Article

Specificity of Reward Sensitivity and Parasympathetic-Based Regulation among Children with Attention-Deficit/Hyperactivity and Disruptive Behavior Disorders

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Abstract

Attention-deficit/hyperactivity disorder (ADHD) is associated with disruptionsin reward sensitivity and regulatory processes. However, it is unclear whether thesedisruptions are better explained by comorbid disruptive behavior disorder (DBD)symptomology. This study sought to examine this question using multiple levels ofanalysis (i.e., behavior, autonomic reactivity). One hundred seventeen children (aged 6 to 12 years; 72.6% male; 69 with ADHD) completed theBalloon-Analogue Risk Task (BART) to assess external reward sensitivity behaviorally.Sympathetic-based internal reward sensitivity and parasympathetic-based regulationwere indexed via cardiac pre-ejection period (PEP) and respiratory sinus arrhythmia(RSA), respectively. Children with ADHD exhibited reduced internal reward sensitivity (i.e.,lengthened PEP; F(1,112)=4.01, p=0.047) compared to healthy controls and werecharacterized by greater parasympathetic-based dysregulation (i.e., reduced RSAaugmentation F(1,112)=10.12, p=0.002). However, follow-up analyses indicated theADHD effect was better accounted for by comorbid DBD diagnoses; that is, childrenwith ADHD and comorbid ODD were characterized by reduced internal rewardsensitivity (i.e., lengthened PEP; t=2.47, p=0.046) and by parasympathetic-baseddysregulation (i.e., reduced RSA augmentation; t=3.51, p=0.002) in response to rewardwhen compared to typically developing youth. Furthermore, children with ADHD and comorbid CD exhibited greater behaviorally-based external reward sensitivity (i.e.,more total pops; F(3,110)= 5.96, p=0.001) compared to children with ADHD only (t=3.87, p=0.001) and children with ADHD and ODD (t=3.56, p=0.003). Results suggest that disruptions in sensitivity to reward may be betteraccounted for, in part, by comorbid DBD.Key Words: attention-deficit/hyperactivity disorder, autonomic nervous system,disruptive behavior disorders, reward sensitivityPowered

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... Recruitment and identification procedures were identical to those described in Tenenbaum et al. (2018) and are described here in brief. Children with ADHD were a sub-sample from a Summer Treatment Program (STP) recruited from a doublemasked, cross-over study examining tolerance to stimulant medication. ...
... Diagnoses of ADHD for children enrolled in the STP were identical to procedures described in Tenenbaum et al. (2018) and described here in brief. Diagnoses were made in accordance with best-practice recommendations (Pelham et al. 2005a). ...
... Procedures were identical to those described in Tenenbaum et al. (2018). In brief, disposable silver/silver-chloride electrodes were placed in an electrocardiogram (ECG) and impedance cardiography (ICG) configuration, and were both recorded throughout a two-minute resting baseline period and the go/ no-go tasks. ...
Article
Attention-deficit/hyperactivity disorder (ADHD) is associated with deficits in response inhibition, response execution, and emotion regulation. However, the nature of the associations among these deficits remains unclear. Thus, this study examines these associations using a multi-method design. One hundred sixty-six children (aged 5–13 years; 66.3% male; 75 with ADHD) completed two conditions (i.e., neutral and fear) of an emotional go/no-go task. Parasympathetic-based regulation was indexed via respiratory sinus arrhythmia (RSA), and sympathetic-based reactivity was indexed via cardiac pre-ejection period (PEP). Overall, children exhibited more difficulty with response execution (i.e., more omission errors, fewer correct go responses) and less difficulty with response inhibition (i.e., fewer commission errors, more correct no-go responses) during the fear condition than the neutral condition. Children with ADHD displayed more difficulty with response execution during the fear condition compared to typically developing youth. Additionally, children with ADHD displayed parasympathetic-based dysregulation (i.e., RSA increase from baseline) and reduced sympathetic-based reactivity (i.e., PEP lengthening) compared to typically developing youth across task conditions. In sum, children with ADHD demonstrate greater difficulty with response execution during emotionally salient contexts, as well as parasympathetic-based emotion dysregulation. Future work should examine these associations longitudinally with the aim of predicting impairment and treatment response in youth with ADHD.
... Parasympathetic Functioning in Youth with ADHD. At rest, youth with ADHD exhibit reduced RSA compared to typically developing youth Tenenbaum et al., 2018;Tonhajzerova et al., 2009). A review of six studies concluded that unmedicated youth with ADHD experience reduced parasympathetic activity (indexed via heart rate variability [a proxy for RSA]) at rest compared to typically developing youth (Rash & Aguirre-Camacho, 2012). ...
... More recent work that accounted for diagnostic comorbidity and a medication washout period among a large sample of youth with and without ADHD (i.e., N > = 117; e.g., Morris et al., 2019;Tenenbaum et al., 2018), suggest youth with ADHD exhibit reduced RSA at rest compared to typically developing youth. However, inconsistencies remain within the recent literature, even after accounting for diagnostic comorbidity and/or psychostimulant status, with some studies suggesting that youth with ADHD do not experience differences in RSA at rest when compared to typically developing youth (e.g., McQuade & Breaux, 2017;Musser et al., 2018;Ward et al., 2015). ...
... Specifically, youth with ADHD were examined twice via a doublemasked, cross-over, active medication vs placebo design, while medication naïve typically developing youth were examined once, while RSA and EDA measures were collected. As outlined in previous literature, medication-free youth with ADHD tend to experience reduced RSA and EDA at rest compared to typically developing youth (Conzelmann et al., 2014;Morris et al., 2019;Tenenbaum et al., 2018;Tonhajzerova et al., 2009). In line with evidence that MPH increases dopamine, which impacts relevant functions of the ANS, and prior empirical literature, it was hypothesized that MPH would increase autonomic activity across both ANS branches among youth with ADHD. ...
Article
Psychostimulants are commonly prescribed medications for youth with attention-deficit/hyperactivity disorder (ADHD). Limited studies have evaluated how psychostimulants (e.g., methylphenidate [MPH]) impact autonomic nervous system (ANS) indexes among youth with ADHD. Understanding the effects of MPH on autonomic functioning is essential, given that youth with ADHD have been shown to experience atypical autonomic functioning (i.e., reduced activity across both sympathetic and parasympathetic branches) compared to typically developing youth. The current study investigated how a specific psychostimulant, Osmotic Release Oral System [OROS] MPH, impacts parasympathetic (indexed by respiratory sinus arrhythmia [RSA]) and sympathetic (indexed by electrodermal activity [EDA]) functioning among youth with ADHD via a within-subjects, double-masked, cross-over design. Two hundred fifty-six participants (157 youth with ADHD), ages 5 to 13 years, completed a two-minute resting baseline task while electrocardiograph and electrodermal data were obtained. Youth with ADHD completed the resting baseline task twice, 3 weeks apart, once during active medication and once during placebo conditions (counterbalanced). Typically developing youth were assessed without medication or placebo. Youth with ADHD during the placebo condition exhibited reduced RSA and EDA compared to typically developing youth. In contrast, youth with ADHD during the medication condition did not differ significantly from typically developing youth with respect to either RSA nor EDA. As such, OROS MPH appears to normalize RSA and EDA levels among youth with ADHD to levels comparable to typically developing youth. Future studies including indexes of the ANS among youth with ADHD are urged to consider the impact of MPH.
... presentation in adolescence, when ADHD presentations appear to stabilize (Langberg et al., 2008). Given high comorbidity between ADHD and oppositional defiant (ODD) and conduct disorder (CD) symptoms (Bendiksen et al., 2017) and the relevance of reward processing to these disorders (Tenenbaum et al., 2018), more conservative follow-up analyses adjusting for ODD and CD symptoms were conducted for supported mediational models. ...
