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Using Brain-Based Cognitive Measures to Support Clinical Decisions in ADHD
Abstract
Measures of cognition support diagnostic and treatment decisions in attention deficit hyperactivity disorder. We used an integrative neuroscience framework to assess cognition and associated brain-function correlates in large attention deficit hyperactivity disorder and healthy groups. Matched groups of 175 attention deficit hyperactivity disorder children/adolescents and 175 healthy control subjects were assessed clinically, with the touch screen-based cognitive assessment battery "IntegNeuro" (Brain Resource Ltd., Sydney, Australia) and the "LabNeuro" (Brain Resource Ltd., Sydney, Australia) platform for psychophysiologic recordings of brain function and body arousal. IntegNeuro continuous performance task measures of sustained attention classified 68% of attention deficit hyperactivity disorder patients with 76% specificity, consistent with previous reports. Our additional cognitive measures of impulsivity, intrusive errors, inhibition, and response variability improved sensitivity to 88%, and specificity to 91%. Positive predictive power was 96%, and negative predictive power, 88%. These metrics were stable across attention deficit hyperactivity disorder subtypes and age. Consistent with their brain-based validity, cognitive measures were correlated with corresponding brain-function and body-arousal measures. We propose a combination of candidate cognitive "markers" that define a signature for attention deficit hyperactivity disorder: "sustained attention," "impulsivity," "inhibition," "intrusions," and "response variability." These markers offer a frame of reference to support diagnostic and treatment decisions, and an objective benchmark for monitoring outcomes of interventions.
... The following is a brief description of each of the tasks used in each domain (Brain Resource. BRISC and WebNeuro Assessment Manual, Brain Resource Ltd., V1.7; 2010.; Mathersul et al., 2009;Williams et al., 2010): ...
... WebNeuro domain summary scores are provided by the battery's automated algorithms (Gordon et al., 2013;Burger et al., 2014;Mathersul et al., 2009;Silverstein et al., 2007;Williams et al., 2005;Williams et al., 2010). The outputted scores are provided as normalized scores. ...
... The outputted scores are provided as normalized scores. Gender, age, and educational level, are used to normalize each domain score to the WebNeuro normative sample of 1000 participants (Gordon et al., 2013;Mathersul et al., 2009;Williams et al., 2010); thus, these variables are accounted for in the final z-scores output (dependent variable) for each participant. Although education is inherently related to the z-score through the normalization procedure, there was still significant variability in education associated with all of the domain scores (Table 2). ...
Background
In trauma-exposed adults, the relationship between an individual's socioeconomic position (SEP) and post-traumatic stress disorder (PTSD) has been well demonstrated. One potential mechanism by which the stress associated with lower SEPs may impact trauma outcomes is through changes in neurocognition. In both healthy and clinical samples, area-level factors also appear to be independently related to neurocognition. Far less is known about how neighborhood socioeconomic disadvantage, may impact cognition in traumatically-injured adults. The current study employed hierarchical linear modeling to longitudinally investigate whether neighborhood disadvantage was associated with neurocognitive functioning in five domains: processing speed, sustained attention, controlled attention, cognitive flexibility, and response inhibition.
Methods
One-hundred and ninety-five socioeconomically diverse traumatically-injured subjects (mean age = 32.8, 52.8% female) were recruited from an Emergency Department. Two-weeks, three-months, and six-months post-trauma, participants completed self-report measures and a computerized test battery to evaluate neurocognition. An Area Deprivation Index (ADI) score, a measure of a neighborhood's socioeconomic disadvantage, was derived from each participants' home address.
Results
Greater neighborhood disadvantage was significantly related to lower scores in all domains. Results of hierarchical linear models revealed neighborhood disadvantage was significantly associated with processing speed, controlled attention, cognitive flexibility, and response inhibition across time, even after adjusting for individual annual household income, baseline PTSD symptoms, and previous adverse life experiences. This relationship was stable for all domains except sustained attention, which varied across time.
Conclusion
These findings indicate neighborhood disadvantage contributes uniquely to neurocognitive functioning and, for the majority of domains, these contributions are stable across time. The relationship between area-level variables and cognitive function may underlie individual vulnerability to developing psychiatric disorders. Future work should continue to examine the interaction between socioenvironmental stressors and PTSD symptoms longitudinally.
... ADHD is associated with impairment in several of these cognitive and arousal constructs, but no single measure is clearly helpful in diagnosis or treatment selection [12,1,[13][14][15][16]. The clinical application of these measures has likely been limited by phenotypic http heterogeneity. ...
... We chose several widely available and cost-effective measures that are relevant to cognitive and physiologic arousal theories of ADHD pathophysiology as input and validation features. Performance measures from a cognitive battery were selected as input features [1,14]. Measures of central and peripheral arousal systems were used as external validators. ...
... Inclusion criteria for ADHD subjects and controls included: age 6-17 years, normal body mass for age/gender, and English fluency. Exclusion criteria for both groups included IQ 80, physical brain injury, neurologic disorder, concurrent stimulant use, cardiac abnormalities, psychosis, or history of drug abuse or dependence [14,24]. ADHD subjects had to meet ADHD criteria for inclusion, while controls were excluded if they had a personal or family history of an Axis I psychiatric disorder. ...
Objective
We previously reported a first attempt to identify objectively-defined subtypes of youth with ADHD: neurocognitively-defined Attention-Deficit/Hyperactivity Disorder (ADHD) subgroups (putative “biotypes”) using unsupervised machine learning (Leikauf, 2017). Here, we aimed to determine whether these subtypes could be independently replicated in novel “test” datasets, and whether a predictive model could be generated that accurately predicts group membership at the individual level.
Methods
We utilized data from two independent studies (n = 336 and n = 170) to determine whether previously identified (n= 140) cognitive subtypes could be independently replicated in these larger datasets. All studies included participants ages 6-17. We used a previously validated, computerized cognitive battery that was identical across studies(Williams et al., 2010; Williams et al., 2005). Hierarchical clustering was used to generate clusters/subtypes. Support vector machines were trained and used to form a predictive model, then applied to the smaller (“test”) datasets. Individual predicted group membership in the test datasets were compared to actual groups identified independently by hierarchical clustering to generate accuracy statistics and statistically tested using the binomial test.
Results
Average accuracy in cross-validated testing was 84% (p < .001). Accuracy in the n = 170 test set was 80% (p < .001). In the previously reported data, balanced accuracy was 71% (p = .014). Cognitive subtypes were similar to those previously identified in their patterns of deficits: a cognitively inattentive group with long and variable reaction times on sustained attention tasks and a cognitively impulsive group with poor performance across task scores measuring inhibition.
Conclusions
Previously identified cognitive ‘biotypes’ were independently identified in two novel datasets, in a total of 646 youth with ADHD. An independently generated predictive model significantly predicted an individual’s type in each of the separate datasets. Cognitively inattentive and cognitively impulsive types are replicable and individual group status can be predicted using cognitive markers with good accuracy.
Leikauf, J. E. G., K. R.; Saggar, M.; Hong, D. S.; Clarke, S.; Efron, D.; Tsang, T. W.; Hermens, D. F.; Kohn, M. R.; Williams, L. M. (2017). Identification of biotypes in Attention-Deficit/Hyperactivity Disorder, a report from a randomized, controlled trial. Personalized Medicine in Psychiatry(In Press). doi:10.1016
Williams, L. M., Hermens, D. F., Thein, T., Clark, C. R., Cooper, N. J., Clarke, S. D., . . . Kohn, M. R. (2010). Using brain-based cognitive measures to support clinical decisions in ADHD. Pediatr Neurol, 42(2), 118-126. doi:10.1016/j.pediatrneurol.2009.08.010
Williams, L. M., Simms, E., Clark, C. R., Paul, R. H., Rowe, D., & Gordon, E. (2005). The test-retest reliability of a standardized neurocognitive and neurophysiological test battery: "neuromarker". Int J Neurosci, 115(12), 1605-1630. doi:10.1080/00207450590958475
... ADHD is associated with impairment in several of these cognitive and arousal constructs, but no single measure is clearly helpful in diagnosis or treatment selection [12,1,[13][14][15][16]. The clinical application of these measures has likely been limited by phenotypic heterogeneity. ...
... We chose several widely available and cost-effective measures that are relevant to cognitive and physiologic arousal theories of ADHD pathophysiology as input and validation features. Performance measures from a cognitive battery were selected as input features [1,14]. Measures of central and peripheral arousal systems were used as external validators. ...
... Inclusion criteria for ADHD subjects and controls included: age 6-17 years, normal body mass for age/gender, and English fluency. Exclusion criteria for both groups included IQ ≤ 80, physical brain injury, neurologic disorder, concurrent stimulant use, cardiac abnormalities, psychosis, or history of drug abuse or dependence [14,24]. ADHD subjects had to meet ADHD criteria for inclusion, while controls were excluded if they had a personal or family history of an Axis I psychiatric disorder. ...
Attention-Deficit/Hyperactivity Disorder (ADHD) is a heterogeneous disorder. Current subtypes lack longitudinal stability or prognostic utility. We aimed to identify data-driven biotypes using multiple cognitive measures, then to validate these biotypes using EEG, ECG, and clinical response to atomoxetine as external validators. Study design was a double-blind, randomized, placebo-controlled crossover trial of atomoxetine including 116 subjects ages 6 through 17 with diagnosis of ADHD and 56 typically developing controls. Initial features for unsupervised machine learning included a cognitive battery with 20 measures affected in ADHD. External validators included baseline mechanistic validators (using electroencephalogram/EEG and electrocardiogram/ECG) and clinical response (ADHD Rating Scale and correlation with cognitive change). One biotype, labeled impulsive cognition, was characterized by increased errors of commission and shorter reaction time, had greater EEG slow wave (theta/delta) power and greater resting heart rate. The second biotype, labeled inattentive cognition, was characterized by longer/more variable reaction time and errors of omission, had lower EEG fast wave (beta) power, resting heart rate that did not differ from controls, and a strong correlation (r = −0.447, p < 0.001) between clinical response to atomoxetine and improvement in verbal memory immediate recall. ADHD comprises at least two biotypes that cut across current subtype criteria and that may reflect distinct arousal mechanisms. The findings provide evidence that further investigation of cognitive subtypes may be at least as fruitful as symptom checklist-based subtypes for development of biologically-based diagnostics and interventions for ADHD.
... Nevertheless, screening the children with ADHD using some of these information sources and tests, especially self-reports such as Conner's parent and teacher rating scale, not only is time-consuming and expensive, but also are questionable in terms of reliability [8]. Therefore, many researchers [9][10][11][12][13][14] with the confirmation of effects of mental disorder, especially the ADHD, on electroencephalogram (EEG) have proposed indicators extracted from the EEG signal to screen the ADHD children in some specific societies such as preschools or primary schools. ...
... The most common effect reported in these literatures was significant difference between the EEG frequency content of ADHD, and healthful children which usually appears as the different electrical distributions in brain maps extracted from the relative power of standard EEG bands (delta, theta, alpha and beta) [10,15,16]. The scrutiny of these electrical distributions in the theta and beta bands of ADHD children averagely revealed a significant separation (p [ 0.05) in the frontal and parietal lobes of ADHD children, which means disorder in the networks located in these lobes, especially attention networks (alerting, orienting, conflict network), and sensorimotor networks [13,15]. ...
... Hyperactivity, impulsivity and inattention are the subjective observations and perceptions which usually applied for the ADHD diagnosing. Currently, researchers [10,13,15,16,19,20,52] confirm that the origin of the appearance of these subjective observations and perceptions in the ADHD children are steady electrical (and chemical) changes created in brain functions. Therefore, they often reported a change in the frequency content of EEG signals recorded from the ADHD children. ...
Screening and timely diagnosis of children with attention-deficit/hyperactivity disorder (ADHD) are currently an important challenge in studies of children’s ethology for increasing community mental health. Nevertheless, most studies on ADHD employed self-report questionnaires in which the reliability is questionable. A few of the studies for diagnosing the ADHD, which used the EEG signals, was not able to enhance the accuracy due to the use of stand-alone classifiers. Therefore, in this paper, we provided a novel analysis framework by combining a set of fuzzy inference system (FIS), called the mixture of expert fuzzy models (MEFM), which have high potential for diagnosing the ADHD children. Within this framework, we developed the MEFM utilizing features extracted from the continuous wavelet transform scalograms of EEG signals obtained from five different channels (Fz, Cz, Pz, C3 and C4). Then, we tuned the internal parameters of the MEFM employing the genetic algorithm. We, also, evaluated the MEFM classifier applying the tenfold cross-validation method and compared this classifier with stand-alone FIS and support vector machine (SVM). Experimental results of MEFM classifier due to collective decision-making of the gating network exhibited a significant improvement (99.01% accuracy) compare to stand-alone classifiers (98.07, 97.81% and 88.25 for RBF-SVM, stand-alone fuzzy inference system (SFIS), linear-SVM). These results also illustrate that the MEFM classifier (due to distributed structure in comparison with the SFIS classifier) extremely reduced the number of fuzzy rules. Therefore, this new fuzzy combination (among the classifiers developed by several EEG channel) not only is a novelty in the fuzzy theory, but also considers being a better alternative for identifying and screening children with ADHD.
