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Attention regulation by children with Down syndrome: coordinated joint attention and social referencing looks.

We examined attention regulation of children in two different situations designed to elicit triadic interactions (i.e., between self, other, and object). Thirty-five children with Down syndrome and 23 children with typical development were observed in a semi-structured adult-child interaction designed to elicit coordinated joint attention and an ambiguous situation in which a moving robot prompted an emotional response from the adults in order to elicit social referencing looks from the child. Children with Down syndrome engaged in significantly fewer social referencing looks. Group differences were not found for coordinated joint attention looks, suggesting that the difficulty for children with Down syndrome is in cognitive appraisal abilities.

Adult↗

Nicotine and attention in adult attention deficit hyperactivity disorder (ADHD).

Nicotine, like the psychostimulants methylphenidate and dextroamphetamine, acts as an indirect dopamine agonist and improves attention and arousal. Adults and adolescents with attention deficit hyperactivity disorder (ADHD) smoke much more frequently than normal individuals or those with other psychiatric conditions, perhaps as a form of self-medication for ADHD symptoms. Nicotine might therefore have some value as a treatment for ADHD. The present study is an acute double-blind crossover administration of nicotine and placebo with smokers (n = 6) and nonsmokers (n = 11) diagnosed with adult ADHD. The drug was delivered via a transdermal patch at a dosage of 7 mg/day for nonsmokers and 21 mg/day for smokers. Results indicate significant clinician-rated global improvement, self-rated vigor and concentration, and improved performance on chronometric measures of attention and timing accuracy. Side effects were minimal. These acute results indicate the need for a longer clinical trial and a comparison with other stimulants in adult ADHD treatment.

Adult↗

Impaired stimulus-driven orienting of attention and preserved goal-directed orienting of attention in unilateral visual neglect.

Neglect patients do not respond to stimuli presented on the side of space contralateral to the side of their brain lesions, indicating deficits to attentional or representational mechanisms. We describe a patient who shows a left neglect in normal reading and line bisection but an intact ability to locate the left end of the stimulus. Further tests showed that his seemingly intact ability to search into the "neglected" side was due to his ability to use local elements of the stimulus as cues in his serial search for the left end. The patient's left neglect was significantly reduced after he located the left end of the stimulus. In contrast, his neglect was not reduced by making the stimulus on the neglected side physically more salient. These results suggest that his neglect is due largely to an impairment of the mechanism mediating automatic, stimulus-driven orienting of attention. In contrast, the controlled goal-directed attentional search is largely preserved and can be used to alleviate neglect.

Apraxias↗

Functional magnetic resonance imaging investigation of the effects of neurofeedback training on the neural bases of selective attention and response inhibition in children with attention-deficit/hyperactivity disorder.

Two functional magnetic resonance imaging (fMRI) experiments were undertaken to measure the effect of neurofeedback training (NFT), in AD/HD children, on the neural substrates of selective attention and response inhibition. Twenty unmedicated AD/HD children participated to these experiments. Fifteen children were randomly assigned to the Experimental (EXP) group whereas the other five children were randomly assigned to the Control (CON) group. Only subjects in the EXP group underwent NFT. EXP subjects were trained to enhance the amplitude of the SMR (12-15 Hz) and beta 1 activity (15-18 Hz), and decrease the amplitude of theta activity (4-7 Hz). Subjects from both groups were scanned one week before the beginning of NFT (Time 1) and 1 week after the end of NFT (Time 2), while they performed a "Counting Stroop" task (Experiment 1) and a Go/No-Go task (Experiment 2). At Time 1, in both groups, the Counting Stroop task was associated with significant activation in the left superior parietal lobule. For the Go/No-Go task, no significant activity was detected in the EXP and CON groups. At Time 2, in both groups, the Counting Stroop task was associated with significant activation of the left superior parietal lobule. This time, however, there were significant loci of activation, in the EXP group, in the right ACC, left caudate nucleus, and left substantia nigra. No such activation loci were seen in CON subjects. For the Go/No-Go task, significant loci of activation were noted, in the EXP group, in the right ventrolateral prefrontal cortex, right ACcd, left thalamus, left caudate nucleus, and left substantia nigra. No significant activation of these brain regions was measured in CON subjects. These results suggest that NFT has the capacity to functionally normalize the brain systems mediating selective attention and response inhibition in AD/HD children.

Attention↗

Attentional and neurocognitive characteristics of high-risk offspring of parents with schizophrenia compared with DSM-IV attention deficit hyperactivity disorder children.