... There is ongoing debate as to whether ADHD is associated with reward-system dysregulation independent of comorbid disruptive behavior disorder symptomology (Tenenbaum et al., 2018). It has been argued that shared risk factors may contribute to ADHD commonly co-occurring with ODD and CD; better understanding of distinct and shared etiological influences or risk factors across these disorders may ultimately improve personalization of intervention and prediction of intervention response. ...
Article
To identify sources of phenotypic heterogeneity in attention-deficit/hyperactivity disorder (ADHD) accounting for diversity in developmen-tal/ pathogenic pathways, we examined, in a large sample of youth (N = 354), (a) associations between observed temperamental emotionality at age 3, an electrocortical index (i.e., reward positivity [RewP]) of initial responsiveness to reward at age 9, and ADHD symptoms at age 12, and (b) whether the association between emotionality and ADHD symptoms is mediated by initial responsiveness to reward. Bivariate analyses indicated greater positive emotionality (PE) was associated with enhanced RewP, lower age-9ADHD and lower age-12 inattention (IA). Negative emotionality (NE) was not associated with RewP or ADHD. Mediation analyses revealed the association between PE and hyper-activity/impulsivity (H/I) was mediated by RewP; enhanced RewP was associated with greater H/I. Greater PE was associated with enhanced RewP at a trend level. These effects held accounting for age-9 ADHD, age-12 IA and age-12 oppositional defiant and conduct disorder symptoms. As such, preschool emotionality is associated with adolescent ADHD-H/I symptoms through late childhood initial responsiveness to reward. These relations indicate that individual differences in emotionality and reward responsiveness may be informative for personalizing ADHD interventions.
... DBD is a common and highly impairing psychiatric disorder characterized by conduct problems, irritability, and oppositional defiant behaviour [2]. Children with ADHD and DBD (ADHD DBD+ ) have additional impairments and worse prognosis than children with ADHD alone or DBD alone [3,4]. In particular, many empirical studies have shown that comorbid DBD predicts ADHD persistence through adulthood. ...
Article
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Background Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder. Many previous studies have shown that the comorbid status of disruptive behaviour disorders (DBD) was a predictor for ADHD persistence into adulthood. However, the brain mechanisms underlying such a relationship remain unclear. Thus, we aim to investigate whether the brain functional alteration in adults with ADHD could also be detected in children with ADHD co-occurring with disruptive behaviours from both quantitative and categorical dimensions. Methods A total of 172 children with ADHD (cADHD), 98 adults with ADHD (aADHD), 77 healthy control children (cHC) and 40 healthy control adults (aHC) were recruited. The whole-brain spontaneous fluctuations in brain activity of each participant were recorded using functional near-infrared spectroscopy (fNIRS), and the functional connectivities (FCs) were calculated. We first compared the FC differences between aADHD and aHC. Then, for the regions with significantly abnormal FCs in aADHD, we further compared these features between cADHD and cHC. In addition, the correlation between these FCs and the conduct disorder (CD)/oppositional defiant disorder (ODD) symptoms were analysed in cADHD. Moreover, to render the results readily interpretable, we compared the FC differences among ADHDCD−, subthreshold ADHDCD+ and cHC groups, and among ADHDODD−, ADHDODD+ and cHC groups. Finally, we repeated the above analysis after controlling for other comorbidities and core symptoms to diminish the potential confounding effects. Results We found that compared with aHC, aADHD showed significantly increased FCs in the VN, DMN, SMN, and DAN. The aforementioned abnormal FCs were also detected in cADHD, however, in an opposite orientation. Notably, these abnormal FCs were positively correlated with CD symptoms. Finally, the subthreshold ADHDCD+ group even exhibited a tendency of adult-like increased FCs compared with the cHC. The results held after controlling for other comorbidities and core symptoms. Conclusion This study provides functional neuroimaging evidence that CD might be a risk factor for ADHD persistence into adulthood. Our work highlights the importance of differentiating ADHDCD+ from ADHD and inspiring further understanding of brain development in ADHD.
... Given that ADHD has been associated with impairments on tests intended to assess a broad range of constructs (Willcutt et al., 2005), identifying neurocognitive components that are intact in pediatric ADHD is important for improving our understanding of the mechanisms and processes that underlie -and do not underlie -the disorder's heterogeneous behavioral presentation (Kofler et al., 2019). For example, Raiker and colleagues reported that pediatric ADHD may be associated with a strength in motor speed and intact reward sensitivity (Tenenbaum et al., 2018). Similarly, we have found that ADHD is likely not associated with impairments in set shifting (Irwin et al., 2019), response speeds (Kofler et al., 2016), or episodic buffer processes (Kofler, Spiegel et al., 2018) based in part on a subset of the current sample. ...
Article
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Objective: Attention-deficit/hyperactivity disorder (ADHD) has been associated with large magnitude impairments in working memory, whereas short-term memory deficits, when detected, tend to be less pronounced. However, confidence in these findings is limited due to task impurity combined with methodological and statistical limitations of the current evidence base. Method: A well-characterized, clinically evaluated sample of 172 children ages 8-13 years (M = 10.30, SD = 1.42; 72 girls; 64% White/non-Hispanic) were administered multiple, counterbalanced working memory tests. Bifactor-(s-1) modeling was used to characterize the presence and magnitude of central executive working memory, phonological short-term memory, and visuospatial short-term memory deficits in pediatric ADHD. Results: ADHD status was associated with very large magnitude impairments in central executive working memory that are present in most pediatric cases (d = 1.63-2.03; 75%-81% impaired), and these deficits covaried with ADHD inattentive and hyperactive/impulsive symptom severity based on both parent and teacher report. There was also evidence for a unique, albeit significantly smaller, impairment in visuospatial short-term memory (d = 0.60; 38% impaired); however, visuospatial short-term memory abilities did not covary with ADHD symptom severity. There was no evidence linking ADHD with phonological short-term memory deficits across either the dimensional or categorical analyses. Conclusion: These findings provide strong evidence that ADHD is associated with marked central executive working memory deficits that covary with their behavioral symptom presentation across settings. In contrast, visuospatial short-term memory deficits, when present, are likely epiphenomenal, and the most parsimonious conclusion appears to be that phonological short-term memory is intact in pediatric ADHD. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
... The current study attempted to balance these considerations by including both a clinical and healthy control group. The ADHD and clinical control groups were matched for the number of non-ADHD disorders because neither cognitive dysfunction nor behavioral symptoms (e.g., difficulty concentrating, restlessness) appear unique to ADHD (e.g., Snyder, 2013;Youngstrom, Arnold, & Frazier, 2010), and emerging evidence suggests that some (formally) putative pathways to the ADHD phenotype may be linked with common comorbidities rather than ADHD itself (Tenenbaum et al., 2018). Though inclusion of non-ADHD disorders could potentially have obscured diagnostic group differences, exploratory analyses revealed that the pattern of results is unchanged when the control groups are examined separately. ...