... These three inter-related processes are hypothesized to underlie the triad of inattention, hyperactivity and impulsivity signs. In addition, the combination of poor attention, intrusions and impulsive responding is likely to produce inconsistent responses to tasks, as reflected in an excessive variability of response times [18]. ...
... On their own, sustained attention disturbances classify approximately 68% of individuals with ADHD, consistent with evidence from the Test of Variables of Attention (TOVA) and Conners Continuous Performance Test, which assess alterations in sustained attention [18]. When the marker of sustained attention is considered in combination with markers of impulsivity, errors of intrusion from irrelevant information, and response variability, the sensitivity increases to 86% and specificity is 91% (TABLES 2 & 3; [18]). ...
... On their own, sustained attention disturbances classify approximately 68% of individuals with ADHD, consistent with evidence from the Test of Variables of Attention (TOVA) and Conners Continuous Performance Test, which assess alterations in sustained attention [18]. When the marker of sustained attention is considered in combination with markers of impulsivity, errors of intrusion from irrelevant information, and response variability, the sensitivity increases to 86% and specificity is 91% (TABLES 2 & 3; [18]). ...
There remains a translational gap between research findings and their implementation in clinical practice that applies to attention-deficit/hyperactivity disorder (ADHD), as well as to other major disorders of brain health in childhood, adolescence and adulthood. Research studies have identified potential ‘markers’ to support diagnostic, functional assessment and treatment decisions, but there is little consensus about these markers. Of these potential markers, cognitive measures of thinking functions, such as sustaining attention and associated electrical brain activity, show promise in complementing the clinical management process. Emerging evidence highlights the relevance of emotional, as well as thinking, functions to ADHD. Here, we outline an integrative neuroscience framework for ADHD that offers one means to bring together cognitive measures of thinking functions with measures of emotion, and their brain and genetic correlates. Understanding these measures and the relationships between them is a first step towards the development of tools that will help to assess the heterogeneity of ADHD, and aid in tailoring treatment choices.
... These three inter-related processes are hypothesized to underlie the triad of inattention, hyperactivity and impulsivity signs. In addition, the combination of poor attention, intrusions and impulsive responding is likely to produce inconsistent responses to tasks, as reflected in an excessive variability of response times [18]. ...
... On their own, sustained attention disturbances classify approximately 68% of individuals with ADHD, consistent with evidence from the Test of Variables of Attention (TOVA) and Conners Continuous Performance Test, which assess alterations in sustained attention [18]. When the marker of sustained attention is considered in combination with markers of impulsivity, errors of intrusion from irrelevant information, and response variability, the sensitivity increases to 86% and specificity is 91% (Tables 2 & 3; [18]). ...
... On their own, sustained attention disturbances classify approximately 68% of individuals with ADHD, consistent with evidence from the Test of Variables of Attention (TOVA) and Conners Continuous Performance Test, which assess alterations in sustained attention [18]. When the marker of sustained attention is considered in combination with markers of impulsivity, errors of intrusion from irrelevant information, and response variability, the sensitivity increases to 86% and specificity is 91% (Tables 2 & 3; [18]). ...
... Las teorías cognitivas del TDAH atribuyen a este trastorno síntomas como los de impulsividad, pobre inhibición comportamental y déficits en el funcionamiento ejecutivo (e.g. Barkley, 1997a;Logan, 1994;Quay, 1988;Williams et al., 2010). Diversos autores proponen que se incluyan estos parámetros cognitivos en los protocolos del diagnóstico clínico (e.g. ...
... Diversos autores proponen que se incluyan estos parámetros cognitivos en los protocolos del diagnóstico clínico (e.g. Babb, Levine y Arseneault, 2010;Gibney, McIntosh, Dean y Dunham, 2002;Schaughency y Hynd, 1989;Williams et al. 2010). ...
... Till date, the most robust and stable finding reported in patients with ADHD has been an increase in theta band power (4-7 Hz), notably increased theta relative to beta band power (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) which has been referred to in the literature as "theta to beta" ratio (TBR). First proposed in 1991 by Luber and hypothesized to reflect cortical hyperarousal and slowing [10,11], TBR quickly gained recognition as a potential electrophysiological marker of ADHD. ...
... In July of 2013, the US Food and Drug Association (FDA) approved the Neuropsychiatric EEG-Based Assessment Aid Health (FDA,2013), for the assessment of ADHD, which was marketed as "Brain Wave Diagnostic Tool." However, the usage of TBR as a biomarker was questioned by several studies that have rendered this index controversial in its implementation to diagnose ADHD [14][15][16][17][18][19][20]. This was also backed by a meta-analysis performed by Arns et al. in 2013 who concluded that increased TBR should not be considered a reliable diagnostic measure for ADHD [21]. ...
Purpose of Review
Attention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders characterized by inattention, impulsivity, diminished executive functions, and hyperactivity. Objective criteria can be used to assess the diagnosis and response of the disease to medications.
Recent Findings
Several biomarkers belonging to electrophysiological, genetic, peripheral, and miRNA-based biomarkers have shown promise in studies to be an objective aid to clinical diagnostic criteria for the diagnosis of ADHD.
Summary
This review article focuses on summarizing the existing evidence for different biomarkers that have been studied in the past for diagnosing ADHD.
... Average percent accuracy and reaction times for correct identification of facial expressions of fear in an emotion identification task were used to assess threat-related emotion identification. Raw scores for each measure were transformed into standardized scores using peer regression modeling, using established norms for populations aged six years and above (Williams et al., 2010a). This transformation enabled comparison across ages, provided a reference against normative functioning, and allowed computation of summary scores across different scales of measurement (i.e. ...
... These data were collected using a computerized cognitive performance battery (IntegNeuro™ (Clark et al., 2006)). This battery has been established as sensitive for identifying cognitive problems in ADHD (Williams et al., 2010a) and also has demonstrated test-retest reliability over a time frame of six weeks (Williams et al., 2005). In addition to the response inhibition, sustained attention and emotion identification tasks, IntegNeuro also includes tests of verbal memory, working memory, information processing speed, and planning. ...
... EEG data were collected according to standard procedures, which have been described in detail elsewhere , Williams et al., 2010. Briefly, participants were seated in a comfortable chair 60 cm in front of a computer screen in a sound-and light-attenuated room, with ambient temperature 24°C. ...
... Briefly, participants were seated in a comfortable chair 60 cm in front of a computer screen in a sound-and light-attenuated room, with ambient temperature 24°C. After being fitted with a Quick-Cap for EEG recording, participants completed a standardized cognitive battery LabNeuro (Gordon, Barnett, Cooper, Tran, & Williams, 2008;Williams et al., 2010), consisting of two resting baseline recordings and 10 cognitive tasks. For the current study, only data from the oddball task were analyzed. ...
Objective:
Atomoxetine has several characteristics that make it an attractive alternative to stimulants for treating ADHD, but there are currently no tests identifying individuals for whom the medication should be a first-line option.
Method:
Within the ADHD Controlled Trial Investigation Of a Non-stimulant (ACTION) study, we examined neuro-cortical activity in 52 youth with ADHD. Baseline event-related potentials (ERP) were compared between those who subsequently responded to 6 weeks of atomoxetine versus those who did not.
Results:
Responders were distinguished by significantly lower auditory oddball N2 amplitudes than both non-responders and typically developing controls, particularly in the right frontocentral region ( p = .002, Cohen's d = 1.1). Leave-one-out cross validation determined that N2 amplitude in this region was able to accurately predict non-responders with a specificity of 80.8%. There were no P3 differences between responders and non-responders.
Conclusion:
The N2 amplitude is a biomarker that may have utility in predicting response to atomoxetine for youth with ADHD.
... Although all forms of education are fundamentally brain-based, BBL is a method for maximising the brain's potential during classroom learning (Yatim et al., 2022). BBL uses strategies discovered through neuroscience and cognitive science studies to improve educational practices (Williams et al., 2010). It is a student-focused and instructor-guided approach that makes the most of students' natural cognitive strengths and aptitudes while emphasizing acquiring knowledge with real-world applications (Uzezi & Jonah, 2017). ...
Neurosciences is emerging as an interdisciplinary field that is making progress toward having a meaningful impact on school psychology. The present study was designed to integrate neuroscience with the brain's capacity to affect students' self-efficacy by deploying neuroscience-based instructional practices for mathematics. This experimental study aimed to examine how Brain-Based Learning (BBL) influences elementary school students' self-efficacy to learn and perform in mathematics. The A-B-A research design was used for the current single-subject investigation. Thirty-nine eighth-graders from a public secondary school participated in the study. Mathematics Motivation Scale (MMS) was used to collect data from respondents throughout the study stages. One-way repeated-measures ANOVA and visual analysis were deployed for the analysis of data. The results reveal that in the baseline phase (A), students' self-efficacy mean scores (M1 = 3.63, M2 = 3.58, M3 = 3.64) were lower than in the treatment phase (B) mean scores (M4 = 4.64, M5 = 4.75, M6 = 4.70). Mean scores (M7 = 4.12, M8 = 4.06, M9 = 4.00) decreased from treatment phase (B) to withdrawal phase A. The results indicate that significance rise of self-efficacy in the treatment phase (B) was due to the intervention applied to students. The use of BBL-based activities like visual imaging, role playing, and brainstorming were suggested to enhance students’ self-efficacy in mathematics classes.
... Areas of functioning assessed included baseline level of cognitive ability using an abbreviated IQ test, as well as, selected aspects of neurocognitive functioning that have been shown in the research literature to hold power in differentiating those with and without ADHD (14)(15)(16)(17)(18)(19). Additional measures designed to briefly assess for the presence of common co-morbidities and disorders that may account for a child's attention difficulties, such as learning disorders, depression, and anxiety were also included. ...
Current pediatric practice guidelines recommend children with complex attention deficit hyperactivity disorder (ADHD) receive a psychological evaluation. However, obtaining such an evaluation in a timely manner can be difficult. The authors present a framework for an economical, efficient, and efficacious approach to diagnosing complex ADHD based on a 5-year project to “fast track” these types of assessments in a tertiary care setting. Patients were triaged to the “fast track” for a streamlined assessment, by a psychologist, within a developmental pediatrics center. Assessment data, diagnoses, and recommendations were recorded for 79 participants. For most of the children, not only was ADHD confirmed, but diagnostic criteria were also met for at least one comorbid condition. For 64% of children the diagnostic picture changed, resulting in an ADHD diagnosis with corresponding changes to treatment planning. Fast track programming cut the wait time for evaluations in half. Preliminary data shows it is possible to clarify diagnoses for this complex population and provide much needed treatment recommendations in a timelier manner through utilization of a “fast track” approach to triage and assessment.
... Cognitive tasks are often used in clinical settings as a supplement to other diagnostic tools, as well as to inform treatment decisions (Molitor & Langberg, 2017;Williams et al., 2010). The Trail Making Test (TMT) in particular has a long history of use as a measure of executive function in neuropsychological test batteries, in both clinical and research settings. ...
Objective
The trail making task is used to assess executive functioning in ADHD youth, yet has only been validated in adult populations. We compare the relative contributions of various cognitive measures to performance on a trail making task analog, the Switching of Attention (SoA) task, in typically-developing and ADHD adolescents.
Method
Participants were 160 adolescents with ADHD from the International Study to Predict Optimized Treatment—in ADHD, assessed at pretreatment baseline and 6-week medicated follow-up, and 160 matched typically-developing peers. Attention, processing speed, working memory, impulsivity, and motor speed were assessed using a cognitive battery.
Results
Processing speed and working memory significantly contributed to SoA performance in ADHD, regardless of medication status. While medicated, motor speed also underpinned the prediction of most task measures. For typically-developing adolescents, sustained attention and working memory contributed to SoA performance.
Conclusion
Typically-developing, unmedicated and treated ADHD adolescents recruit different aspects of cognition during SoA completion.
... Fp1 and Cz electrodes were observed in the research procedure. In [23], the study was conducted by using signals with 2 min recording time in 169 ADHD and 167 non-ADHD participants. In this research, electrodes of significance were Fz and FCz. ...