Offspring of individuals with schizophrenia are at increased baseline risk for a range of early mental disorders. Studies investigating the premorbid characteristics of individuals with schizophrenia indicate that they suffer from social, behavioral, attentional and neurocognitive impairments, often resembling attention deficit hyperactivity disorder (ADHD). In this study, we compared the executive functioning and general intelligence among three groups: (i) children and adolescents with DSM-IV ADHD (n=41), (ii) "high-risk" (HR) offspring of parents with DSM-IV schizophrenia, and (iii) normal comparison subjects (n=35). Our results indicated that both HR and ADHD groups had lower Verbal IQ scores. ADHD cases had significantly lower percent correct and total errors in Wisconsin Cart Sorting Test when compared with normal comparison subjects. The HR cases also had lower Performance IQ scores as well as worse abstraction--flexibility and comprehension performance. The HR group was further stratified with (HR-A) and without (HR-NA) comorbid ADHD, and HR-A subjects were significantly noted to be more impaired on most tests. The overall worse performance of HR offspring was attributable to significantly lower performance among the HR-A youth. Further, our results suggested that the most profoundly impaired HR subjects were in fact children and adolescents who also met criteria for ADHD. Future studies with broader neuropsychological test batteries are necessary to investigate the differences and similarities between ADHD and the HR-A subgroup.

Adolescent↗

Effects of methylphenidate on event-related potentials and performance of attention-deficit hyperactivity disorder children in auditory and visual selective attention tasks.

Attention-deficit hyperactivity disorder (ADHD) children participated in a double-blind placebo-controlled study in which the effects of a dosage of 15 mg methylphenidate (MPH) on auditory and visual selective attention tasks was determined by presenting frequent (90%) and infrequent (10%) stimuli in both relevant and irrelevant input channels. The subject's task was to respond to the infrequent tones in the relevant input channel. Processing activity (negativity and positivity) was assessed for both tasks. N1, P2, N2, and P3b peaks were scored in the auditory task and N1, P1, N2, P2, P3(1), and P3b peaks were scored in the visual task. Effects of MPH were more prevalent in the visual than in the auditory condition. In the visual condition MPH enhanced the percentage of hits, caused higher central, parietal, and occipital P3b amplitudes to attended stimuli (both standards and deviants), and also enhanced the frontal processing negativity (PN). In the auditory task MPH did not influence performance, but it enhanced the frontal PN as well as the parietal and occipital P3b amplitudes to all stimulus types. In ADHD children, MPH ameliorates some, but not all, deficits and also improves processing where no differences with normal children are present.

Adolescent↗

Covert visual spatial attention in boys with attention deficit hyperactivity disorder: lateral effects, methylphenidate response and results for parents.

We report three related studies of covert visual spatial orienting in child attention deficit hyperactivity disorder (ADHD). In Study 1, we examined covert visual spatial orienting in ADHD and comparison boys, Study 2 comprised a dose-response study of methylphenidate for the ADHD group, and Study 3 was an investigation of biological and adoptive parents. In contrast with comparison subjects (n = 17). ADHD boys aged 6-12 (n = 27) showed both slower reaction times overall and within-condition (lateral) asymmetries in reaction times. Specifically, boys with ADHD reacted more slowly to uncued targets in the left visual field than in the right visual field. Responses to stimuli in the two visual fields were differentially affected by methylphenidate for the ADHD group. Medication equalized visual field responses to the uncued targets, resulting in a significant cue x dose x visual field interaction. Further, medication altered the relative cue responsivity in the two visual fields, resulting in a significant dose x visual field interaction for the Validity Effect. Biological parents of ADHD boys (n = 16) also showed slower reaction times to uncued left visual field targets than to right visual field targets; in addition they showed slower response to invalidity cued targets in the right visual field. These literal effects were not observed in adoptive parents of ADHD boys (n = 12) or biological parents of comparison boys (n = 14). Possible abnormal hemispheric asymmetry of attention functions in boys with ADHD and their biological parents is discussed.

Adoption↗

Differential measures of 'sustained attention' in children with attention-deficit/hyperactivity or tic disorders: relations to monoamine metabolism.

Controversy exists on whether the constructs tested by paper/pencil and computerized continuous-performance tests (CPT) are similar, and the deficits recorded in children with attention-deficit/hyperactivity symptoms (ADHD) are comparable. Signal-detection measures were recorded on four such tests of 'sustained attention', with increasing working-memory requirements in healthy children (14; mean 10 years), and those with ADHD (14; mean 10 years) or a tic syndrome (TS, 11; mean 11 years). Clinical associations were sought from 24-h urinary measures of monoamine activity. The cancellation paper/pencil test revealed no group differences for errors or signal detection measures. On the CPT, ADHD children made more omission and commission errors than control subjects, but TS children made mostly omissions. This reflected the poor perceptual sensitivity (d-prime, d') for ADHD and conservative response criteria (beta) for TS children. This group difference extended to the CPTax, which was shown on a regression analysis to test for putative working-memory-related abilities as well as concentration. In all children, immediate response-feedback reduced omissions, and modestly improved d'. CPTax performance related negatively to dopamine metabolism in control subjects and to serotonin metabolism in the ADHD group. But comparisons between the metabolites in the ADHD group suggest that increased serotonin and decreased noradrenaline, with respect to dopamine metabolism, may detract from CPT performance in terms of d'. CPT tasks demonstrated a perceptual-based impairment in ADHD and response conservatism in TS patients independent of difficulty. Catecholamine activity was implicated in the promotion of perceptual processing in normal and ADHD children, but serotonin activity may contribute to poor CPTax (working-memory) performance in ADHD patients.