Article
Inhibition is a key neurocognitive domain in ADHD that is commonly assessed with the stop-signal task. The stop-signal involves both “go” and “stop” trials; previous research indicates that response times are reliably slower to “go” trials during tasks with vs. without intermittent “stop” trials. However, it is unclear whether this pattern reflects deliberate slowing to maximize inhibitory success (performance adjustment hypothesis) and/or disrupted bottom-up information processing due to increased cognitive demands (dual-task hypothesis). Given the centrality of “go” responding for estimating children’s inhibitory speed, finding that children with ADHD slow differently –or for different reasons– has the potential to inform cognitive and self-regulatory theories of ADHD. The current study used a carefully-controlled experimental design to assess the mechanisms underlying stop signal-related slowing in ADHD. Children ages 8-13 with (n = 81) and without ADHD (n = 63) completed the stop-signal task and a control task that differed only in the presence/absence of “stop” trials. Using drift-diffusion modeling, Bayesian repeated-measures ANOVAs revealed a pattern consistent with the performance adjustment hypothesis, such that children adopted more cautious response strategies (BF10 = 6221.78; d = 0.38) but did not show changes in processing speed (BF01 = 3.08; d = 0.12) or encoding/motor speed (BF01 = 5.73; d = 0.07) when inhibition demands were introduced. Importantly, the ADHD/Non-ADHD groups showed equivalent effects of intermittent “stop” trials (BF01 = 4.30-5.56). These findings suggest intact self-regulation/performance monitoring in the context of adapting to increased inhibitory demands in ADHD, which has important implications for the continued isolation of potential mechanisms associated with ADHD symptoms and impairment.
... * (Ward et al., 2015) excluded. Crowell et al., 2006 **** **** * * *** *** 8* High Griffiths et al., 2017 *** **** ** ** ** *** 7* High Karalunas et al., 2014 **** **** ** ** ** ** 8* High Musser et al., 2011 **** **** ** ** *** *** 9* High Musser et al., 2013 **** **** ** ** *** *** 9* High Musser and Nigg, 2017 **** **** ** ** *** *** 9* High Negrao et al., 2011 ** **** * * ** ** 5* Low Rukmani et al., 2016 **** **** ** ** *** *** 9* High Shibagaki and Furuya, 1997 *** *** ** ** 5* Low Tenenbaum et al., 2017 **** **** ** ** *** *** 9* High Tonhajzerova et al., 2009 **** **** ** ** *** *** 9* High Ward et al., 2015 **** **** ** ** *** *** 9* High Note: Abbreviations: R1= rater 1; R2=rater 2. study effects, and adjustment for publication bias rendered effects no longer significant. Third, we were not able to perform meta-analysis for adults independently, due to the low number of studies reporting this important information. ...
Article
Background: Research suggests that Attention-Deficit/Hyperactivity Disorder (ADHD) is associated with autonomic nervous system dysregulation, but the findings were mixed. Method: We conducted a literature review and meta-analysis to quantify the effect of ADHD on vagally-mediated heart rate variability (HRV). PsycINFO, PubMed, Web of Science and Scopus, were searched for case-control or cohort studies reporting measures of vagally-mediated HRV, after a task demand, among individuals with ADHD relative to healthy subjects. Results: Thirteen articles comprising a total of 869 patients with ADHD and 909 healthy participants were included. As compared to controls, ADHD patients had reduced vagally-mediated HRV, corresponding to a small effect size (Hedge's g = 0.20; CI 95% 0.01 to 0.40). Heterogeneity was high (Q (18) = 76.59, p < 0.001; I² = 77%). There was some evidence of small study effects. Task type, respiration rate assessment and associated comorbid disorders were statistically significant moderators. Conclusions: These findings provide evidence for the associations between ADHD and autonomic dysregulation. Future studies addressing HRV reactivity are needed.
... In contrast, the cardiac pre-ejection period (PEP; the systolic time interval) is an index of sympathetic cardiac activity and reflects the time between depolarization of the left ventricle and opening of the aortic valve (Brenner and Beauchaine, 2011). A shorter PEP suggests higher contractility and greater sympathetic tone and has been associated with the start of a stress reaction (Berntson et al., 1994a,b) as well as with reward sensitivity (Tenenbaum et al., 2018). Beauchaine et al. (2001) provided evidence that adolescents with comorbid CD and ADHD symptoms exhibited longer PEP at baseline and less or decreased PEP reactivity to reward than those in ADHD-only or control groups. ...
Article
The aim of this study was to conduct a systematic review of the literature and meta-analysis to estimate the association between psychophysiological activity and reactivity at baseline or after a psychological task with conduct problems (CP) among children and adolescents. We systematically reviewed published studies reporting autonomic nervous system activity in youth with CP and meta-analyzed the relationship between CP and autonomic baseline as well as task-related reactivity in 66 studies (N = 10,227). Across 34 included case-control studies that were based on CP cut-off scores, we found a significant pooled effect for task related Skin-Conductance, Respiratory Sinus Arrhythmia, and cardiac Pre-Ejection Period, but no significant group differences for Heart Rate nor for any baseline measures. Findings suggested reduced parasympathetic and sympathetic reactivity to emotional tasks, pointing to co-inhibition of the two systems. However, across 32 studies with correlational design we only found a significant negative correlation of baseline and task-related heart rate with CP. The present meta-analysis derived several conclusions that have the potential to inform biological vulnerability models and biologically driven interventions.
... Some limitations of this study are the small sample size and the absence of female participants. Tenenbaum et al. (2018) similarly focused on ADHD and CD/ODD, and found that increased reward sensitivity (measured using the Balloon Analogue Risk-Taking Task), lengthening of PEP and reduced RSA withdrawal were explained by comorbid CD and ODD symptoms, and not by hyperactivity or inattention, in a sample of children with ADHD. In addition to these studies, Crowell et al. (2006) found signs of autonomic hyper-activation both at baseline and in association with reward, during a tablet-based game played by pre-schoolers with ADHD + ODD. ...
Article
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Although arousal mechanisms have frequently been found to be atypical in ADHD, these findings usually emerged from indirect behavioural measures which give only a limited understanding of arousal dysregulation in this condition. To assess the hypothesis that functioning of the autonomic nervous system (ANS), one component of arousal, is atypical in ADHD, we carried out a systematic review of the literature on 55 studies investigating electro-dermal, heart rate and pupillometry measures under different experimental conditions (resting-state, cognitive tasks and in response to reinforcers or socio-emotional stimuli). Our literature review identified ANS dysfunction in individuals with ADHD, more often in the direction of hypo-arousal than hyper-arousal, particularly at rest and during tasks requiring response regulation and sustained attention. Almost half of the reported findings were null. Stimulant medications increased ANS activity and, in some studies, reinforcers and rewards produced a similar effect, suggesting that ANS function can be modified in ADHD. Further research is needed to assess the influence of comorbid symptoms and to explore methodological parameters that may influence findings.
... This finding may explain why psychoeducation approaches are not effective with these children (e.g., traditional social skills training; Evans et al., 2018), but can be effective when taught in the context of an intensive behavioral program that uses operant conditioning principles to address performance deficits (Pelham et al., 2014). In addition, there has been research on malleable characteristics of children with ADHD that may explain the effectiveness of behavior modification approaches, such as reward sensitivity (Tenenbaum et al., 2018;Tripp & Alsop, 2001). Identification and an improved understanding of malleable constructs that are causally related to impairment in children with ADHD will help us improve our behavioral interventions and their long-term benefits. ...
Article
Multiple psychosocial interventions are efficacious for children and adolescents with attention-deficit/hyperactivity disorder (ADHD) including behavioral parent training, behavioral classroom management, behavioral peer interventions, and organization training programs. Unfortunately, there is a significant gap between research and practice such that evidence-based treatments often are not implemented in community and school settings. Using a life course model for ADHD treatment implementation, we discuss future research directions that support movement from the current, fragmented system of care to a more comprehensive, integrated, and multisystemic approach. Specifically, we offer six recommendations for future research. Within the realm of treatment development and evaluation, we recommend (1) identifying and leveraging mechanisms of change, (2) examining impact of youth development on treatment mechanisms and outcomes, and (3) designing intervention research in the context of a life course model. Within the realm of implementation and dissemination, we recommend investigating strategies to (4) enhance access to evidence-based treatment, (5) optimize implementation fidelity, and (6) examine and optimize costs and cost-effectiveness of psychosocial interventions. Our field needs to go beyond short-term, efficacy trials to reduce symptomatic behaviors conducted under ideal controlled conditions and successfully address the research-to-practice gap by advancing development, evaluation, implementation, and dissemination of evidence-based treatment strategies to ameliorate ADHD-related impairment that can be used with fidelity by parents, teachers, and community health providers.