In this paper, EEG data processing was conducted in order to define the parameters for neurofeedback. A new survey was conducted based on a brief review of previous research. Two groups of participants were chosen: ADHD (3) and nonADHD (14). The main part of this study includes EEG signal data pre-processing and processing. We have outlined statistical features of observed EEG signals such as mean value, grand-mean value and their ratios. It can be concluded that an increase in grand-mean values of power theta-low beta ratio on Cz electrode gives confirmation of previous research. The value of alpha-delta power ratio higher than 1 on C3, Cz, P3, Pz, P4 in ADHD group is proposed as a new approach to classification. Based on these conclusions we will design a neurofeedback protocol as a continuation of this work.
... Results from the open eyes condition are less conclusive. Some studies have found a significant increase of the theta/beta ratio increase in children with ADHD with respect to controls in open eyes condition (González Castro et al., 2010;Monastra et al., 1999Monastra et al., , 2001Nazari, Wallois, Aarabi, & Berquin, 2011;Ogrim, Kropotov, & Hestad, 2012;Snyder & Hall, 2006;Sohn et al., 2010;Williams et al., 2010). However, in a metaanalysis ( Arns et al., 2013), a much smaller discrepancy was found between ADHD and control subjects in the open eyes condition compared to the closed eyes condition, particularly in more recent studies. ...
The present report examines the possible differences in absolute Power Spectral Density (PSD), the topography of brain rhythms, and low frequency (delta and theta) vs. beta PSD when attention deficit disorder (ADHD) children and controls are compared. These results would potentially be useful to test the validity of the developmental lag and differential developmental models for ADHD. The EEG resting state under the experimental conditions of open and closed eyes were recorded in samples of control subjects and children with ADHD (6-17 years old). The PSD from 0 to 46 Hz was calculated and ANOVAs were performed to compare the groups of subjects in the two experimental conditions. To observe differences in the co-maturation of the brain rhythms between the groups of subjects, correlations of the PSD of all frequency ranges were computed. These results showed an increase in delta power in children with ADHD compared to control subjects. The topographies of the different brain rhythms were similar in children with ADHD and controls. The maturational power-to-power frequency-coupling between low frequencies and beta rhythms was lower in children with ADHD. The increased delta PSD in ADHD and the similar brain rhythms topographies in children with ADHD and controls support the developmental lag model, whereas the decreased co-maturation of low frequencies vs. beta PSD in children with ADHD suggests a differential maturation rate for low and beta frequencies in children with ADHD compared to controls.
... In summary, although these finding have indicated that the EEG actions (or transitions between states in the complement plot) are informative to evaluate and maybe separate the ADHD from healthy children, these finding do not confirm that [45,46] 2010 169 ADHD and 167 control 7-19 Fz/FCz, u/b ratio ( p < 0.05) Loo [45,47] 2013 390 ADHD and 100 control Cz, u/b ratio 38 Liechti [45,48] 2013 54 ADHD and 51 control 8-16 Cz, u/b ratio 53 Buyck [45,49] 2014 62 ADHD and 55 control 5-15 & 20-50 Cz, u/b ratio 49-55 Helgadóttir [50] 2015 90 ADHD and 90 control 90 ADHD and 90 control 90 ADHD and 90 control 45 ADHD and 45 control 315 ADHD and 315 control 86.4 ...
Attention-deficit/hyperactivity disorder (ADHD) is an important challenge in studies of children's ethology that unbalances the opposite behaviors for creating inattention along with or without hyperactivity. Nevertheless, most studies on the ADHD children, which employed the EEG signals for analyzing the ADHD influence on the brain activities, considered the EEG signals as a random or chaotic process without considering the role of these opposites in the brain activities. In this study, we considered the EEG signals as a biotic process according to these opposites and examined the ADHD effect on the brain activity by defining the dual sets of transitions between states in the complement plots of quantized EEG segments. The results of this study generally indicated that the complement plots of quantized EEG signal have a surprising regularity similar to the Mandala patterns compared to the chaotic processes. These results also indicated that the probability of occurrence of dual sets in the complement plots of ADHD children was averagely different (p < 0.01) from that of healthy children, so that the SVM classifier developed by these probabilities could significantly separate the ADHD from healthy children (99.37% and 98.25% for training and testing sets, respectively). Therefore, the complement plots of quantized EEG signals relevant to the ADHD children not only can quantify informational opposition caused from inattention, hyperactivity and impulsivity, but also these plots can provide remarkable information for developing new diagnostic and therapeutic techniques.
... Therefore this evaluation is considered in neuroscience studies and clinical applications such as Schizophrenia, dementia and ADHD [1,5]. Another recent research [6] suggests that brain-based cognitive measures can support clinical decisions in ADHD and improve sensitivity and specificity of the decisions. ...
... TBR in children correlated with behavioral measures of impulsivity and inhibition both in ADHD and normal children. 6 TBR findings in adults correlated with response times that were used as a marker for attention. 7 However, problems began to appear with the accuracy of TBR when attempted as a diagnostic test. ...
Quantitative EEG measurement of the scalp vertex theta/beta ratio (TBR) is marketed as a tool for use in the evaluation of patients who may have attentiondeficit/ hyperactivity disorder (ADHD). The American Academy of Neurology (AAN) recently assessed the literature about this tool. The assessment urged caution, considering that the TBR remains an investigational research tool at this time. This perspective comments further on that assessment and its rationale, and recommends a perspective for the clinician and payer.
... Our results are similar to, and sometimes even more promising than, other diagnostic measurements. For instance, Williams and colleagues [45] could classify 68% of the children with ADHD correctly when using IntegNeuro. However, only 2 of the 3 pathways are included in IntegNeuro, and it is not suitable for young children. ...
Background:
A computer-based game, named Timo's Adventure, was developed to assess specific cognitive functions (eg, attention, planning, and working memory), time perception, and reward mechanisms in young school-aged children. The game consists of 6 mini-games embedded in a story line and includes fantasy elements to enhance motivation.
Objective:
The aim of this study was to investigate the validity of Timo's Adventure in normally developing children and in children with attention-deficit/hyperactivity disorder (ADHD).
Methods:
A total of 96 normally developing children aged 4-8 years and 40 children with ADHD were assessed using the game. Clinical validity was investigated by examining the effects of age on performances within the normally developing children, as well as performance differences between the healthy controls and the ADHD group.
Results:
Our analyses in the normally developing children showed developmental effects; that is, older children made fewer inhibition mistakes (r=-.33, P=.001), had faster (and therefore better) reaction times (r=-.49, P<.001), and were able to produce time intervals more accurately than younger children (?=.35, P<.001). Discriminant analysis showed that Timo's Adventure was accurate in most classifications whether a child belonged to the ADHD group or the normally developing group: 78% (76/97) of the children were correctly classified as having ADHD or as being in the normally developing group. The classification results showed that 72% (41/57) children in the control group were correctly classified, and 88% (35/40) of the children in the ADHD group were correctly classified as having ADHD. Sensitivity (0.89) and specificity (0.69) of Timo's Adventure were satisfying.
Conclusions:
Computer-based games seem to be a valid tool to assess specific strengths and weaknesses in young children with ADHD.
... Achados neuropsicológicos sugeriram que tais manifestações relatadas são causadas por déficit das funções executivas, resultando na dificuldade de organizar e monitorar informações na memória de curta duração e em controlar, manter e direcionar a atenção. Resumidamente, apresentam lentidão no processamento da informação e tendem a fazer significantemente maior número de erros em testes [6][7][8][9][10] . ...
Objetivo: Este estudo buscou caracterizar e comparar os achados cognitivo-linguísticos e a neuroimagem de escolares disléxicos, com transtorno do déficit de atenção com hiperatividade e bom desempenho acadêmico. Métodos: Participaram 53 escolares, divididos em GI, 17 escolares disléxicos; GII, 17 com transtorno do déficit de atenção com hiperatividade e GIII, 19 com bom desempenho acadêmico. Realizou-se o teste de desempenho cognitivo-linguístico e o exame de neuroimagem. Resultados: Os resultados indicaram desempenho inferior de GI e GII em relação aos desempenhos cognitivo-linguísticos do GIII. Os resultados de neuroimagem indicaram hipoperfusão na porção mesial do lobo temporal-esquerdo para GI e no frontal-esquerdo para GII. Conclusão: O perfil cognitivo-linguístico dos escolares do GI e GII pode ser decorrente das alterações de fluxo sanguíneo em regiões do sistema nervoso central.
... Psychometric properties have been established for each of these tests, including norms, construct validation, validation against traditional neuropsychological tests tapping equivalent functions, test-retest reliability, and consistency across cultures [59][60][61][62][63][64]. The tests have been used effectively in patient groups in previous research by the investigators [65][66][67][68]. ...
Background
Understanding how brain circuit dysfunctions relate to specific symptoms offers promise for developing a brain-based taxonomy for classifying psychopathology, identifying targets for mechanistic studies and ultimately for guiding treatment choice. The goal of the Research Domain Criteria (RDoC) initiative of the National Institute of Mental Health is to accelerate the development of such neurobiological models of mental disorder independent of traditional diagnostic criteria. In our RDoC Anxiety and Depression (“RAD”) project we focus trans-diagnostically on the spectrum of depression and anxiety psychopathology. Our aims are a) to use brain imaging to define cohesive dimensions defined by dysfunction of circuits involved in reactivity to and regulation of negatively valenced emotional stimulation and in cognitive control, b) to assess the relationships between these dimension and specific symptoms, behavioral performance and the real world capacity to function socially and at work and c) to assess the stability of brain-symptom-behavior-function relationships over time.
Methods and design
Here we present the protocol for the “RAD” project, one of the first RDoC studies to use brain circuit functioning to define new dimensions of psychopathology. The RAD project follows baseline-follow up design. In line with RDoC principles we use a strategy for recruiting all clients who “walk through the door” of a large community mental health clinic as well as the surrounding community. The clinic attends to a broad spectrum of anxiety and mood-related symptoms. Participants are unmedicated and studied at baseline using a standardized battery of functional brain imaging, structural brain imaging and behavioral probes that assay constructs of threat reactivity, threat regulation and cognitive control. The battery also includes self-report measures of anxiety and mood symptoms, and social and occupational functioning. After baseline assessments, therapists in the clinic apply treatment planning as usual. Follow-up assessments are undertaken at 3 months, to establish the reliability of brain–based subgroups over time and to assess whether these subgroups predict real–world functional capacity over time. First enrollment was August 2013, and is ongoing.
Discussion
This project is designed to advance knowledge toward a neural circuit taxonomy for mental disorder. Data will be shared via the RDoC database for dissemination to the scientific community. The clinical translational neuroscience goals of the project are to develop brain-behavior profile reports for each individual participant and to refine these reports with therapist feedback. Reporting of results is expected from December 2016 onward.
Trial registration
ClinicalTrials.gov Identifier: NCT02220309. Registered: August 13, 2014.
... In a framework called the 'INTeGRATe Model' we have integrated these common concepts of sR and their brain basis ; see Figure 1). From this framework, we have identified three facets of sR that can be assessed using self-report, and correlate to brain and heart rate function (Williams et al., 2009a;Williams et al., 2010). These are: positivity-negativity bias (the tendency to expect the worst), emotional resilience (a 'thick skin' and capacity for selfefficacy) and social skills (capacity to engage with others). ...
... Swanson et al. (Swanson et al., 2010; also see Willcutt et al., 2008;Williams et al., 2010) summarized the meta-analyses of neuropsychological tasks for ADHD reported by (Nigg, 2005) and . Those tests with the largest effect sizes are analyzed here. ...
Boakes, Patterson, Kendig, and Harris (2015) showed that schedule-induced drinking (SID), typically concentrated in the first half of the interpellet interval, is not moved there exclusively by competition from magazine entries, and that not all arbitrary responses can be maintained by adventitious reinforcement. They attribute such inferences to Killeen and Pellón (2013) and Patterson and Boakes (2012), and on that basis reject their explanation for the excessive nature of many adjunctive responses as a result of reinforcement. It is a mistaken attribution, as Killeen and Pellón emphasized that reinforcers act on many competing interim and terminal responses. That attribution is a minor oversight on the authors' part; their return to a discredited motivational account is, however, a major blunder. It discards the seminal recent advances in understanding the nature of schedule-induced responses (e.g., those of Patterson and Boakes), and even the positive contributions of their own article: Their data show very strong correlations between magazine entries and drinking, providing much more evidence for response competition than their microanalysis provides against it. (PsycINFO Database Record
... Early studies (Monastra, Lubar, & Linden, 2001;Snyder et al., 2008) suggested high accuracy in identifying people with ADHD; a metaanalysis reported a large effect size of 3.08 (Snyder & Hall, 2006). However in the past 5 years, empiric and meta-analytic studies (Arns, Conners, & Kraemer, 2013;Buyck & Wiersema, 2014;Liechti et al., 2013;Loo et al., 2013;Ogrim, Kropotov, & Hestad, 2012;Williams et al., 2010) have not supported the asso-ciation between ADHD and the theta/beta ratio measure, a conceivable suggested reason being a general increase in this ratio among normal control populations in recent years (Arns et al., 2013). While this theta/beta ratio measure may be elevated in a subgroup of individuals with ADHD, neither the characteristics of this subgroup nor what brain state is indexed by the theta/beta ratio have been determined. ...
