or OCD. Nevertheless, there is still much to be learned about the treatment of tic disorders; standardized and sufficiently large drug trials in patients with tic disorders fulfilling evidence-based medicine standards are still scarce. The same is true for direct comparisons of different agents as well as of medication versus behavioral treatment. Finally, the question of how to predict the individual course of tics and how best to deal with the problems of waxing and waning of tics in this context still limits evidence base for treatment decisions. Large clinical experience is still a pre-requisite for making optimal decisions for the treatment of individual patients suffering from a tic disorder.
Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie 07/2012; 40(4):217-36; quiz 236-7. · 0.99 Impact Factor
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ABSTRACT: This study addressed whether Tourette syndrome is associated with an impairment of fine motor skills or altered interhemispheric transfer. We additionally investigated the association between interhemispheric transfer and size of the corpus callosum.
The sample, a subsample of our larger neuroimaging sample, included 27 treatment-naive males with 'pure' Tourette syndrome (age range 10y 2mo-14y 4mo; mean age 11y 10mo, SD 1y 2mo) and 26 matched healthy comparison children (age range 10y 2mo-14y 4mo; mean age 11y 10mo, SD 1y 1mo). A finger tapping task and the Purdue Pegboard were used to assess fine motor skills. Interhemispheric transfer time (ITT) was measured with the Poffenberger paradigm. The neuroanatomical data were derived from our previous neuroimaging study.
ITT was negatively correlated with the size of callosal subregion 3 (r=-0.366, p=0.028), indicating that a shorter ITT was associated with a larger corpus callosum.
Our findings support the assumption that previously reported impairment of motor skills in Tourette syndrome does not directly result from tics but from other factors such as medication or comorbidities. Following the assumption that callosal subregion 3 in Tourette syndrome grows as a consequence of tic performance over years, our preliminary results suggest that this growth might accelerate interhemispheric transfer in Tourette syndrome.
Developmental Medicine & Child Neurology 05/2012; 54(7):629-35. · 2.92 Impact Factor
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ABSTRACT: BackgroundThe causes and pathophysiological mechanisms of the common comorbidity of tic disorders and Attention-deficit/Hyperactivity
disorder (TD+ADHD; about 50% of TD, about 20% of ADHD) still remain unclear. Studies with a 2×2 design comparing groups
of children with TD, ADHD, TD+ADHD and healthy controls are in need and may disentangle the influences of TD versus ADHD
in the case of comorbidity. Unfortunately, conceptual and methodological problems can restrain possible conclusions from these
studies.
MethodA review of the literature on artifactual and non-artifactual models of comorbidity in general and specially for TD+ADHD
was conducted.
ResultsThe first section describes various possible models of comorbidity and their corresponding hypotheses concerning expected
patterns of findings comparing groups of children with TD, ADHD, TD+ADHD and healthy controls. In the second part research
results concerning psychopathological, neuropsychological, neurophysiological, structural and functional imaging, as well
as genetic characteristics are summarized. In the third section possible conclusions and their limitations due to conceptual
and methodological problems possibly contributing to the ambiguous results are discussed. Finally, future research strategies
and the need for full causal models are outlined.
ConclusionSome components of the etiological pathways of TD+ADHD may well be shared with the ‘pure’ conditions while others may be
unique.
European Child & Adolescent Psychiatry 04/2012; 16:5-14. · 2.82 Impact Factor
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ABSTRACT: Objectives
To describe the associations between a range of demographic, family and clinical factors and clinician-rated measures of global
impairment in children with ADHD symptoms obtained at the baseline assessment in the ADHD Observational Research in Europe
(ADORE) study.
Methods
Global impairment was measured by clinicians using the Clinical Global Impression-Severity (CGIS) scale and the Children's
Global Assessment Scale (CGAS).Associations with independent variables were investigated using forward-stepwise regression
models.
Results
For the CGI-S and CGAS analyses, complete data sets were available for 1,265 and 985 children, respectively. The baseline
mean CGI-S score in this population was 4.4 (SD 0.9) and the mean CGAS score was 55.0 (SD 10.6). Factors significantly associated
with increased impairment on both outcome measures were: increased severity of ADHD symptoms, increased peer relationship
problems and presence of oppositional defiant disorder and/or conduct disorder.Also, the presence of anxiety and/or depression
and the presence of somatic symptoms were associated with increased impairment on CGI-S,while family health problems and premature
birth were associated with increased impairment on CGAS.