... In terms of component cognitive mechanisms, previous research in ADHD has focused on reward valuation and reward processing [10,11], on control of sustained attention [12,13] and on executive function [14,15]. However, these approaches neglect to operationalize the critical component of cognitive effort, a central process model of both cognitive control [16] and reward valuation [17]. ...
Article
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ADHD is defined by behavioral symptoms that are not well characterized in relation to ADHD's neurobiological mechanisms. This approach has limited our ability to define ADHD nosology and predict outcomes because it does not systematically examine facets of the disorder such as the inability to maintain cognitively effortful activities, as promoted in the NIMH RDoC approach. Existing data indicate ADHD is associated with differences in reward valuation and processing, but we do not know whether ADHD is also associated with higher levels of aversion to exerting cognitive effort and/or altered reward x effort interactions. Our ongoing study addresses this knowledge gap by examining individuals' preferences between rewards associated with minimal effort and reward alternatives with a higher payoff but higher effort costs ("effort discounting"); thereby permitting us to characterize differences in biases and tradeoffs during effort-related decision-making in ADHD. The study takes advantage of a well-defined sample of ADHD-diagnosed and healthy control individuals to address three aims. First, we determine whether ADHD is associated with steeper discounting of larger, more effortful rewards. Second, we examine the subjective perception of effort in youth diagnosed with ADHD and healthy controls using tasks requiring varying levels of cognitive effort. Third, we explore relationships amongst indices of effort discounting, theoretically-related traits (e.g., grit, distress tolerance), biomarkers of effort-related decision-making (eye movements and pupil size), and various cognitive measures. Successful completion of the aims will permit us to better characterize ADHD-healthy control differences and lay a foundation for more computational approaches to ADHD diagnostic criteria.
... Research comparing children with ADHD to children with ODD is especially relevant in this context, as BPT was developed for children with behavioral disorders in general. Thus, it is currently not clear how different comorbidities affect reinforcement learning in ADHD, some studies have explored the effect of reward on cognitive tasks, thereby comparing children with ADHD to children with ADHD and comorbid ODD (e.g., Tenenbaum et al. 2019; Van der Meere et al. 2005); however, research into effects of comorbidity on learning from reward and punishment is scarce. For the specific recommendation of limiting the use of punishment techniques in BPT for ADHD this may be especially relevant. ...
Article
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Attention Deficit Hyperactivity Disorder [ADHD] is one of the most common psychiatric disorders of childhood with poor prognosis if not treated effectively. Recommended psychosocial evidence-based treatment for preschool and school-aged children is Behavioral Parent and Teacher Training [BPT]. The core elements of BPT are instrumental learning principles, i.e., reinforcement of adaptive and the ignoring or punishment of non-adaptive behaviors together with stimulus control techniques. BPT is moderately effective in reducing oppositional behavior and improving parenting practices, however it does not reduce blinded ratings of ADHD symptoms. Also after training effects dissipate. This practitioner review proposes steps that can be taken to improve BPT outcomes for ADHD, based on purported causal processes underlying ADHD. The focus is on altered motivational processes (reward and punishment sensitivity), as they closely link to the instrumental processes used in BPT. Following a critical analysis of current behavioral treatments for ADHD we selectively review motivational reinforcement-based theories of ADHD, including the empirical evidence for the behavioral predictions arising from these theories. This includes consideration of children’s emotional reactions to expected and unexpected outcomes. Next we translate this evidence into potential ADHD specific adjustments designed to enhance the immediate and long-term effectiveness of BPT programs in addressing the needs of children with ADHD. This includes the use of remediation strategies for proposed deficits in learning not commonly used in BPT programs and cautions regarding the use of punishment. Finally we address how these recommendations can be effectively transferred to clinical practice.
... This is surprising as the main clinical populations sampled were individuals with ADHD (Demurie et al., 2016;Desman et al., 2008;Ma et al., 2016) and SUD (Charles-Walsh et al., 2016;Chung et al., 2011). Both disorders are characterised by disrupted reward processing (García-García et al., 2014;Tenenbaum et al., 2018), and with this particular sensitivity to rewarding stimuli, we may have expected an enhanced effect of reward on IC for these sub-groups. In the case of SUD populations, the lack of effect of reward may be due to the severity of the condition, for example, harmful use or dependency (Byrne & Worthy, 2019), yet we did not have enough data to reliably investigate any differences by clinical diagnosis. ...
Article
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Contemporary theories predict that Inhibitory Control (IC) can be improved when rewards are available for successfully inhibiting. In non-clinical samples empirical research has demonstrated some support, however ‘null’ findings have also been published. The aim of this meta-analysis was to clarify the magnitude of the effect of reward on IC, and identify potential moderators. Seventy-three articles (contributing k = 80 studies) were identified from Pubmed, PsychInfo and Scopus, published between 1997 – 2020, using a systematic search strategy. A random effects meta-analysis was performed on effect sizes generated from IC tasks which included rewarded and non-rewarded inhibition trials. Moderator analyses were conducted on clinical samples (vs ‘healthy controls’), task type (Go/No-Go vs Stop Signal vs Flanker vs Simon vs Stroop vs Anti-Saccade), reward type (monetary vs points vs other), and age (adults vs children). The prospect of reward for successful inhibition significantly improved IC (SMD=0.429 (95% CI= 0.288, 0.570), I2=96.7%), compared to no reward conditions/groups. This finding was robust against influential cases and outliers. The significant effect was present across all IC tasks. There was no evidence the effect was moderated by type of reward, age or clinical samples. Moderator analyses did not resolve considerable heterogeneity. Findings suggest that IC is a transient state that fluctuates in response to motivations driven by reward. Future research might examine the potential of improving inhibitory control through rewards as a behavioural intervention.
... Youth with AB consistently pursue large, immediate rewards despite the possibility of loss (see Byrd et al., 2014 for review). For example, youth with CD and ADHD continue to engage in reward-seeking behavior despite the increasing probability of loss compared to youth with ADHD only (Tenenbaum et al., 2017). Furthermore, youth and adults high on AB continue pursuing rewards even as contingencies change and result in losses, as exemplified in response reversal tasks (Matthys et al., 2004) and passive avoidance tasks (Newman & Kosson, 1986). ...
Thesis
Antisocial Behavior (AB), is associated with persistence in risky, reward-driven behaviors despite severe potential consequences such as incarceration. Neuroimaging research has the potential to elucidate the biological mechanisms of these behaviors and to contribute to our understanding of the etiology of AB. However, little is known about the reward-related neural mechanisms that contribute to AB. The few neuroimaging studies that have investigated associations between reward processing and AB often report conflicting findings, perhaps due to methodological and sample heterogeneity across studies. Furthermore, research on adolescent reward-related brain function has typically examined these processes in small, primarily Caucasian, middle-class samples. These samples may have limited generalizability to more diverse or low-income populations that are at increased risk for AB. Finally, studies of typically developing adolescents and studies of youth and adults high on AB fail to adequately investigate specific phases of reward processing in racially-diverse samples. This dissertation is comprised of three studies that examine the neural correlates of reward and loss processing and how variability in these reinforcement circuits is related to AB. Study 1 addresses questions regarding the direction of the relationship between AB and neural response to reward and loss by conducting a systematic review of functional magnetic resonance imaging (fMRI) studies of reward and loss processing in adult AB. To better understand factors contributing to the development of reward processing in adolescence, Study 2 examines the effects of age, pubertal status, race, and gender on neural response to reward and loss in a relatively large, well-sampled cohort of primarily low-income adolescents from urban environments. This study uses a novel version of the Monetary Incentive Delay (MID) task, which has been modified to allow for sufficient temporal separation of phases of reward and loss processing and comparisons to neutral conditions. Finally, Study 3 builds on the results of Study 2 by examining the relationship between AB and neural response to reward and loss using the same sample and task. This study aimed to elucidate the relationship between AB reward- and loss-related neural functioning by investigating whether individual differences in traits such as disinhibition and sensation-seeking explain associations and whether the callous-unemotional traits moderate associations between AB and neural response to reward and loss.