Electroencephalography (EEG) and related measures have a long and productive history in child psychopathology research and are currently experiencing a renaissance in interest, particularly for use as putative biomarkers.
First, the recent history leading to the use of EEG measures as endophenotypes and biomarkers for disease and treatment response are reviewed. Two key controversies within the area of noninvasive human electrophysiology research are discussed, and problems that currently either function as barriers or provide gateways to progress. First, the differences between the main types of EEG measurements (event-related potentials, quantitative EEG, and time-frequency measures) and how they can contribute collectively to better understanding of cortical dynamics underlying cognition and behavior are highlighted. Second, we focus on the ongoing shift in analytic focus to specific cortical sources and source networks whose dynamics are relevant to the clinical and experimental focus of the study, and the effective increase in source signal-to-noise ratio (SNR) that may be obtained in the process.
Understanding of these issues informs any discussion of current trends in EEG research. We highlight possible ways to evolve our understanding of brain dynamics beyond the apparent contradictions in understanding and modeling EEG activity highlighted by these controversies. Finally, we summarize some promising future directions of EEG biomarker research in child psychopathology.
© 2015 Association for Child and Adolescent Mental Health.
... 8 In contrast, increased gamma activity in epilepsy and smokers is related to decrease neuronal inhibition and excessive activation of the glutamatergic system. 12 Consistently, recent studies on gamma activity in schizophrenia have suggested that dysfunctions in gamma activity might account for the heterogeneity of symptoms. Decreased gamma activity has been found in patients with negative symptoms, for example, slowing of mental activity, while abnormal increased gamma activity has been found in patients with positive symptoms, for example, reality distortion. ...
Methadone maintenance treatment (MMT) has been used as a treatment for opiate dependence since the mid-1960s. Evidence suggests that methadone binds to mu opiate receptors as do other opiates and induces changes in neurophysiological function. However, little is known, about how neural activity within the higher frequency gamma band (>30 Hz) while at rest changes in those stabilized on MMT despite its association with the excitation-inhibition balance within pyramidal-interneuron networks. Our study investigated differences in resting gamma power (37-41 Hz) between patients undergoing MMT for opiate dependence, illicit opiate users, and healthy controls subjects. Electroencephalographic data were recorded from 26 sites according to the international 10-20 system. Compared with the healthy controls subjects, people either undergoing MMT (mean difference [MD] = 0.32, 95% CI = 0.09-0.55, P < .01) or currently using illicit opiates (MD = 0.31, 95% CI = 0.06-0.56, P = .01) exhibited significant increased gamma power. The sLORETA (standardized low-resolution electromagnetic tomography) between-group comparison revealed dysfunctional neuronal activity in the occipital, parietal, and frontal lobes in the patients undergoing MMT. A more severe profile of dysfunction was observed in those using illicit opiates. Our findings suggest that long-term exposure to opioids is associated with disrupted resting state network, which may be reduced after MMT.
© EEG and Clinical Neuroscience Society (ECNS) 2015.
... The controversy results from a series of recent studies by independent research groups that were not supportive of the association between the TBR and ADHD [30][31][32][33][34][35][36]. These negative findings were reflected in a recent meta-analysis by Arns et al. ...
The heterogeneity in clinical presentation and outcome in neurodevelopmental disorders such as attention deficit hyperactivity disorder (ADHD) autism spectrum disorder (ASD) necessitates the identification and validation of biomarkers that can guide diagnosis, predict developmental outcomes, and monitor treatment response. Electrophysiology holds both practical and theoretical advantages as a clinical biomarker in neurodevelopmental disorders, and considerable effort has been invested in the search for electroencephalography (EEG) biomarkers in ADHD and ASD.
Here, we discuss the major themes in the evaluation of biomarkers and then review studies that have applied EEG to better inform diagnosis, focusing on the controversy surrounding the theta:beta ratio in ADHD; prediction of risk, highlighting recent studies of infants at high risk for ASD; and treatment monitoring, presenting new efforts in the redefinition of outcome measures in clinical trials of ASD treatment.
We conclude that insights gained from EEG studies will contribute significantly to a more mechanistic understanding of these disorders and to the development of biomarkers that can assist with diagnosis, prognosis, and intervention. There is a need, however, to utilize approaches that accommodate, rather than ignore, diagnostic heterogeneity and individual differences.
... Biological validation against brain measures has also been established in the same participants [56,59,[61][62][63]. The touchscreen cognitive assessments have demonstrated utility in clinical groups [64][65][66][67][68][69]. ...
The aim of iSPOT-D is to identify biological pretreatment measures that predict or moderate MDD treatment response or remission to escitalopram, sertraline or venlafaxine; and develop a model that incorporates multiple predictors and moderators.Methods/designThe iSPOT-D study is a multi-center, international, randomized, prospective, open-label trial (1). It is enrolling 2016 MDD outpatients (ages 18–65) from primary or specialty care practices (672 per treatment arm; 672 age-, sex- and education-matched healthy controls). Study-eligible patients are antidepressant medication (ADM) naïve or washed-out with no protocol ADM contraindications. Baseline assessments include symptoms; distress; daily function; cognitive performance; electroencephalogram and event-related potentials; heart rate and genetic measures. A subset of these baseline assessments are repeated after eight weeks of treatment. Outcomes include the 17-item Hamilton Rating Scale for Depression (primary) and self-reported depressive symptoms, social functioning, quality of life, emotional regulation, and side-effect burden (secondary). Participants may then enter a naturalistic telephone follow-up at weeks 12, 16, 24 and 52. The first half of the sample will be used to identify potential predictors and moderators, and the second half to replicate and confirm.DiscussionFirst enrolment was in December 2008, and enrollment of the first 50% (1008 MDD participants) was completed in Dec 2010. iSPOT-D evaluates clinical and biological predictors of treatment response in the largest known sample of MDD collected worldwide.Conclusion
Initial findings reveal a remission rate of 45.4% and a response rate of 62.6% after 6–8 weeks of treatment. Initial findings will be discussed including factors for response prediction and MDD subtype differences.
... Это были сообщения о регистрации медленных фронтальных волн с частотой 5-6 Гц [50]. Более поздний количественный ана лиз ЭЭГ подтвердил наличие медленных (те та) волн на ЭЭГ фронтальных и центральных зон при СДВГ [2,34,39,48,54,78], что послу жило дополнительным аргументом для сто ронников "лобного" происхождения этого синдрома. Однако дифференцированный анализ ЭЭГ у детей с разной выраженностью симптомов невнимания и гиперактивно сти/импульсивности позволил установить, что фронтальные тета волны характерны только для детей с выраженным дефицитом внимания и сопутствующими трудностями обучения [15,17,32,59]. ...
The study presents the interdisciplinary approach to the analysis of the brain mechanisms of learning difficulties in primary schoolchildren. The neuropsychological assessment and the resting-state EEG estimation were applied to analyze the neurophysiological factors of cognitive deficits in children with ADHD symptoms aged 7-8 and 9-10. EEG recordings of children with ADHD symptoms more frequently, as compared to children with typical development, contained EEG patterns of the fronto-thalamic system non-optimal functioning, reflected in frontal theta waves (FTW), right hemisphere local electrical activity (EA) deviations and EEG patterns associated with the general activation deficit arising from the brainstem reticular formation (DA). We specified cognitive impairments associated with different types of resting-state EEG deviations in ADHD children. Children with FTW of both age groups demonstrated pronounced difficulties in programming, regulation and control (executive functions) and verbal performance. Children with right hemisphere local EA abnormalities had executive functions deficit combined with difficulties in nonverbal performance. Children with EEG signs of DA of both age groups had a decreased cognitive processing speed and efficiency. Younger children with DA demonstrated difficulties in nonverbal task performance. Thus, the interdisciplinary study provided the evidence for at least three neurophysiological factors which can specifically impede the cognitive performance in ADHD children.
... The first EEG data on behavioral problems in children were collected at the dawn of electrophysiology in which slow 5-6 Hz waves were recorded from frontal leads (Jasper, Solomon, & Bradley, 1938). Later, qualitative EEG studies corroborated the presence of slow theta waves in the frontal and central cortices in ADHD subjects (Chabot & Serfontein, 1996;Lazzaro et al., 1998;Bresnahan & Barry, 2002;Hermens, Soei, Clarke, Kohn, Gordon, & Williams, 2005;Williams et al., 2010) and provided another argument in favor of the frontal lobe origin of ADHD. However, the analysis of EEG data that were collected from ADHD children with different sets of behavioral symptoms (inattentive/ hyperactive-impulsive/combined types) suggested that frontal theta waves were specific only to the inattentive type (Lubar Swartwood, Swartwood, & Timmermann, 1995;Machinskaya & Krupskaya, 2001;Barry, Clarke, & Johnstone, 2003). ...
We neuropsychologically assessed cognitive deficits in 109 children with symptoms of attention-deficit/hyperactivity disorder (ADHD) and 51 children with typical development aged 7-8 and 9-10 and visually analyzed resting-state electroencephalography (EEG). The EEG recordings of children with ADHD more frequently contained EEG patterns of fronto-thalamic non-optimal functioning compared with controls, reflected by groups of bilaterally synchronous frontal theta waves (FTWs) and right hemisphere local deviations of brain electrical activity. We found cognitive impairments associated with ADHD in children with different deviations of resting-state EEG. Children with FTWs in both age groups exhibited pronounced difficulties in programming, regulation and control (executive functions), and verbal performance. Children with right hemisphere local EEG abnormalities had executive dysfunction combined with difficulties in nonverbal performance. Executive performance in typically developing children significantly improved from 7-8 to 9-10 years of age. An analysis of neuropsychological scores in children with ADHD symptoms from age 7-8 to 9-10 with the same EEG abnormalities indicated specific age-related improvement of cognitive abilities. In children whose EEG showed patterns of fronto-thalamic involvement presented significant improvement in executive and verbal performance from 7-8 to 9-10 years of age. Overcoming the same age gap in children with right hemisphere local EEG deviations significantly improved only nonverbal performance, whereas improvements in executive function were not statistically significant.
Abstract
The purpose of this study was to investigate the optimal challenge point for learning motor skills in children with and without attention deficit/hyperactivity disorder (ADHD). Ninety-six 9- to 10-year-old children, including 48 children with ADHD and 48 neurotypical children, were randomly assigned to one of four practice groups with varying levels of nominal and functional task difficulty. They performed 63 trials of a dart throwing task in the acquisition phase and 18 trials in the retention and transfer tests a day later. The results showed that neurotypical children outperformed children with ADHD in all phases of the study. Both groups improved in the acquisition phase and performed better in the retention and transfer tests. Interestingly, low nominal task difficulty was associated with better learning for both groups, despite lower average performance for children with ADHD. Thus, despite their performance differences, we did not find a difference in the effective challenge point between children with ADHD and their neurotypical peers.
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CONTEXT
Correct diagnosis is essential for the appropriate clinical management of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents.
OBJECTIVE
This systematic review provides an overview of the available diagnostic tools.
DATA SOURCES
We identified diagnostic accuracy studies in 12 databases published from 1980 through June 2023.
STUDY SELECTION
Any ADHD tool evaluation for the diagnosis of ADHD, requiring a reference standard of a clinical diagnosis by a mental health specialist.
DATA EXTRACTION
Data were abstracted and critically appraised by 1 reviewer and checked by a methodologist. Strength of evidence and applicability assessments followed Evidence-based Practice Center standards.
RESULTS
In total, 231 studies met eligibility criteria. Studies evaluated parental ratings, teacher ratings, youth self-reports, clinician tools, neuropsychological tests, biospecimen, EEG, and neuroimaging. Multiple tools showed promising diagnostic performance, but estimates varied considerably across studies, with a generally low strength of evidence. Performance depended on whether ADHD youth were being differentiated from neurotypically developing children or from clinically referred children.
LIMITATIONS
Studies used different components of available tools and did not report sufficient data for meta-analytic models.
CONCLUSIONS
A valid and reliable diagnosis of ADHD requires the judgment of a clinician who is experienced in the evaluation of youth with and without ADHD, along with the aid of standardized rating scales and input from multiple informants across multiple settings, including parents, teachers, and youth themselves.