Conclusions
The severity of clinician-rated impairment in the ADORE sample is increased by the presence of disruptive behaviour problems
and emotional problems, somatic symptoms, peer relationship difficulties, family health problems and premature birth.
European Child & Adolescent Psychiatry 04/2012; 15:i30-i37. · 2.82 Impact Factor
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ABSTRACT: BackgroundThe strengths and difficulties questionnaire (SDQ) is a brief screening instrument that addresses negative and positive behavioural
attributes of children and adolescents in the age range of 4–16years and can be completed by parents, teachers, and as a
self-report. Furthermore, the impact supplement of the extended SDQ surveys for perceived problems, impact, and burden.
ObjectiveThis paper aims to examine the psychometric properties of the parent form and to investigate differences in the SDQ scores
for sociodemographic and socioeconomic subgroups. Patterns of association with other measures of mental health and descriptive
comparison with the first normative sample are also reported.
MethodsWithin the BELLA study module of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS),
a total of 2,406 children and adolescents aged 7–16years as well as their parents answered the items of the SDQ and the additional
impact supplement. The internal consistency of scale responses was assessed via Cronbach’s α (alpha). Likert scale assumptions
of sufficient and similar item-total correlation and item variance were investigated. The factorial validity of the SDQ measurement
model was tested by means of exploratory and confirmatory factor analysis. Mean score differences between males and females,
age groups (7–10years vs. 11–16years), and socioeconomic status groups (Winkler index) were examined via ANOVA.
ResultsFactor analysis provided an exact replication of the original five-factor SDQ subscale structure. All subscales were sufficiently
homogeneous. The mean total difficulties and SDQ subscale scores of the BELLA sample did not differ from the first German
normative data. Younger children were more impaired on various SDQ scales than older children, girls were more emotionally
affected, and boys showed more externalising problems.
ConclusionsThe present study confirmed the validity and reliability of the parent-reported SDQ scale structure. The SDQ was found to
be a valid and helpful questionnaire for use in the framework of an epidemiological survey.
European Child & Adolescent Psychiatry 04/2012; 17:99-105. · 2.82 Impact Factor
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Ulrike Ravens-Sieberer,
Nora Wille,
Michael Erhart,
Susanne Bettge,
Hans-Ulrich Wittchen, Aribert Rothenberger,
Beate Herpertz-Dahlmann,
Franz Resch,
Heike Hölling,
Monika Bullinger,
Claus Barkmann,
Michael Schulte-Markwort,
Manfred Döpfner,
as the BELLA study group
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ABSTRACT: BackgroundOver the past decades the public health relevance of mental health conditions in children and adolescents has been of growing
concern. However, so far no detailed epidemiological data has been available for a representative national sample in Germany.
ObjectivesThe present paper reports prevalence rates of general and specific mental health problems among children and adolescents in
Germany and describes the link between symptoms and impairment as well as the treatment situation.
MethodsThe mental health module (BELLA study) examines mental health problems in a representative sub-sample of 2,863 families with
children aged 7–17 from the National Health Interview and Examination Survey among Children and Adolescents (KiGGS). Mental
health problems were determined using the extended version of the strengths and difficulties questionnaire (SDQ). Further
standardised screening measures were employed to screen for anxiety disorders (SCARED), conduct disorder (CBCL), attention
deficit-/hyperactivity disorder (FBB-HKS, Conners’ Scale) and depressive disorders (CES-DC). Furthermore, substance abuse
and suicidal tendencies were assessed. Health-related quality of life (HRQoL) and health care use were determined.
ResultsOverall, 14.5% of the children and adolescents aged 7–17 fulfilled the criteria for at least one specific mental health problem
associated with impairment, or had an overall mental health problem indicated by an abnormal SDQ score and present impairment.
However, high comorbidity was found in the children concerned. Symptoms of overall mental health problems were present in
8.6% of the children and 6.6% of the adolescents. This number was reduced to prevalence rates of 6.3 and 4.9% when additional
impairment was taken as a criterion. Irrespective of the type of disorder, fewer than half of the children affected were reported
as receiving treatment. However, for those suffering from mental health problems, large impairments in HRQoL were observed.
ConclusionsThe observed prevalence of mental health problems as well as their large impact on well-being and functioning calls for early
prevention. This is especially important with regard to the large decrease in HRQoL in the children and adolescents affected.