... These characteristics overlap with CU traits (4,22). Studies analyzing sympathetic arousal (using the cardiac preejection period) during reward-related tasks found associations with comorbid ODD: Tenenbaum et al. (23) compared healthy children and children with ADHD, ADHD+ODD, and ADHD+CD regarding their sympathetic activity during a risky decision-making task and found the lowest activity in children with ADHD+ODD. In a sample of children with ADHD, Beauchaine et al. (24) found that sympathetic activity during a rewarded simple-matching task was associated with parentreported conduct behavior problems. ...
Article
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Objectives: Neurocognitive functions might indicate specific pathways in developing attention deficit hyperactivity disorder (ADHD). We focus on reward-related dysfunctions and analyze whether reward-related inhibitory control (RRIC), approach motivation, and autonomic reactivity to reward-related stimuli are linked to developing ADHD, while accounting for comorbid symptoms of oppositional defiant disorder (ODD), and callous-unemotional (CU) traits. Methods: A sample of 198 preschool children (115 boys; age: m = 58, s = 6 months) was reassessed at age 8 years (m = 101.4, s = 3.6 months). ADHD diagnosis was made by clinical interviews. We measured ODD symptoms and CU traits using a multi-informant approach, RRIC (Snack-Delay task, Gift-Bag task) and approach tendency using neuropsychological tasks, and autonomic reactivity via indices of electrodermal activity (EDA). Results: Low RRIC and low autonomic reactivity were uniquely associated with ADHD, while longitudinal and cross-sectional links between approach motivation and ADHD were completely explained by comorbid ODD and CU symptoms. Conclusion: High approach motivation indicated developing ADHD with ODD and CU problems, while low RRIC and low reward-related autonomic reactivity were linked to developing pure ADHD. The results are in line with models on neurocognitive subtypes in externalizing disorders.
... Given the deficits in ER among children with ODD, it is important to note that ER difficulties may not only contributory factors to ODD but also share underlying factors with ODD. For example, for neurophysiological factors, previous study indicated children with ODD symptoms tended to have decreased parasympathetic-based dysregulation, which was related to the physiological process of ER (Tenenbaum et al., 2018). Regarding social factors, (Eisenberg, 2020) indicated children's ER and behavioral problems were affected by cultural factors and context (e.g., degree of emotion in context). ...
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... Neural response to reward has also been implicated in associations between evening chronotype and mental illness. Altered reward processing is common across mental health problems [10,[82][83][84][85][86][87][88][89][90][91]. For instance, blunted reward sensitivity has been linked with anhedonia, or the inability to experience pleasure, a common symptom of depression [86]. ...
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Importance Psychiatric nosology is limited by behavioral and biological heterogeneity within existing disorder categories. The imprecise nature of current nosologic distinctions limits both mechanistic understanding and clinical prediction. We demonstrate an approach consistent with the National Institute of Mental Health Research Domain Criteria initiative to identify superior, neurobiologically valid subgroups with better predictive capacity than existing psychiatric categories for childhood attention-deficit/hyperactivity disorder (ADHD).Objective To refine subtyping of childhood ADHD by using biologically based behavioral dimensions (ie, temperament), novel classification algorithms, and multiple external validators.Design, Setting, and Participants A total of 437 clinically well-characterized, community-recruited children, with and without ADHD, participated in an ongoing longitudinal study. Baseline data were used to classify children into subgroups based on temperament dimensions and examine external validators including physiological and magnetic resonance imaging measures. One-year longitudinal follow-up data are reported for a subgroup of the ADHD sample to address stability and clinical prediction.Main Outcomes and Measures Parent/guardian ratings of children on a measure of temperament were used as input features in novel community detection analyses to identify subgroups within the sample. Groups were validated using 3 widely accepted external validators: peripheral physiological characteristics (cardiac measures of respiratory sinus arrhythmia and pre-ejection period), central nervous system functioning (via resting-state functional connectivity magnetic resonance imaging), and clinical outcomes (at 1-year longitudinal follow-up).Results The community detection algorithm suggested 3 novel types of ADHD, labeled as mild (normative emotion regulation), surgent (extreme levels of positive approach-motivation), and irritable (extreme levels of negative emotionality, anger, and poor soothability). Types were independent of existing clinical demarcations including DSM-5 presentations or symptom severity. These types showed stability over time and were distinguished by unique patterns of cardiac physiological response, resting-state functional brain connectivity, and clinical outcomes 1 year later.Conclusions and Relevance Results suggest that a biologically informed temperament-based typology, developed with a discovery-based community detection algorithm, provides a superior description of heterogeneity in the ADHD population than does any current clinical nosologic criteria. This demonstration sets the stage for more aggressive attempts at a tractable, biologically based nosology.
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A better understanding of what leads youth to initially engage in antisocial behavior (ASB) and more importantly persist with such behaviors into adulthood has significant implications for prevention and intervention efforts. A considerable number of studies using behavioral and neuroimaging techniques have investigated abnormalities in reward and punishment processing as potential causal mechanisms underlying ASB. However, this literature has yet to be critically evaluated, and there are no comprehensive reviews that systematically examine and synthesize these findings. The goal of the present review is twofold. The first aim is to examine the extent to which youth with ASB are characterized by abnormalities in (1) reward processing; (2) punishment processing; or (3) both reward and punishment processing. The second aim is to evaluate whether aberrant reward and/or punishment processing is specific to or most pronounced in a subgroup of antisocial youth with psychopathic features. Studies utilizing behavioral methods are first reviewed, followed by studies using functional magnetic resonance imaging. An integration of theory and research across multiple levels of analysis is presented in order to provide a more comprehensive understanding of reward and punishment processing in antisocial youth. Findings are discussed in terms of developmental and contextual considerations, proposed future directions and implications for intervention.
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attention-deficit/hyperactivity disorder (adhd) is currently defined as a cognitive/behavioral developmental disorder where all clinical criteria are behavioral. inattentiveness, overactivity, and impulsiveness are presently regarded as the main clinical symptoms. the dynamic developmental behavioral theory is based on the hypothesis that altered dopaminergic function plays a pivotal role by failing to modulate nondopaminergic (primarily glutamate and gaba) signal transmission appropriately. a hypofunctioning mesolimbic dopamine branch produces altered reinforcement of behavior and deficient extinction of previously reinforced behavior. this gives rise to delay aversion, development of hyperactivity in novel situations, impulsiveness, deficient sustained attention, increased behavioral variability, and failure to responses ().