Robust evidence from adult samples indicates that neurocognitive dysfunction is a hallmark of many mental illnesses, contributing to the loss of daily function and quality of life that these illnesses cause. However, it is still unclear whether neurocognitive deficits associated with mental illnesses begin to manifest well before adulthood or impact treatment response. Here we address this gap by evaluating neurocognitive function in four groups of children and adolescents with different mental illnesses compared to their matched healthy peers. Our team evaluated the neurocognitive performance of youth diagnosed with attention deficit and hyperactivity disorder ( N = 343), anorexia ( N = 40), first onset psychosis ( N = 25) and functional neurological disorder ( N = 56) versus age-matched healthy controls ( N = 483), cross-sectionally. Performance was assessed using an objective assessment battery designed for use across diagnoses and settings and validated for its correlations with underlying brain structure and function. The following cognitive domains were assessed: sustained attention, cognitive flexibility, decision speed, executive function, information processing speed, psychomotor response speed, response inhibition, verbal memory and working memory. Distinct profiles of neurocognitive dysfunction were detected for each diagnosis relative to the healthy reference group. Youth with first onset psychosis displayed the most severe and generalized impairments across domains of sustained attention, verbal memory, response inhibition, cognitive flexibility, information processing speed and working memory. Children and adolescents with attention deficit and hyperactivity disorder showed impairments in multiple domains of at least moderate severity with the most pronounced impairments in executive function, sustained attention and working memory. Children and adolescents with anorexia displayed more specific moderate impairments limited to cognitive flexibility, response inhibition, sustained attention, decision speed and verbal memory. Impairments in functional neurological disorder were also relatively specific and moderate, limited to executive function, working memory, cognitive flexibility, decision speed and information processing speed. These findings suggest that neurocognitive impairment in mental illness is transdiagnostic and can be detected as early as childhood or adolescence with standardized computerized testing.
Importance:
Cognitive deficits in depression have been associated with poor functional capacity, frontal neural circuit dysfunction, and worse response to conventional antidepressants. However, it is not known whether these impairments combine together to identify a specific cognitive subgroup (or "biotype") of individuals with major depressive disorder (MDD), and the extent to which these impairments mediate antidepressant outcomes.
Objective:
To undertake a systematic test of the validity of a proposed cognitive biotype of MDD across neural circuit, symptom, social occupational function, and treatment outcome modalities.
Design, setting, and participants:
This secondary analysis of a randomized clinical trial implemented data-driven clustering in findings from the International Study to Predict Optimized Treatment in Depression, a pragmatic biomarker trial in which patients with MDD were randomized in a 1:1:1 ratio to antidepressant treatment with escitalopram, sertraline, or venlafaxine extended-release and assessed at baseline and 8 weeks on multimodal outcomes between December 1, 2008, and September 30, 2013. Eligible patients were medication-free outpatients with nonpsychotic MDD in at least the moderate range, and were recruited from 17 clinical and academic practices; a subset of these patients underwent functional magnetic resonance imaging. This prespecified secondary analysis was performed between June 10, 2022, and April 21, 2023.
Main outcomes and measures:
Pretreatment and posttreatment behavioral measures of cognitive performance across 9 domains, depression symptoms assessed using 2 standard depression scales, and psychosocial function assessed using the Social and Occupational Functioning Assessment Scale and World Health Organization Quality of Life scale were analyzed. Neural circuit function engaged during a cognitive control task was measured using functional magnetic resonance imaging.
Results:
A total of 1008 patients (571 [56.6%] female; mean [SD] age, 37.8 [12.6] years) participated in the overall trial and 96 patients participated in the imaging substudy (45 [46.7%] female; mean [SD] age, 34.5 [13.5] years). Cluster analysis identified what may be referred to as a cognitive biotype of 27% of depressed patients with prominent behavioral impairment in executive function and response inhibition domains of cognitive control. This biotype was characterized by a specific profile of pretreatment depressive symptoms, worse psychosocial functioning (d = -0.25; 95% CI, -0.39 to -0.11; P < .001), and reduced activation of the cognitive control circuit (right dorsolateral prefrontal cortex: d = -0.78; 95% CI, -1.28 to -0.27; P = .003). Remission was comparatively lower in the cognitive biotype positive subgroup (73 of 188 [38.8%] vs 250 of 524 [47.7%]; P = .04) and cognitive impairments persisted regardless of symptom change (executive function: ηp2 = 0.241; P < .001; response inhibition: ηp2 = 0.750; P < .001). The extent of symptom and functional change was specifically mediated by change in cognition but not the reverse.
Conclusions and relevance:
Our findings suggest the presence of a cognitive biotype of depression with distinct neural correlates, and a functional clinical profile that responds poorly to standard antidepressants and instead may benefit from therapies specifically targeting cognitive dysfunction.
Trial registration:
ClinicalTrials.gov Identifier: NCT00693849.
Introduction
Robust evidence from adult samples indicates that neurocognitive dysfunction is a hallmark of many mental illnesses, contributing to the loss of daily function and quality of life that these illnesses cause. However, it is still unclear whether neurocognitive deficits associated with mental illnesses begin to manifest well before adulthood. The current study addresses this gap by evaluating neurocognitive function in four groups of children and adolescents with different mental illnesses compared to their matched healthy peers.
Methods
We evaluated the neurocognitive performance of four samples of youth diagnosed with ADHD (N=343), Anorexia (N=40), First-onset psychosis (N=25), and Conversion Disorder (N=56) with age-matched healthy controls. Performance was assessed using an objective assessment battery designed for use across diagnoses and settings and validated for its correlations with underlying brain structure and function. The resulting analyses assessed accuracy and reaction time performance for neurocognitive domains well established in the adult literature, such as cognitive flexibility, executive function, response inhibition, verbal fluency, verbal memory, visual memory, sustained attention, and working memory. Clinical and healthy group performance was compared using non-parametric testing.
Results
Distinct profiles of neurocognitive dysfunction were detected for each diagnosis. Particularly, children and adolescents with ADHD diffusely performed worse than their healthy counterparts, with exceptional impairment in working memory. Children and adolescents with anorexia displayed more specific impairments limited to response inhibition and verbal memory. While youth with ADHD had the most cognitive domains affected, youth with first-onset psychosis displayed the most severe impairments compared to healthy controls. Finally, deficits in conversion disorder were limited to cognitive flexibility, executive function, decision making, response inhibition, and working memory. These findings suggest that neurocognitive impairment in mental illness is transdiagnostic and can be detected as early as childhood or adolescence with standardized computerized testing.
According to the BIOS theory, attention deficit hyperactivity disorder (ADHD) is a disorder that transfers the power of the high-frequency bands to the low-frequency bands by changing the electrical actions generated by the brain's opposite structures. Nevertheless, studies on this disorder have often focused on the EEG walks (voltage levels) and provided no information about the status of the brain's opposites, which generate the EEG actions (voltage changes in time). In this study, we accordingly investigated the status of partial opposites in the trigonometric plots obtained from the EEG signals of children with and without ADHD, which have been recorded under the resting eyes-open and eyes-closed conditions. In other words, we first extracted a set of features from the status of partial opposites activated in the trigonometric space and the status of transitions in this plot. Then, we evaluated these features to separate children with and without ADHD by using the t-test analysis and the SVM classifiers. Generally, the outcomes of this analysis in addition to improving the separability of the ADHD children with a figure of merit (FOM) of about 72.4% detected that ADHD changes the EEG actions, so that the larger EEG actions usually occur more than the smaller EEG actions. Therefore, it seems that the proposed technique can significantly improve clinical protocols, especially in applications such as diagnostic tools, neurofeedback, and game therapy.
Individuals with substance use disorders (SUD) experience impaired facial emotion recognition. This pilot study explored the efficacy of a cognitive behavioral therapy (CBT) intervention to improve facial cues interpretation. Twenty-four men with SUD were randomized into an equal-size experimental and control groups and were evaluated by a cognitive-assessment battery at baseline and post-intervention. Post-intervention individuals in the experimental group recognized happy expressions with higher accuracy, and their response times were slower in sadness/disgust/neutral expressions. Interventions focused at improving social cues interpretation may facilitate social interactions and treatment outcomes for SUD population.
Introduction
We developed a neurocognitive assessment tool (NCAT) in consultation with mental health professionals working with children with AD/HD as a diagnostic aid and screening tool. This study examines the predictive utility of NCAT in the classification of children with AD/HD Inattentive presentation.
Method
Fifty three children with AD/HD Inattentive presentation and 161 typically-developing children completed an NCAT assessment. Discriminant function analyses examined group membership prediction for separate components of NCAT and for the components combined.
Results
The combined model correctly classified 93.4% of participants, with 91.4% sensitivity and 93.9% specificity. Contributions to classification were from SNAP-IV, psychological needs satisfaction, self-regulation, executive function performance, and EEG. The combined model resulted in a 9.3% increase in specificity and 5.9% increase in sensitivity compared to SNAP-IV.
Conclusions
NCAT provides good discrimination between children with and without AD/HD of the Inattentive presentation, and further investigation including other subtypes and comorbidities is warranted.
Individuals with congenital insensitivity to pain with anhidrosis (CIPA) are reported to have intellectual disability but to our knowledge, no detailed study about neuropsychological functioning of this condition has ever been published. The present study assessed neuropsychological outcomes of two children with CIPA using standardized neuropsychological tests. The neuropsychological assessment revealed difficulties in a wide range of cognitive, executive, and integrative functions, such as a behavioral and adaptive level. Both children with CIPA functioned in the intellectual disability range with symptoms related to an executive dysfunction and negative-oriented personal emotional processing, and limitations in academic and self-care skills.
Attention deficit hyperactivity disorder (ADHD) is a chronic heritable developmental delay psychiatric disorder requiring chronic management, characterized by inattention, hyperactivity, hyperkinectivity and impulsivity. Subjective clinical evaluation still remains crucial in its diagnosis. Discussed are two key aspects in the “characterizing ADHD” and on the quest for objective “pathognomonic/endophenotypic diagnostic markers of ADHD”. The first aspect briefly revolves around issues related to identification of pathognomonic/endophenotypic diagnostic markers in ADHD. Issues discussed include changes in ADHD definition, remission/persistence and overlapping-symptoms cum shared-heritability with its co-morbid cross-border mental disorders. The second aspect discussed is neurobiological and EEG-based studies on ADHD. Given the neurobiological and temporal aspects of ADHD symptoms the electroencephalograph (EEG) like NeuralScan by Medeia appears as an appropriate tool. The EEGs appropriateness is further enhanced when coupled with suitable behavior/cognitive/motor/psychological tasks/paradigms yielding EEG-based markers like event-related-potential (ERPs like P3 amplitudes and latency), reaction time variability (RTV), Theta:Beta ratio (TBR) and sensorimotor rhythm (SMR). At present, these markers could potentially help in the neurobiological characterization of ADHD and either help in identifying or lay the groundwork for identifying pathognomonic and/or endophenotypic EEG-based markers enabling its diagnosis, treatment and management.
Attention-deficit hyperactivity disorder (ADHD) is one of the most common neuropsychiatric disorders of childhood. Diagnosis of ADHD is based on core symptoms and checklists. However, these are both subjective, which can lead to the problems of overdiagnosis and underdiagnosis. Elevated theta/beta ratio (TBR) of EEG band has been approved by the US Food and Drug Administration as a tool to assist in the diagnosis of ADHD. However, several recent studies have demonstrated that there are no significant differences in TBR between people with and without ADHD. In this study, we attempted to develop a new method for differentiating between male with and without ADHD by analyzing EEG features. Thirty boys with ADHD combined type (aged 8 years 5 months ± 1 year 11 months) and 30 age-matched controls (aged 8 years 5 months ± 1 year 8 months) were enrolled in this study. A classification analysis-based approach comprising training and classification phases was developed for classifying each subject’s EEG features as ADHD or non-ADHD. Eight crucial feature descriptors were selected and ranked based on the t test. Compared with TBR in our study, the developed method had a higher area under the curve (87.78%), sensitivity (80.0%), and specificity (80.0%). Our method is more precise than using TBR in the diagnosis of ADHD. This newly developed method is a useful tool in identifying patients with ADHD and might reduce the possibility of overdiagnosis and underdiagnosis.
Attention Deficit Hyperactivity Disorder (ADHD) is a common behavioral disorder may be found in 5% to 8% of the children. Early diagnosis of ADHD is crucial for treating the disease and reducing its harmful effects on education, employment, relationships and life quality. On the other hand, nonlinear analysis methods are widely applied in processing
the Electroencephalogram (EEG) signals. It has been proved that the brain neuronal activity and its related EEG signals have chaotic behavior. Hence, chaotic indices can be employed to classify the EEG signals. In this study, a new approach is proposed based on the combination of some nonlinear features to distinguish ADHD from normal children. Lyapunov exponent, fractal dimension, correlation dimension and sample, fuzzy and approximate entropies are the nonlinear extracted features. For computing, the chaotic time series of obtained EEG in the brain frontal lobe (FP1, FP2, F3, F4 and Fz) need to be
analyzed. Experiments on a set of EEG signal obtained from 50 ADHD and 26 normal cases yielded a sensitivity, specificity and accuracy of 98%, 92.31%, and 96.05%, respectively. The obtained accuracy provides a significant improvement in comparison to the other similar studies in identifying and classifying children with ADHD.