European Child & Adolescent Psychiatry 04/2012; 17:22-33. · 2.82 Impact Factor
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Tobias Banaschewski,
David Coghill,
Paramala Santosh,
Alessandro Zuddas,
Philip Asherson,
Jan Buitelaar,
Marina Danckaerts,
Manfred Döpfner,
Stephen V. Faraone, Aribert Rothenberger,
Joseph Sergeant,
Hans-Christoph Steinhausen,
Edmund J.S. Sonuga-Barke,
Eric Taylor
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ABSTRACT: A systematic review of published and unpublished data on the use of long-acting medications in ADHD and hyperkinetic disorder
is reported, giving effect sizes and numbers-to-treat for extended-release stimulant preparations and atomoxetine (ATX). A
panel of experts from several European countries used the review to make recommendations about the use of these drugs in practice,
and conclusions are reported: (1) Long-acting preparations should be available and used; (2) They should not replace short-acting
drugs (which will be the initial treatment for many children for reasons of cost and flexibility of dosing). Individual clinical
choice is needed. (3) Both ATX and extended-release preparations of stimulants should be available. The choice will depend
upon the circumstances, and detailed recommendations are made.
European Child & Adolescent Psychiatry 04/2012; 15(8):476-495. · 2.82 Impact Factor
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ABSTRACT: Attention deficit hyperactivity disorder is one of the most frequent neuropsychiatric disorders in childhood. Transcranial magnetic stimulation studies based on muscle responses (motor-evoked potentials) suggested that reduced motor inhibition contributes to hyperactivity, a core symptom of the disease. Here we employed the N100 component of the electroencephalographic response to transcranial magnetic stimulation as a novel marker for a direct assessment of cortical inhibitory processes, which has not been examined in attention deficit hyperactivity disorder so far. We further investigated to what extent affected children were able to regulate motor cortical inhibition, and whether effects of age on the electroencephalographic response to transcranial magnetic stimulation were compatible with either a delay in brain maturation or a qualitatively different development. N100 amplitude evoked by transcranial magnetic stimulation and its age-dependent development were assessed in 20 children with attention deficit hyperactivity disorder and 19 healthy control children (8-14 years) by 64-channel electroencephalography. Amplitude and latency of the N100 component were compared at rest, during response preparation in a forewarned motor reaction time task and during movement execution. The amplitude of the N100 component at rest was significantly lower and its latency tended to be shorter in children with attention deficit hyperactivity disorder. Only in controls, N100 amplitude to transcranial magnetic stimulation was reduced by response preparation. During movement execution, N100 amplitude decreased while motor evoked potential amplitudes showed facilitation, indicating that the electroencephalographic response to transcranial magnetic stimulation provides further information on cortical excitability independent of motor evoked potential amplitudes and spinal influences. Children with attention deficit hyperactivity disorder showed a smaller N100 amplitude reduction during movement execution compared with control children. The N100 amplitude evoked by transcranial magnetic stimulation decreased with increasing age in both groups. The N100 reduction in children with attention deficit hyperactivity disorder at all ages suggests a qualitative difference rather than delayed development of cortical inhibition in this disease. Findings further suggest that top-down control of motor cortical inhibition is reduced in children with attention deficit hyperactivity disorder. We conclude that evoked potentials in response to transcranial magnetic stimulation are a promising new marker of cortical inhibition in attention deficit hyperactivity disorder during childhood.
Brain 04/2012; 135(Pt 7):2215-30. · 9.46 Impact Factor
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ABSTRACT: Neurofeedback (NF), a type of neurobehavioral training, has gained increasing attention in recent years, especially concerning the treatment of children with ADHD. Promising results have emerged from recent randomized controlled studies, and thus, NF is on its way to becoming a valuable addition to the multimodal treatment of ADHD. In this review, we summarize the randomized controlled trials in children with ADHD that have been published within the last 5 years and discuss issues such as the efficacy and specificity of effects, treatment fidelity and problems inherent in placebo-controlled trials of NF. Directions for future NF research are outlined, which should further address specificity and help to determine moderators and mediators to optimize and individualize NF training. Furthermore, we describe methodological (tomographic NF) and technical ('tele-NF') developments that may also contribute to further improvements in treatment outcome.
Expert Review of Neurotherapeutics 04/2012; 12(4):447-60.