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Two emotional/motivational constructs that have been posited to underlie anxiety and depressive disorders are heightened sensitivity to threat and reduced sensitivity to reward, respectively. It is unclear, though, whether these constructs are only epiphenomena or also connote risk for these disorders (and relatedly, whether they connote risk for separate disorders). Using family history of psychopathology as an indicator of risk, the present study examined whether biomarkers of sensitivity to threat (startle potentiation) and reward (frontal EEG asymmetry) were associated with similar or different familial liabilities. In addition, the present study examined whether these biomarkers were associated with risk independent of proband DSM-IV diagnosis. One-hundred and seventy-three individuals diagnosed with panic disorder (PD), early onset major depressive disorder (MDD), both (comorbids), or controls completed two laboratory paradigms assessing sensitivity to predictable/unpredictable threat (measured via startle response) and reward (measured via frontal EEG asymmetry during a gambling task). Results indicated that across all participants: (a) startle potentiation to unpredictable threat was associated with family history of PD (but not MDD); and (b) frontal EEG asymmetry while anticipating reward was associated with family history of MDD (but not PD). Additionally, both measures continued to be associated with family history of psychopathology after controlling for proband DSM-IV diagnosis. Results suggest that the proposed biomarkers of sensitivity to unpredictable threat and reward exhibit discriminant validity and may add to the predictive validity of the DSM-IV defined constructs of PD and MDD, respectively. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
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Background Current diagnostic systems for mental disorders rely upon presenting signs and symptoms, with the result that current definitions do not adequately reflect relevant neurobiological and behavioral systems - impeding not only research on etiology and pathophysiology but also the development of new treatments. Discussion The National Institute of Mental Health began the Research Domain Criteria (RDoC) project in 2009 to develop a research classification system for mental disorders based upon dimensions of neurobiology and observable behavior. RDoC supports research to explicate fundamental biobehavioral dimensions that cut across current heterogeneous disorder categories. We summarize the rationale, status and long-term goals of RDoC, outline challenges in developing a research classification system (such as construct validity and a suitable process for updating the framework) and discuss seven distinct differences in conception and emphasis from current psychiatric nosologies. Summary Future diagnostic systems cannot reflect ongoing advances in genetics, neuroscience and cognitive science until a literature organized around these disciplines is available to inform the revision efforts. The goal of the RDoC project is to provide a framework for research to transform the approach to the nosology of mental disorders.
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Objective: To evaluate measures of cardiac activity and reactivity as prospective biomarkers of treatment response to an empirically supported behavioral intervention for attention-deficit/hyperactivity disorder (ADHD). Method: Cardiac preejection period (PEP), an index of sympathetic-linked cardiac activity, and respiratory sinus arrhythmia (RSA), an index of parasympathetic-linked cardiac activity, were assessed among 99 preschool children (ages 4-6 years) with ADHD both at rest and in response to behavioral challenge, before participants and their parents completed 1 of 2 versions of the Incredible Years parent and child interventions. Results: Main effects of PEP activity and reactivity and of RSA activity and reactivity were found. Although samplewide improvements in behavior were observed at posttreatment, those who exhibited lengthened cardiac PEP at rest and reduced PEP reactivity to incentives scored higher on measures of conduct problems and aggression both before and after treatment. In contrast, children who exhibited lower baseline RSA and greater RSA withdrawal scored lower on prosocial behavior before and after treatment. Finally, children who exhibited greater RSA withdrawal scored lower on emotion regulation before and after treatment. Conclusions: We discuss these findings in terms of (a) individual differences in underlying neurobiological systems subserving appetitive (i.e., approach) motivation, emotion regulation, and social affiliation and (b) the need to develop more intensive interventions targeting neurobiologically vulnerable children.
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In recent years, there has been growing enthusiasm that functional MRI could achieve clinical utility for a broad range of neuropsychiatric disorders. However, several barriers remain. For example, the acquisition of large-scale datasets capable of clarifying the marked heterogeneity that exists in psychiatric illnesses will need to be realized. In addition, there continues to be a need for the development of image processing and analysis methods capable of separating signal from artifact. As a prototypical hyperkinetic disorder, and movement related artifact being a significant confound in functional imaging studies, ADHD offers a unique challenge. As part of the ADHD-200 Global Competition and this special edition of Frontiers, the ADHD-200 Consortium demonstrates the utility of an aggregate dataset pooled across five institutions in addressing these challenges. The work aimed to A) examine the impact of emerging techniques for controlling for “micro-movements,” and B) provide novel insights into the neural correlates of ADHD subtypes. Using SVM based MVPA we show that functional connectivity patterns in individuals are capable of differentiating the two most prominent ADHD subtypes. The application of graph-theory revealed that the Combined (ADHD-C) and Inattentive (ADHD-I) subtypes demonstrated some overlapping (particularly sensorimotor systems), but unique patterns of atypical connectivity. For ADHD-C, atypical connectivity was prominent in midline default network components, as well as insular cortex; in contrast, the ADHD-I group exhibited atypical patterns within the dlPFC regions and cerebellum. Systematic motion-related artifact was noted, and highlighted the need for stringent motion correction. Findings reported were robust to the specific motion correction strategy employed. These data suggest that rs-fcMRI data can be used to characterize individual patients with ADHD and to identify neural distinctions underlying the clinical heterogeneity of ADHD.
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We used the Balloon Analog Risk Task (BART) to examine risk taking and sensitivity to punishment, two relevant aspects of behavioral inhibition, in 203 school-age children with attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), ADHD+ODD, and controls. Participants earned points on the BART by pumping 30 separate balloons that exploded at variable intervals. No points were earned on a trial when a balloon exploded. The number of pumps across all balloons estimated risk taking and the reduction in pumps following balloon explosions was interpreted as an indicator of sensitivity to negative punishment. We found that all groups significantly differed from one another on risk taking. The ADHD+ODD group pumped the most, followed by the ODD, ADHD, and the control group, respectively. For sensitivity to negative punishment, all groups performed differently, with the ODD group showing the least sensitivity to an exploded balloon, followed by the ADHD, control, and ADHD+ODD groups, respectively. Children with ADHD+ODD demonstrated significantly different patterns of risk taking and sensitivity to negative punishment than children with either ADHD-only or ODD-only. ADHD youth with comorbid ODD had the greatest levels of risk taking, but they were also the most sensitive to negative punishment. The relationship between ADHD and ODD, as well as the nature of comorbidity in constructs related to risk taking and related behaviors, are discussed. KeywordsADHD–Oppositional defiant disorder–Risk taking–Punishment–Comorbidity
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This study investigated reward responsivity in youth with high levels of callous-unemotional (CU) traits using a cross-sectional design. Whereas deficits in responding to punishment cues are well established in youth with CU traits, it is unclear whether responsivity to rewarding stimuli is impaired as well. Participants were 148 predominantly Caucasian, adjudicated adolescents between the ages of 11 and 17 (M = 15.1, SD = 1.4) who completed the Balloon Analogue Risk Task as part of a larger battery investigating aggression and social information processing. A Reward Responsivity variable was created to capture changes in participants' responding after receiving a reward. A hierarchical regression analysis indicated that higher levels of CU traits significantly predicted less reward responsivity, above and beyond gender, sensation seeking, and impulsivity. Results support Blair's (2004) Integrated Emotion Systems model that proposes individuals with CU traits are impaired in their responsivity to both appetitive and aversive stimuli.
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Despite growing interest in conceptualizing ADHD as involving disrupted emotion regulation, few studies have examined the physiological mechanisms related to emotion regulation in children with this disorder. This study examined parasympathetic and sympathetic nervous system reactivity via measures of respiratory sinus arrhythmia (RSA) and cardiac pre-ejection period (PEP) in children with ADHD (n=32) and typically developing controls (n=34), using a novel emotion task with four conditions: negative induction, negative suppression, positive induction, and positive suppression of affect. Both groups showed strong task-response effects in RSA. However, typically developing children showed systematic variation in parasympathetic activity (RSA) depending on both emotion valence (more activation for negative emotion, reduced activation for positive emotion) and task demand (more activation for suppression than induction). In contrast, children with ADHD displayed a stable pattern of elevated parasympathetic activity (RSA) across all task conditions compared to baseline. No group differences in sympathetic activity (PEP) were observed. It is concluded ADHD in childhood is associated with abnormal parasympathetic mechanisms involved in emotion regulation.