Attention-deficit/hyperactivity disorder (ADHD) as a behavioral challenge, which affects the people's learning and experiences, is one of the disorders, which leads to reducing the complexity of brain processes and human behaviors. Nevertheless, recent studies often focused on the effects of this disorder in the frequency content of single and multichannel EEG segments and only a few studies that employed the approximate entropy for estimating this reduction. In this study, we provide a different view of this reduction by focusing on the texture of patterns appeared on the auto-recurrence plots obtained from the phase space trajectories reconstructed from the EEG signals recorded under the open-eyes and closed-eyes resting conditions. The outcomes of this analysis generally indicated a significant difference in the texture of recurrence plots, which its reason was the increase of recurrence, parallel and similar behaviors in the trajectories. Evaluating the features extracted from these recurrence plots in the studied children without and with ADHD using the sequential forward selection (SFS) algorithm also provided a remarkable accuracy (90.95% for the testing sets), which is a confirmation on changing the texture of recurrence plots relevant to the EEG signals of ADHD children. Nevertheless, evaluating these results and the results of previous researches with each other represented that the volume of statistical population is an important factor for reducing the rate of separability in the classifiers developed by an EEG segment. Therefore, these findings generally proved that although the ADHD averagely leads to the complexity reduction of EEG processes, the classifiers developed by just an EEG segment cannot be applicable in clinical conditions.
Diagnosis of attention-deficit hyperactivity disorder (ADHD) is currently based on core symptoms or checklists; however, the inevitability of practitioner subjectivity leads to over- and underdiagnosis. Although the Federal Drug Administration has approved an elevated theta/beta ratio (TBR) of the electroencephalogram (EEG) band as a tool for assisting ADHD diagnosis, several studies have reported no significant differences of the TBR between ADHD and control subjects. This study detailed the development of a method based on approximate entropy (ApEn) analysis of EEG to compare ADHD and control groups. Differences between ADHD presentation in boys and girls indicate the necessity of separate investigations. This study enrolled 30 girls with ADHD and 30 age-matched controls. The results revealed significantly higher ApEn values in most brain areas in the control group than in the ADHD group. Compared with TBR-related feature descriptors, ApEn-related feature descriptors can produce the higher average true positive rate (0.846), average true negative rate (0.814), average accuracy (0.817), and average area under the receiver operating characteristic curve value (0.862). Therefore, compared with TBR, ApEn possessed the better potential for differentiating between girls with ADHD and controls.
Importance
The symptoms that define mood, anxiety, and trauma disorders are highly overlapping across disorders and heterogeneous within disorders. It is unknown whether coherent subtypes exist that span multiple diagnoses and are expressed functionally (in underlying cognition and brain function) and clinically (in daily function). The identification of cohesive subtypes would help disentangle the symptom overlap in our current diagnoses and serve as a tool for tailoring treatment choices.
Objective
To propose and demonstrate 1 approach for identifying subtypes within a transdiagnostic sample.
Design, Setting, and Participants
This cross-sectional study analyzed data from the Brain Research and Integrative Neuroscience Network Foundation Database that had been collected at the University of Sydney and University of Adelaide between 2006 and 2010 and replicated at Stanford University between 2013 and 2017. The study included 420 individuals with a primary diagnosis of major depressive disorder (n = 100), panic disorder (n = 53), posttraumatic stress disorder (n = 47), or no disorder (healthy control participants) (n = 220). Data were analyzed between October 2016 and October 2017.
Main Outcomes and Measures
We followed a data-driven approach to achieve the primary study outcome of identifying transdiagnostic subtypes. First, machine learning with a hierarchical clustering algorithm was implemented to classify participants based on self-reported negative mood, anxiety, and stress symptoms. Second, the robustness and generalizability of the subtypes were tested in an independent sample. Third, we assessed whether symptom subtypes were expressed at behavioral and physiological levels of functioning. Fourth, we evaluated the clinically meaningful differences in functional capacity of the subtypes. Findings were interpreted relative to a complementary diagnostic frame of reference.
Results
Four hundred twenty participants with a mean (SD) age of 39.8 (14.1) years were included in the final analysis; 256 (61.0%) were female. We identified 6 distinct subtypes characterized by tension (n=81; 19%), anxious arousal (n=55; 13%), general anxiety (n=38; 9%), anhedonia (n=29; 7%), melancholia (n=37; 9%), and normative mood (n=180; 43%), and these subtypes were replicated in an independent sample. Subtypes were expressed through differences in cognitive control (F5,383 = 5.13, P < .001, ηp² = 0.063), working memory (F5,401 = 3.29, P = .006, ηp² = 0.039), electroencephalography-recorded β power in a resting paradigm (F5,357 = 3.84, P = .002, ηp² = 0.051), electroencephalography-recorded β power in an emotional paradigm (F5,365 = 3.56, P = .004, ηp² = 0.047), social functional capacity (F5,414 = 21.33, P < .001, ηp² = 0.205), and emotional resilience (F5,376 = 15.10, P < .001, ηp² = 0.171).
Conclusions and Relevance
These findings offer a data-driven framework for identifying robust subtypes that signify specific, coherent, meaningful associations between symptoms, behavior, brain function, and observable real-world function, and that cut across DSM-IV-defined diagnoses of major depressive disorder, panic disorder, and posttraumatic stress disorder.
Studies in clinical and aging populations support associations between immunological function, cognition and mood, although these are not always in line with animal models. Moreover, very little is known about the relationship between immunological measures and cognition in healthy young adults. The present study tested associations between the state of immune system and memory recall in a group of relatively healthy adults. Immediate and delayed memory recall was assessed in 30 participants using the computerised cognitive battery. CD4, CD8 and CD69 subpopulations of lymphocytes, Interleukin-6 (IL-6) and cortisol were assessed with blood assays. Correlation analysis showed significant negative relationships between CD4 and the short and long delay memory measures. IL-6 showed a significant positive correlation with long-delay recall. Generalized linear models found associations between differences in all recall challenges and CD4. A multivariate generalized linear model including CD4 and IL-6 exhibited a stronger association. Results highlight the interactions between CD4 and IL-6 in relation to memory function. Further study is necessary to determine the underlying mechanisms of the associations between the state of immune system and cognitive performance.
Objective:
There is a lack of evidence-based diagnostic paradigms and personalized interventions for preschoolers with ADHD. This study aimed to evaluate the performance of preschoolers diagnosed with ADHD on a continuous performance test (CPT) before and after a single methylphenidate (MPH) challenge.
Method:
The Test of Variables of Attention (TOVA)-a CPT-was administered to 61 preschoolers (5.64 ± 0.69 years; 74% boys) with ADHD before and after a single MPH challenge (0.3 or 0.5 mg/kg). Baseline TOVA performance was correlated with Conners' Rating Scales (CRS) and compared with post-MPH TOVA performance.
Results:
A high rate of omission errors and several significant correlations between TOVA values and CRS scores were found at baseline. A single MPH administration improved TOVA performance significantly and was well tolerated.
Conclusion:
TOVA assessment may assist in the evaluation of the effect of MPH in preschoolers with ADHD and may help in planning interventions for them.
Background:
Antidepressant treatment failure is a common problem worldwide. In this study, we assess whether or not an important aspect of depression, cognitive impairment, is untreated by antidepressants by studying the effect of acute antidepressant treatment on a range of cognitive domains.
Methods:
In this randomised longitudinal study, which is part of the International Study to Predict Optimized Treatment in Depression (iSPOT-D) trial, we assessed the effects of acute antidepressant treatment in a large patient population, across clinical remission outcomes, on a range of cognitive domains: attention, response inhibition, executive function during visuospatial navigation, cognitive flexibility, verbal memory, working memory, decision speed, information processing speed, and psychomotor response speed. We enrolled patients from primary or specialty care clinics in a multicentre, international, open-label, randomised, prospective trial. Eligible patients (aged 18-65 years) were previously untreated or were willing to undergo a 1-week medication washout before the study start, and could not have had inadequate response to study medications in the past. We enrolled a large population of medication-free (ie, untreated) outpatients in a depressive episode and assessed them for cognitive function at enrolment (pre-treatment), and again after 8 weeks of treatment with one of three antidepressant drugs (escitalopram, sertraline, or venlafaxine extended-release). Patients were randomly assigned (1:1:1) to one of the three antidepressants using a blocked randomisation procedure (block size of 12). As a comparison group, we also simultaneously enrolled matched healthy participants. Healthy participants received no medication or intervention, but were assessed for change in cognitive and clinical measures during the same interval and testing protocol. Therefore, this group acts as a test-retest control for the primary outcome measure examined in this study, change in cognitive measures over 8 weeks of treatment in depressed patients. This study is registered with ClinicalTrials.gov, number NCT00693849.
Findings:
Between Dec 8, 2008, and Sept 30, 2011, we enrolled 1008 eligible people into the study. Impairment in five domains-attention, response inhibition, verbal memory, decision speed, and information processing-showed no relative improvement with acute treatment (controlling for time or repeated testing), irrespective of antidepressant treatment group, even in patients whose depression remitted acutely according to clinical measures. Broader cognitive impairment was associated with greater illness chronicity (earlier illness onset) but not with symptom severity or previous antidepressant failures.
Interpretation:
Depression is associated with impairments in higher-order cognitive functions and information processing, which persist independently of clinical symptom change with treatment. We recorded no difference between the three antidepressants tested, with none showing efficacy for these impairments. Although the 8-week treatment period limits interpretation to acute treatment effects, it does highlight cognitive impairment as an untargeted contributor to incomplete treatment success.
Funding:
Brain Resource Company Operations Pty Ltd and NIH.
The aim of this study was to determine the role of the Test of Variables of Attention (TOVA), a computer-based continuous performance test (CPT), in assessing suspected attention-deficit/hyperactivity disorder (ADHD), a pervasive cause of disability in children and adolescents.
One hundred and fifty children and adolescents referred to a community-hospital-based neurology clinic for suspected ADHD underwent a comprehensive clinical evaluation by a pediatric neurologist in addition to the TOVA test. Retrospective chart data were analyzed separately for children aged 6–12 years (n=101) and adolescents (13–18 years) (n=49). Parents and teachers completed
The correlation between the neurologist’s impression of the presence of attention deficit and the TOVA scores was good in the younger group (r=0.28, p≤0.001) and weaker in the older group (r=0.29, p≤0.05). On nonparametric analysis, the neurological evaluation did not distinguish between low and high TOVA scorers in the older group. The neurologist’s impression correlated more closely with the DSM-IV parents ratings (r=0.29, p≤0.01) than the teachers’ (r=0.08, p≤0.05).
The TOVA correlated well with clinical assessment of ADHD and has added value in the evaluation of ADHD in adolescents, for whom standardized rating scales are lacking. In younger children, an experienced clinician can usually reach an accurate diagnosis based on accepted clinical criteria, including parent and teacher reports.
The development of a quantitative electroencephalographic (QEEG)-based procedure for use in the assessment of attention deficit–hyperactivity disorder (ADHD) was examined through a series of studies investigating test reliability and validation issues. This process, involving a spectral analysis of the electrophysiological power output from a single, midline, central location (the vertex), was conducted in 469 participants, 6 to 20 years of age, classified as ADHD, inattentive type; ADHD, combined type; or control. The results indicated that the QEEG scanning procedure was reliable (r = .96), was consistent with the Attention Deficit Disorders Evaluation Scale (S. B. McCarney, 1995) and the Test of Variables of Attention (L. M. Greenberg, 1994; chi-square, p < .01), and differentiated participants with ADHD from a nonclinical control group (p < .001). The sensitivity of the QEEG-derived attentional index was 90%; the specificity was 94%.