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A key underlying process that may contribute to attention-deficit/hyperactivity disorder (ADHD) involves alterations in reward evaluation, including assessing the relative value of immediate over delayed rewards. This study examines whether children with ADHD discount the value of delayed rewards to a greater degree than typically developing children using a delay discounting task. Children aged 7-9 years diagnosed with ADHD and controls completed a task in which they chose between a hypothetical $10 available after a delay (7, 30, 90 and 180 days) versus various amounts available immediately. ADHD participants discounted more steeply than controls. However, this effect did not survive covarying of IQ. ADHD is associated with a steeper delay gradient when contemplating hypothetical later rewards, but not independently of IQ. The interplay of cognitive processing and IQ with reward evaluation in ADHD requires further exploration.
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This study investigated the role of self-regulation of emotion in relation to functional impairment and comorbidity among children with and without AD/HD. A total of 358 probands and their siblings participated in the study, with 74% of the sample participants affected by AD/HD. Parent-rated levels of emotional lability served as a marker for self-regulation of emotion. Nearly half of the children affected by AD/HD displayed significantly elevated levels of emotional lability versus 15% of those without this disorder. Children with AD/HD also displayed significantly higher rates of functional impairment, comorbidity, and treatment service utilization. Emotional lability partially mediated the association between AD/HD status and these outcomes. Findings lent support to the notion that deficits in the self-regulation of emotion are evident in a substantial number of children with AD/HD and that these deficits play an important role in determining functional impairment and comorbidity outcomes.
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Current versions of the DSM and ICD have facilitated reliable clinical diagnosis and research. However, problems have increasingly been documented over the past several years, both in clinical and research arenas (e.g., 1, 2). Diagnostic categories based on clinical consensus fail to align with findings emerging from clinical neuroscience and genetics. The boundaries of these categories have not been predictive of treatment response. And, perhaps most important, these categories, based upon presenting signs and symptoms, may not capture fundamental underlying mechanisms of dysfunction. One consequence has been to slow the development of new treatments targeted to underlying pathophysiological mechanisms.
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This study compared children with ADHD-only, ADHD+ODD and normal controls (age 8-12) on three key neurocognitive functions: response inhibition, reinforcement sensitivity, and temporal information processing. The goal was twofold: (a) to investigate neurocognitive impairments in children with ADHD-only and children with ADHD+ODD, and (b) to test whether ADHD+ODD is a more severe from of ADHD in terms of neurocognitive performance. In Experiment 1, inhibition abilities were measured using the Stop Task. In Experiment 2, reinforcement sensitivity and temporal information processing abilities were measured using a Timing Task with both a reward and penalty condition. Compared to controls, children with ADHD-only demonstrated impaired inhibitory control, showed more time underestimations, and showed performance deterioration in the face of reward and penalty. Children with ADHD+ODD performed in-between children with ADHD-only and controls in terms of inhibitory controls and the tendency to underestimate time, but were more impaired than controls and children with ADHD-only in terms of timing variability. In the face of reward and penalty children with ADHD+ODD improved their performance compared to a neutral condition, in contrast to children with ADHD-only. In the face of reward, the performance improvement in the ADHD+ODD group was disproportionally larger than that of controls. Taken together the findings suggest that, in terms of neurocognitive functioning, comorbid ADHD+ODD is a substantial different entity than ADHD-only.
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Children with attention deficit/hyperactivity disorder (ADHD) choose smaller sooner (SS) over larger later (LL) rewards more than controls. Here we assess the contributions of impulsive drive for immediate rewards (IDIR) and delay aversion (DAv) to this pattern. We also explore the characteristics of, and the degree of familiality in, ADHD SS responders. We had 360 ADHD probands; 349 siblings and 112 controls (aged between 6 to 17 years) chose between SS (1 point after 2 s) and LL reward (2 points after 30 s) outcomes on the Maudsley Index of Delay Aversion (Kuntsi, Oosterlaan, & Stevenson, 2001): Under one condition SS choice led to less overall trial delay under another it did not. ADHD participants chose SS more than controls under both conditions. This effect was larger when SS choice reduced trial delay. ADHD SS responders were younger, had lower IQ, more conduct disorder and had siblings who were more likely to be SS responders themselves. The results support a dual component model in which both IDIR and DAv contribute to SS choice in ADHD. SS choice may be a marker of an ADHD motivational subtype.
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Event-related brain potentials were examined in 32 adolescents (50% female) from a high-risk sample, who were exposed to cocaine and other drugs prenatally. Adolescents were selected for extreme high- or low-risk behavior on the Balloon Analog Risk Task, a measure of real-world risk-taking propensity. The feedback error-related negativity (fERN), an event-related potential (ERP) that occurs when an expected reward does not occur, was examined in a game in which choices lead to monetary gains and losses with feedback delayed 1 or 2 s. The fERN was clearly visible in the fronto-central scalp region in this adolescent sample. Feedback type, feedback delay, risk status, and sex were all associated with fERN variability. Monetary feedback also elicited a P300-like component, moderated by delay and sex. Delaying reward feedback may provide a means for studying complementary functioning of dopamine and norepinephrine systems.
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Data from the 2003 and 2007 National Survey of Children's Health (NSCH) reflect the increasing prevalence of parent-reported attention-deficit/hyperactivity disorder (ADHD) diagnosis and treatment by health care providers. This report updates these prevalence estimates for 2011 and describes temporal trends. Weighted analyses were conducted with 2011 NSCH data to estimate prevalence of parent-reported ADHD diagnosis, current ADHD, current medication treatment, ADHD severity, and mean age of diagnosis for U.S. children/adolescents aged 4 to 17 years and among demographic subgroups. A history of ADHD diagnosis (2003-2011), as well as current ADHD and medication treatment prevalence (2007-2011), were compared using prevalence ratios and 95% confidence intervals. In 2011, 11% of children/adolescents aged 4 to 17 years had ever received an ADHD diagnosis (6.4 million children). Among those with a history of ADHD diagnosis, 83% were reported as currently having ADHD (8.8%); 69% of children with current ADHD were taking medication for ADHD (6.1%, 3.5 million children). A parent-reported history of ADHD increased by 42% from 2003 to 2011. Prevalence of a history of ADHD, current ADHD, medicated ADHD, and moderate/severe ADHD increased significantly from 2007 estimates. Prevalence of medicated ADHD increased by 28% from 2007 to 2011. Approximately 2 million more U.S. children/adolescents aged 4 to 17 years had been diagnosed with ADHD in 2011, compared to 2003. More than two-thirds of those with current ADHD were taking medication for treatment in 2011. This suggests an increasing burden of ADHD on the U.S. health care system. Efforts to further understand ADHD diagnostic and treatment patterns are warranted.
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Recent research has suggested that the presence of significant levels of callous-unemotional (CU) traits designates a clinically important and etiologically distinct subgroup of children and adolescents with serious conduct problems. Based on this research, CU traits have been included in the most recent revision of the Diagnostic and Statistical Manual of Mental Disorders - 5th Edition (DSM-5; American Psychiatric Association, 2013) - as a specifier for the diagnosis of conduct disorder. In this review, we attempt to understand CU traits within a developmental psychopathological framework. Specifically, we summarize research on the normal development of the prosocial emotions of empathy and guilt (i.e., conscience) and we illustrate how the development of CU traits can be viewed as the normal development of conscience gone awry. Furthermore, we review research on the stability of CU traits across different developmental periods and highlight factors that can influence this stability. Finally, we highlight the implications of this developmental psychopathological framework for future etiological research, for assessment and diagnostic classification, and for treatment of children with serious conduct problems.
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This study was designed to examine the hypothesis that certain behavioral demands may tend to trigger sympathetic mechanisms which result in metabolically excessive cardiac output elevations. Oxygen consumption and cardiac output adjustments during a contrived reaction-time shock-avoidance task were compared to a cold pressor test in healthy young male adults. The linear cardiac output/oxygen consumption relationship generated by performance on a graded exercise task was used to assess the metabolic appropriateness of cardiac output adjustments to the reaction-time task and cold pressor. The reaction-time task was generally found to evoke metabolically excessive increases in cardiac output, while cardiac output adjustments to cold pressor were more consistent with changes in metabolic demands. However, the tasks were associated with similar heart rate responses, with a significant attenuation in stroke volume during cold pressor accounting for the differential alterations in cardiac output. This finding suggests a limited reliability for heart rate as an index of cardiac performance. The effects of propranolol, which was employed to evaluate the role of sympathetic influences, indicated that beta-adrenergic mechanisms were responsible for mediating the cardiac output response to the reaction-time task, but only partially contributed to the cold pressor response. Post-hoc analyses of individual differences in cardiovascular reactivity to the reaction-time task suggest that, for hyperreactive individuals, the coping responses evoked by this task may lead to tissue overperfusion with oxygen, thereby providing a stimulus for autoregulatory vascular reflexes which may be associated with the etiology of hypertensive disease.
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ADHD is associated with altered reinforcement sensitivity, despite a number of inconsistent findings. This review focuses on the overlap and differences between seven neurobiologically valid models and lists 15 predictions assessing reinforcement sensitivity in ADHD. When comparing the models it becomes clear that there are great differences in the level of explanation. For example, some models try to explain a single core deficit in terms lower-level reinforcement systems, such as the dopamine transfer to reward back in time. Other models explain multiple deficits, by describing higher-level systems, such as impaired bottom-up prefrontal activation. When reviewing the available experimental evidence in support of the predictions, most experimental studies have been focusing on behavioral changes in the face of reward and response cost over no-reward, and on delay discounting. There is currently a lack in studies that focus on explaining underlying cognitive or neural mechanisms of altered reinforcement sensitivity in ADHD. Additionally, there is a lack in studies that try to understand what subgroup of children with ADHD shows alterations in reinforcement sensitivity. The scarcity in studies testing the neurobiological predictions is explained partly by a lack in knowledge how to test some of these predictions in humans. Nevertheless, we believe that these predictions can serve as a useful guide to the systematic evaluation of altered reinforcement sensitivity in ADHD.
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This review evaluates the diagnostic criteria for three of the most common disorders for which children and adolescents are referred for mental health treatment: attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD). Although research supports the validity and clinical utility of these disorders, several issues are highlighted that could enhance the current diagnostic criteria. For ADHD, defining the core features of the disorder and its fit with other disorders, enhancing the validity of the criteria through the lifespan, considering alternative ways to form subtypes of the disorder, and modifying the age-of-onset criterion are discussed relative to the current diagnostic criteria. For ODD, eliminating the exclusionary criteria of CD, recognizing important symptom domains within the disorder, and using the cross-situational pervasiveness of the disorder as an index of severity are highlighted as important issues for improving classification. Finally, for CD, enhancing the current subtypes related to age of onset and integrating callous-unemotional traits into the diagnostic criteria are identified as key issues for improving classification.
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Youth with conduct problems (CPs) or depression are at high risk for early initiation of substance use, and for future substance use disorders (SUDs). Comorbid CPs and depression increase risk even further, yet understanding how these conditions interact remains elusive. One hypothesis is that altered mesolimbic dopamine function contributes to symptoms of CPs, depression, and SUDs. Cardiac pre-ejection period (PEP) reactivity to incentives is linked theoretically and functionally to central dopamine responding. We evaluated PEP reactivity to reward as a prospective biomarker of substance use in a study of 206 youth with depression, CPs, CPs and depression, or no psychiatric condition. Children were 8-12 years old at the first of three annual assessments. Reduced PEP reactivity was associated with increased likelihood of future alcohol use, and CPs interacted with anxiety and depression to double risk for marijuana and other substance use.
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We examined interactions between children's physiological activity across two systems, the hypothalamic-pituitary-adrenal (HPA)-axis and the parasympathetic nervous system (PNS), as predictors of child-reported internalizing symptoms (depression, anxiety). HPA activity was indexed by baseline salivary cortisol, and PNS activity was indexed by baseline respiratory sinus arrhythmia (RSA). Study 1 consisted of 57 children (54% girls; M age=8.81 years ±.34), and Study 2 included 219 children (51% girls; M age=9.31 years ±.79). Cortisol interacted with RSA to explain unique variance in children's internalizing symptoms. Across the two studies, children with higher cortisol levels in conjunction with higher RSA levels tended to exhibit the lowest levels of depression and anxiety symptoms. Findings demonstrate that contemporaneous consideration of physiological activity across multiple systems can advance understanding of internalizing symptoms in children.
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Neural correlates of emotional dysregulation in attention-deficit/hyperactivity disorder (ADHD) and persisting influence of Methylphenidate (MPH) still remain insufficiently understood. Decreased activation in the subgenual cingulate and the ventral striatum were found during the perception of positive and negative affective pictures in drug-naïve males with ADHD during childhood (n=10). Males with ADHD during childhood treated with MPH (n=10) did not show any significant differences compared to healthy controls (n=10). Further prospective studies need to clarify direct and indirect mechanisms of MPH treatment that may contribute to emotional processing, which is dysfunctional in males without pharmacological treatment in childhood.
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Conceptual models implicating disinhibitory traits often are applied to understanding emergent alcohol use, but, little is known of how inter-individual changes in these constructs relate to increases in alcohol use in early adolescence. The current study utilized behavioral and self-report instruments to capture the disinhibitory-based constructs of sensation seeking and risk-taking propensity to examine if increases in these constructs over time related to increases in early adolescent alcohol use. Participants included a community sample of 257 early adolescents (aged 9 to 12) who completed a self-report measure of sensation seeking, a behavioral task assessing risk-taking propensity, and a self-report of past year alcohol use, at 3 annual assessment waves. Both sensation seeking and risk-taking propensity demonstrated significant increases over time, with additional evidence that change in the behavioral measure of risk-taking propensity was not because of practice effects. Greater sensation seeking and greater risk-taking propensity demonstrated concurrent relationships with past year alcohol use at each assessment wave. Prospective analyses indicated that after accounting for initial levels of alcohol use, sensation seeking, and risk-taking propensity at the first assessment wave, larger increases in both constructs predicted greater odds of alcohol use at subsequent assessment waves. Results indicate the role of individual changes in disinhibitory traits in initial alcohol use in early adolescents. Specifically, findings suggest it is not simply initial levels of sensation seeking and risk-taking propensity that contribute to subsequent alcohol use but in particular increases in each of these constructs that predict greater odds of use. Future work should continue to assess the development of sensation seeking and risk-taking propensity in early adolescence and target these constructs in interventions as a potential means to reduce adolescent alcohol use.
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Wright's (1996) integration of motivational intensity theory (Brehm & Self, 1989) and Obrist's (1981) active coping approach predict that cardiovascular reactivity in active coping depends on the importance of success when task difficulty is unclear. Despite the support for this perspective, one of the basic hypotheses-the mediation of these effects by beta-adrenergic activity-has not been tested yet. To close this gap, participants worked on a delayed-matching-to-sample task and could earn either 1, 15, or 30 Swiss Francs for a successful performance. Results showed that preejection period reactivity-an indicator of beta-adrenergic impact on the heart-increased with increasing incentive value. Thus, this experiment closes a gap in the support of Wright's model by demonstrating that beta-adrenergic reactivity is associated with incentive value under conditions of unclear difficulty.