The aim of the paper is to describe a standardized "Integrative Neuroscience" Platform that can be applied to elucidate brain-body mechanisms. This infrastructure includes a theoretical integration (the INTEGRATE Model). To demonstrate this infrastructure, hypotheses from the INTEGRATE Model are applied in an example investigation of the cognitive, brain and body markers of individual differences in the trait characteristic of Negativity Bias (the tendency to see oneself and one's world as negative). A sample of 270 healthy participants (18-65 years old) were grouped into equal sized matched subsets of high "Negativity Bias" and high "Positivity Bias" (n = 135 in each group). Participants were assessed using a standardized battery of psychological traits, cognition and brain and body (autonomic) activity. Greater "Negativity Bias" relative to "Positivity Bias" was characterized by greater autonomic reactivity and early neural excitation to signals of potential danger, at the timescale of Emotion (< 200 ms). Concomitantly, there was a relatively lower level of "Thinking", reflected in cognitive dimensions and associated electrical brain measures of working memory and EEG Theta power. By contrast, Negativity and Positivity Bias did not differ in levels of emotional resilience and social skills at the longer time scale of Self Regulation. This paper provides a demonstration of how an Integrative Neuroscience infrastructure can be used to elucidate the brain-body basis of trait characteristics, such as Negativity Bias, that are key indicators of risk for poor well-being and psychopathology.
Posttraumatic stress disorder (PTSD) involves deficits in information processing that may reflect hypervigilence and deficient inhibitory control. To date, however, no PTSD neuroimaging study has directly examined PTSD-related changes in executive inhibition. Our objective was to investigate the hypothesis that executive inhibitory control networks are compromised in PTSD.
Functional magnetic resonance imaging (fMRI) was used during a Go/No-Go inhibition task completed by a sample of patients with PTSD (n = 23), a matched sample of healthy (i.e. without trauma exposure) control participants (n = 23) and a sample of control participants with trauma exposure who did not meet criteria for PTSD (n = 17).
Participants with PTSD showed more inhibition-related errors than did individuals without trauma exposure. During inhibition, control participants activated a right-lateralized cortical inhibitory network, whereas patients with PTSD activated only the left lateral frontal cortex. PTSD was associated with a reduction in right cortical activation and increased activation of striatal and somatosensory regions.
The increased inhibitory error and reduced right frontal cortical activation are consistent with compromised inhibitory control in PTSD, while the increased activation of brain regions associated with sensory processing and a greater demand on inhibitory control may reflect enhanced stimulus processing in PTSD, which may undermine cortical control mechanisms.
Both general and social cognition are important in providing endophenotypic markers and predicting real-world functional outcomes of clinical psychiatric disorders. However, to date, focus has been on general cognition, rather than on core domains of social/emotional cognition. This study sought to determine core domains of emotion processing for both explicit identification and implicit recognition and their relationships with core domains of general cognition. Age effects and sex differences were also investigated. A sample of 1,000 healthy individuals (6 to 91 years, 53.5% female) undertook the WebNeuro tests of emotion identification and recognition and tests of general cognitive function. Factor analysis revealed seven core domains of emotion processing: speed of explicit emotion identification, speed of implicit emotion recognition, implicit emotion recognition accuracy, "threat" processing, sadness-disgust identification, "positive emotion" processing, and general "face perception." Seven corresponding core domains of general cognition were identified: information-processing speed, executive function, sustained attention/vigilance, verbal memory, working-memory capacity, inhibition/impulsivity, and sensorimotor function. Factors of emotion processing generally showed positive associations with those of general cognitive function, suggesting commonality in processing speed in particular. Moreover, age had a consistent nonlinear impact on both emotion processing and general cognitive factors, while sex differences were more specific. These findings contribute to a normative and standardized structure for assessment of emotional and general cognition in clinical groups.
A number of psychiatric and neurological disorders are characterized by impairments in facial emotion recognition. Recognition of individual emotions has implicated limbic, basal ganglionic, and frontal brain regions. Since these regions are also implicated in age-related decline and sex differences in emotion processing, an understanding of normative variation is important for assessing deficits in clinical groups. An internet-based test ("WebNeuro") was administered to 1,000 healthy participants (6 to 91 years, 53% female) to assess explicit identification of basic expressions of emotion (happiness, sadness, fear, anger, disgust, neutral). A subsequent implicit recognition condition was based on a priming protocol, in which explicit identification provided the "study" phase. Responses were most accurate for happiness and slowest for fear in the explicit condition, but least accurate for happiness and fastest for fear in the implicit condition. The effects of age, by contrast, showed a similar pattern for both explicit and implicit conditions, following a nonlinear distribution in which performance improved from childhood through adolescence and early adulthood and declined in later adulthood. Females were better than males at explicit identification of fear in particular. These findings are consistent with the priority of threat-related signals, but indicate opposing biases depending on whether emotion processing is conscious or nonconscious. The lifespan trends in emotion processing over 10 decades point to an interaction of brain-based (maturation, stability, and then atrophy of cortical and subcortical systems) and experiential contributing factors. These findings provide a robust normative platform for assessing clinical groups.
Children with attention deficit disorder with hyperactivity (ADD+H; N = 48) were compared with those without hyperactivity (ADD-H; N = 42), as well as with learning disabled and control children, on an extensive battery of interviews, behavior ratings, tests, and direct observations. ADD+H children had more externalizing and internalizing symptoms by parent and teacher report, were more off task during vigilance testing, and had more substance abuse, ADD+H, and aggression among their relatives than did the other groups. ADD-H children were more day-dreamy and lethargic by teacher report, more impaired in perceptual-motor speed, and had more anxiety disorders among their relatives than did ADD+H children. Results indicate that these 2 types of ADD may be separate, distinct childhood disorders rather than subtypes of a common attention deficit.
To precisely describe movement abnormalities in seated children with attention-deficit hyperactivity disorder (ADHD) while they were engaged in a continuous performance task (CPT).
Diagnoses were made by using structured interviews (Schedule for Affective Disorders and Schizophrenia for School-Age Children-Epidemiologic Version) and DSM-IV criteria. Movement patterns of 18 boys with ADHD (9.3 +/- 2.4 years) and 11 normal controls (8.6 +/- 1.8 years) were recorded using an infrared motion analysis system that tracked the position of four markers 50 times per second to a resolution of 0.04 mm.
Boys with ADHD moved their head 2.3 times more often than normal children (p < .002), moved 3.4 times as far (p < .01), covered a 3.8-fold greater area (p < .001), and had a more linear and less complex movement pattern (p < .00004). They responded more slowly and with greater variability on the CPT. Complexity of head movement and variability in response latency significantly correlated with teacher ratings. A predefined composite of movement and attention discriminated 16 of 18 patients from 11 of 11 controls.
The relative inability of boys with ADHD to sit still can be objectively verified, and "fidgeting" appears to consist of more frequent, larger amplitude, whole body movements.
A battery of tests presumed to assess various frontal lobe functions in children was evaluated for the accuracy of the tests in classifying children as having attention deficit hyperactivity disorder (ADHD). Two groups of children were tested: (1) 66 children, ages 6-11 years, with ADHD, and (2) a normal community control group of 64 children of the same age. Results indicated good positive predictive power (PPP) for seven of the tests (ranging from 80 to 90%), suggesting that abnormal scores on these tests may be indicative of the presence of ADHD. However, the rates of negative predictive power (NPP) even for these seven tests were modest (ranging from 50 to 66%). Sensitivity was also poor (ranging from 5 to 43%) as were the levels of false negatives (averaging 40%) creating fair-to-poor overall classification rates for all tests (49 to 70%). It is concluded that while these neuropsychological tests may have some value in clinical evaluations of children's psychological abilities, they may not be useful as the sole criteria for the diagnostic classification of children as ADHD.
The development of a quantitative electroencephalographic (QEEG)-based procedure for use in the assessment of attention deficit-hyperactivity disorder (ADHD) was examined through a series of studies investigating test reliability and validation issues. This process, involving a spectral analysis of the electrophysiological power output from a single, midline, central location (the vertex), was conducted in 469 participants, 6 to 20 years of age, classified as ADHD, inattentive type; ADHD, combined type; or control. The results indicated that the QEEG scanning procedure was reliable (r = .96), was consistent with the Attention Deficit Disorders Evaluation Scale (S. B. McCarney, 1995) and the Test of Variables of Attention (L. M. Greenberg, 1994; chi-square, p < .01), and differentiated participants with ADHD from a nonclinical control group (p < .001). The sensitivity of the QEEG-derived attentional index was 90%; the specificity was 94%.
To develop and validate a self-report screening tool for common mental disorders.
Sequential development and validation studies in three cohorts of patients in general practice and one cohort of patients in a specialist psychiatry clinic.
1585 patients in general practice examined cross-sectionally and longitudinally; 46515 patients attending 386 general practitioners nationwide; 364 patients participating in a longitudinal study of psychiatric disorders in general practice; and 522 patients attending a specialist psychiatry clinic.
Performance of the 12 items from the 34-item SPHERE questionnaire against DSM-III-R and DSM-IV diagnoses of psychiatric disorder, self-reported Brief Disability Questionnaire findings, GPs' ratings of patients' needs for psychological care and degree of risk resulting from mental disorder, and patients' and GPs' reports of reasons for presentation.
Six somatic and six psychological questions identify two levels (and three types) of mental disorder: patients reporting both characteristic psychological and somatic symptoms (Level 1, Type 1), and patients reporting either psychological symptoms (Level 2, Type 2) or somatic symptoms (Level 2, Type 3). This classification system predicts disability ratings (Level 1, 8.2 "days out of role in the last month" and Level 2, 4.1 and 5.4 "days out of role in the last month" for Types 2 and 3, respectively), rates of lifetime psychiatric diagnoses (Level 1, 63% and Level 2, 59% and 48%, respectively), both patients' and GPs' report of reasons for presentation, and doctors' ratings of risk as a result of mental disorder. There are important and differing sociodemographic correlates for the three types of mental disorders.
A classification system based on the 12 items from the 34-item SPHERE questionnaire can be used to identify common mental disorders. This system has acceptable validity and reliability, and is suited specifically for general practice settings.
Research on attention-deficit/hyperactivity disorder (ADHD), a highly prevalent and controversial condition, has, for the most part, been descriptive and atheoretical. The imperative to discover the genetic and environmental risk factors for ADHD is motivating the search for quantifiable intermediate constructs, termed endophenotypes. In this selective review, we conclude that such endophenotypes should be solidly grounded in the neurosciences. We propose that three such endophenotypes — a specific abnormality in reward-related circuitry that leads to shortened delay gradients, deficits in temporal processing that result in high intrasubject intertrial variability, and deficits in working memory — are most amenable to integrative collaborative approaches that aim to uncover the causes of ADHD.
We hypothesized that children with attention-deficit/hyperactivity disorder (ADHD) would underperform on neuropsychological tests that are sensitive to executive function impairments. We further proposed that a linear discriminant analysis using behavioral and neuropsychological variables as dependent variables would pinpoint the capability of behavioral questionnaires and neuropsychological tests to predict the correct classification of ADHD and control children. We designed a transversal study with 62 seven- to twelve-year-old children with ADHD and 62 Full Scale IQ-matched controls using two behavioral scales and 13 neuropsychological tests. Using analysis of variance and covariance with age and school achievement and multifactor analysis of variance, we found that behavioral variables established robust, statistically significant differences between groups (p < .001). Children with ADHD scored worse than controls on 31 out of 61 neuropsychological variables. Children with ADHD, however, obtained better scores that were statistically significant on WISC-R Comprehension and Picture completion. A linear discriminant analysis with nine behavioral variables correctly classified 100% of the participants in both groups. Another linear discriminant analysis using 10 neuropsychological variables correctly classified 85.48% of the participants in both groups. We propose a core battery of selected tests for assessing children with ADHD. The significance of cross-cultural analyses of different developmental disturbances is emphasized.
The purpose of the current study was to elaborate on error monitoring in children with Attention Deficit Hyperactivity Disorder (ADHD) using the ERP methodology.
Children with ADHD executed a visual Go/No-Go task with 25 percent No-Go trials; and a two stimulus reaction time task wherein a neutral warning signal (S1) was presented to inform the child to prepare for an imperative stimulus (S2).
In both tasks, children with ADHD responded as fast as controls but made twice as many errors. In addition, they failed to adjust their speed of responding after making an error. Exploring the error-related potentials revealed that the error-related negativity (ERN) was the same for the two groups, but that children with ADHD showed a diminished error positivity (Pe).
Based on these findings, we conclude that children with ADHD are normal in early error monitoring processes related to error detection, but show abnormal response strategy adjustments and are deviant in later error monitoring processes associated with the subjective/emotional, conscious evaluation of the error.
Attention Deficit Hyperactivity Disorder (ADHD) occurs more frequently in male children and adolescents than in females, with a ratio of approximately 3 to 1. We determined whether psychophysiological differences are associated with the expression of ADHD in males and females, using simultaneously recorded electroencephalography (EEG) and electrodermal activity (EDA).
Quantitative EEG and EDA measures were acquired simultaneously and continuously (2min) during an eyes closed resting condition for 70 ADHD adolescents (48 males, 22 females) and their age- and sex-matched controls.
Males and females with ADHD were differentiated by both EEG theta activity and EDA. ADHD males showed increased theta (widespread), whereas ADHD females showed a localised frontal enhancement of theta with reduced rate of EDA decrement. These sex differences were unrelated to ADHD subtype.
These findings suggest that different psychophysiological processes may underlie ADHD in each sex. The profile of theta enhancement in ADHD males is consistent with a developmental deviation model of ADHD, whereas ADHD in females may be better understood within an arousal model, which emphasizes both central and autonomic function.
These findings highlight the potential for concurrent EDA measures to inform EEG studies of ADHD, particularly in regard to sex differences.
The present study explores the predictive power of seven neuropsychological assessment tools used in combination in classifying children with attention-deficit/hyperactivity disorder (ADHD). Twenty-one ADHD boys and 22 community control children participated. Group differences were significant on the continuous performance test only; however, battery analysis did increase overall predictive power, which was moderate. This study highlights the difficulty in identifying consistent mean differences on tests of frontal/executive functioning across studies, as well as the need to assess the predictive validity of these tests in classifying children with ADHD. The study suggests that these tests may provide greater predictive validity when used in combination. Inconsistencies in the literature are discussed, with consideration of research methodology, the heterogeneity of the ADHD population, and comorbid diagnoses.
Obstructive sleep apnea (OSA) is expected to impair vigilance and executive functioning, owing to the sensitivity of the prefrontal cortex to the effects of sleep fragmentation and intermittent hypoxia. Studies examining the pattern of cognitive dysfunction show variable results, with the heterogeneity in part due to small sample sizes in current studies and little consistency of the tests used. We examined a group of fifty subjects from the Brain Resource International Database (BRID), predicted to have OSA on the basis of the Multivariable Apnea Prediction Index, and compared them with 200 matched controls. On electrophysiological tests, the OSA group showed reduced eyes closed alpha power, increased auditory oddball N100 and P200 amplitude, but reduced N200 and P300 amplitude. The latency to P300 was not significantly different between groups, but latencies to N200 and P200 were prolonged in the OSA group. Performance testing of the executive function found that verbal interference and the switching of attention were impaired in the OSA group. We have demonstrated that a diagnostic algorithm based on apnea symptoms and demographic factors can be used to select a group with likely OSA manifesting deficits in information processing and executive function.
There is controversy over the nature of the disturbance in brain development that underpins attention-deficit/hyperactivity disorder (ADHD). In particular, it is unclear whether the disorder results from a delay in brain maturation or whether it represents a complete deviation from the template of typical development. Using computational neuroanatomic techniques, we estimated cortical thickness at >40,000 cerebral points from 824 magnetic resonance scans acquired prospectively on 223 children with ADHD and 223 typically developing controls. With this sample size, we could define the growth trajectory of each cortical point, delineating a phase of childhood increase followed by adolescent decrease in cortical thickness (a quadratic growth model). From these trajectories, the age of attaining peak cortical thickness was derived and used as an index of cortical maturation. We found maturation to progress in a similar manner regionally in both children with and without ADHD, with primary sensory areas attaining peak cortical thickness before polymodal, high-order association areas. However, there was a marked delay in ADHD in attaining peak thickness throughout most of the cerebrum: the median age by which 50% of the cortical points attained peak thickness for this group was 10.5 years (SE 0.01), which was significantly later than the median age of 7.5 years (SE 0.02) for typically developing controls (log rank test χ(1)² = 5,609, P < 1.0 × 10⁻²⁰). The delay was most prominent in prefrontal regions important for control of cognitive processes including attention and motor planning. Neuroanatomic documentation of a delay in regional cortical maturation in ADHD has not been previously reported.
• cortical development
• structural neuroimaging
04-03 The neural networks of inhibitory control in post-traumatic stress disorder - Volume 18 Issue 6 - EM Falconer, R Bryant, K Felmingham, AH Kemp, G Olivieri, A Peduto, E Gordon, LM Williams
Historically, the focus for Attention Deficit Hyperactivity Disorder (ADHD) has been on children, with considerable research and many opinions available in this area. More recently, the focus has been expanded to include ADHD in adults. Assessment of ADHD in adults is complicated by the high rate of co-occurring disorders as well as symptom overlap with a number of disorders. One popular family of measures for the assessment of attention and executive control is the continuous performance test (CPT). A review of the available research on CPTs reveals that they are quite sensitive to CNS dysfunction. This is both a strength and a limitation of CPTs in that multiple disorders can result in impaired performance on a CPT. The high sensitivity of CPTs is further complicated by the multiple variations of CPTs available, some of which may be more sensitive or demonstrate better specificity to ADHD in adults than others. If CPTs are to be used clinically, further research will be needed to answer the questions raised by this review.
Les auteurs comparent des enfants selon que ceux-ci sont atteints de troubles de l'attention avec hyperactivite ou seulement d'hyperactivite, avec des enfants atteints de troubles d'apprentissage et avec un groupe controle. Les comparaisons sont nombreuses et incluent notamment des batteries d'entretiens, des evaluations comportementales, des tests et des observations directes
Attention is a complex process whose disturbance is considered a core deficit in a number of disorders [e.g., Attention Deficit Hyperactivity Disorder (ADHD), schizophrenia]. In 1956, Rosvold and colleagues [J. Consult. Psychol. 20 (1956) 343.] demonstrated that the continuous performance test (CPT) as a measure of sustained attention was highly sensitive to brain damage or dysfunction. These findings have been replicated with various populations and with various versions of the CPT. The CPT is now cited as the most frequently used measure of attention in both practice and research. Across studies, results are consistent with models of sustained attention that involve the interaction of cortical (frontal, temporal, parietal), subcortical (limbic, basal ganglia), and functional systems including the pathways between the basal ganglia, thalamus, and frontal lobes. Right hemisphere involvement (asymmetric response) is also evident across multiple studies. As such, the CPT demonstrates sensitivity to dysfunction of the attentional system whether this is due to diffuse or more focal damage/dysfunction or in conjunction with any specific disorder. CPT performance can be viewed as symptom specific (attentional disturbance), but it is not disorder specific (e.g., ADHD). Implications for neuropsychological interpretation of CPT results are presented.
This study was undertaken using the INTEGRATE Model of brain organization, which is based on a temporal continuum of emotion, thinking and self regulation. In this model, the key organizing principle of self adaption is the motivation to minimize danger and maximize reward. This principle drives brain organization across a temporal continuum spanning milliseconds to seconds, minutes and hours. The INTEGRATE Model comprises three distinct processes across this continuum. Emotion is defined by automatic action ten- dencies triggered by signals that are significant due to their relevance to minimizing danger- maximizing reward (such as abrupt, high contrast stimuli). Thinking represents cognitive functions and feelings that rely on brain and body feedback emerging from around 200 ms post-stimulus onwards. Self regulation is the modulation of emotion, thinking and feeling over time, according to more abstract adaptions to minimize danger-maximize reward. Here, we examined the impact of dispositional factors, age and genetic variation, on this temporal continuum. Brain Resource methodology provided a standardized platform for acquiring genetic, brain and behavioral data in the same 1000 healthy subjects. Results showed a “paradox” of declining function in the “thinking” time scale over the lifespan (6 to 80+ years), but a corresponding preservation or even increase in automatic functions of “emotion” and “self regulation”. This paradox was paralleled by a greater loss of grey mat- ter in cortical association areas (assessed using MRI) over age, but a relative preservation of subcortical grey matter. Genetic polymorphisms associated with both healthy func- tion and susceptibility to disorder (including the BDNFVal66Met, COMTVal158/108Met, MAOA and DRD4 tandem repeat and 5HTT-LPR polymorphisms) made specific contributions to emotion, thinking and self regulatory functions, which also varied according to age.
An overview of a number of different lines of research is presented to demonstrate that problems with response inhibition are involved in attention-deficit hyperactivity disorder (ADHD). Response inhibition is defined as the capacity to delay prepotent responses, to interrupt ongoing responses given feedback about performance, and to inhibit responding to sources of interference when engaged in tasks requiring self-regulation and goal-directed action. A considerable amount of research is explored on each of these aspects of inhibition in both children and adults with ADHD. Results in that literature are reasonably consistent in supporting the assertion that ADHD creates deficiencies in each of the three areas of inhibitory functioning. Such deficits appear to be rather specific to ADHD and do not seem to be caused by other disorders that often coexist with ADHD, such as mood, anxiety, and learning disorders. More research needs to be done, however, on whether or not conduct disorder is also associated with difficulties in behavioral inhibition and, if so, whether they are of the same qualitative nature as those seen in ADHD and are simply not the result of the large overlap of conduct disorder with ADHD. MRDD Research Reviews 1999;5:177–184. © 1999 Wiley-Liss, Inc.
To determine the nature and severity of cognitive functioning impairment in adolescent anorexia nervosa (AN) when underweight and following weight gain.
In 37 first admission adolescent (12–18 years) AN patients and 45 matched controls, general cognitive functions were assessed at baseline and follow-up using the IntegNeuro-computerized battery. AN participants were tested between days 3 and 10 of their admission when underweight, with retesting conducted after weight restoration.
When underweight, AN participants performed more poorly than controls on sensori-motor speed tasks and exhibited a susceptibility to interference, but had superior working memory. Once the weight is restored, individuals significantly improved relative to their own performance. Relative to controls, they were significantly faster on attention and executive function tasks, exhibited superior verbal fluency, working memory, and a significantly superior ability to inhibit well-learnt responses.
Cognitive impairments in adolescent AN appear to normalize with refeeding and weight gain. © 2009 by Wiley Periodicals, Inc. Int J Eat Disord 2010
Attention Deficit Hyperactivity Disorder (ADHD) is a developmental disorder which is characterized by inattention, hyperactivity, and impulsivity. The current method of diagnosis involves extensive interview and behavior rating scales in order to determine whether an individual displays certain characteristics of ADHD. Researchers have long sought a more objective measure of ADHD, with limited success. The present study explores the predictive power of several neuropsychological assessment tools used in combination in classifying children with ADHD. These tests of frontal/executive functioning included the Hand Movements Scale from the Kaufman Assessment Battery for Children (K-ABC), the Stroop Color-Word Association Test, the Controlled Oral Word Association Test (COWAT, or F-A-S), the Trail Making Test, the Arithmetic and Digit Span subtests of the Wechsler Intelligence Scale for Children, Third Edition (WISC-III), and Conners' Continuous Performance Test (CPT). Twenty-one ADHD boys and 22 community control children completed the one-hour battery which was administered in the home. Group differences were significant on the Digit Span and CPT tests only, and battery analysis did little to increase overall predictive power. For a battery of seven neuropsychological tests, an impaired score on at least two of seven tests provided the strongest prediction, but it was modest, offering limited diagnostic utility. Similar classification rates were obtained with a battery comprised of the three strongest tests. The present study highlights the difficulty in identifying consistent mean differences on tests of frontal/executive functioning across studies, as well as the need to assess the predictive validity of these tests in classifying children with ADHD. Continued study is needed to better understand the variability in previous findings and to explore further the utility of a battery approach. Inconsistencies in the literature are discussed, with consideration of research methodology, developmental obstacles, the heterogeneity of the ADHD population, and comorbid diagnoses.
Thirty hyperkinetic children were selected on the basis of (1) a clinical diagnosis using the DSM-III criteria for Attention Deficit Disorder with Hyperkinesis; (2) having remained in treatment for at least six months and having been seen at least three times by a child psychiatrist, with the diagnosis maintained over that time; and (3) a maternal score greater than 18 on the Conners Abbreviated Parent-Teacher Rating Scale for Hyperkinesis on the initial day of testing. The children were tested on that day with the Continuous Performance Test (CPT) and the Draw-a-Line Slowly Test (DALS) for impulsivity. Age- and sex-normalized data from 15 of the hyperkinetic children and 83 normal school children of similar age selected on the basis of teacher ratings of less than 15 on the Conners Parent-Teacher Rating Scale were subjected to a discriminant function analysis. The stability of the discriminant function obtained, which contained the Continuous Performance Test, Errors of Commission (CPTC), Errors of Omission (CPTO), Mean Reaction Time (MRT), and DALS, was tested on the second group of 15 hyperkinetic children. Of the 15 hyperkinetic children, 9 were correctly classified, as were 99% of the normal school group (p < 0.001).
Developmental normative data for 775 children aged 6-16 are presented for the Test of Variables of Attention (T.O.V.A.), a 23-minute fixed-interval visual Continuous Performance Test with minimal language demands and no left-right discrimination. The target is presented on 22.5% and 77.5% of the trials during the first and second halves, respectively, T.O.V.A. indices include omission and commission errors, response time means and standard deviations, and anticipatory responses. Attention and impulse control developed in a non-linear manner, changing rapidly in early childhood and leveling off during later childhood and adolescence.