Adolescent↗

Non-selective attention and nitric oxide in putative animal models of Attention-Deficit Hyperactivity Disorder.

Non-selective attention (NSA) to environmental stimuli has been measured in putative animal models of Attention-Deficit Hyperactivity Disorder (ADHD), such as the Spontaneously Hypertensive (SHR) and the Naples High-Excitability (NHE) rat lines. A series of experiments has been carried out on male juvenile SHR and Wistar-Kyoto (WKY) controls (experiment 1) and on the NHE and two controls, i.e. the Naples Low-Excitability (NLE) and a random-bred (NRB) line (experiment 2). It was done under basal conditions or following a single injection of the nitric oxide synthase (NOS) inhibitor L-nitro-arginine-methylester (L-NAME: 0.1-10 mg/kg, i.p.), or vehicle, 30 min before testing on day 1 and vehicle alone before testing on days 2 and 3 in SHR/WKY (experiment 3) and the Naples lines (experiment 4). The behavior in a Lát maze during three consecutive 10-min exposures at 24-h intervals was monitored by a CCD video camera and analyzed off-line for frequency and duration of rearings on hindlimbs per 1-min blocks. The results demonstrated that both SHR and NHE rats showed a higher frequency of rearings of shorter duration than controls. With time of testing, the duration of rearings tended to increase in the WKY but not the SHR. In the Naples lines the duration tended to increase in all but mostly in the NHE rats. The acute inhibition of NOS by L-NAME significantly increased the duration of rearing episodes both in SHR and NHE rats only at 10 mg/kg in the second part of the testing period. Therefore, NSA, as indexed by the duration of rearings, is defective in both hyperactivity models against different genetic backgrounds. In addition, this impairment is dependent upon nitric oxide (NO), which appears to play a significant role in these processes.

Animals↗

Event related potentials during attention tasks in VLBW children with and without attention deficit disorder.

OBJECTIVE: Children born prematurely have a higher incidence of attention deficit disorder with or without hyperactivity. We have used visual event related potentials to study possible brain dysfunctions that could explain this higher incidence. METHODS: Very low birth weight (VLBW) children with and without AD/HD and term born children with and without AD/HD, were matched for IQ, age and socio-economic status (n=41, mean age 104 months). A visual oddball paradigm, consisting of target and non-target stimuli, was used with analysis of response times, error scores, N200, P300 and a P500 component. RESULTS: AD/HD children responded slower (F (1,38)=11.20, p<0.002); more varied (F (1,38)=21.77, p<0.000) and made more commission and omission errors (Kruskal-Wallis p<0.000). Non-target N200 was increased in amplitude (F (1.39)=4.01, p=0.05) with a wide anterior topography in children with AD/HD. The late positivity (P500) was decreased over central leads in children with AD/HD during the non-target stimuli (F (3,75)=3.00, p<0.036). No differences could be found in latency, amplitude or topography between VLBW children with AD/HD and term born children with AD/HD. CONCLUSIONS: Prematurity does not induce specific attentional brain dysfunction or maturation delays in stimulus processing during cognitive tasks. Other factors should be investigated to explain the higher incidence of AD/HD in VLBW children.

Analysis of Variance↗

Parents of children with attention-deficit/hyperactivity disorder: psychological and attentional impairment.

Biological parents of ADHD children were compared with parents of nonclinical children on measures of psychological impairment and attentional performance. Parents of children with severe ADHD demonstrated greater impairment in social and psychological functioning. However, no significant differences were found on laboratory measures of sustained attention, memory, cognitive flexibility, encoding, or impulsivity. The possibility that parental adjustment would be more usefully assessed by measures of current adaptive functioning than by means of laboratory tests is discussed.

Adult↗

Mutational analysis of the nicotinic acetylcholine receptor alpha 4 subunit gene in attention deficit/hyperactivity disorder: evidence for association of an intronic polymorphism with attention problems.

Recent studies suggest the presence of genetically distinct subtypes of attention deficit/hyperactivity disorder (ADHD) and that attention problems can be treated with receptor subtype selective nicotine agonists. In this study, individuals with two independent familial subtypes of ADHD defined by latent class analysis were systematically screened for sequence variations in the coding regions and intron/exon junctions of the nicotinic acetylcholine receptor alpha 4 subunit gene (CHRNA4). Common polymorphisms were used for transmission disequilibrium test (TDT) analyses. A significant association was found for a 5' intron 2 single nucleotide polymorphism and severe inattention problems (P = 0.007, effect size = 4, 95% CI 1.3-14.1). The location of the polymorphism is compatible with it affecting pre-mRNA stability or splicing.

Attention↗

Attention and short-term memory in normal children, aggressive children, and non-aggressive children with attention-deficit disorder.

In the present study, fifteen 7- to 9-year-old male school children with attention deficit disorder (ADD) as well as matched groups of aggressive and normal children were compared on scores obtained for initial acquisition of information and its maintenance in the short-term score under various attentional loads. Bi-colored, alphanumeric arrays were used in a partial-report technique. Retention was measured 0, 5, 10, and 20 s, after pre- and postexposure under both rehearsal and nonrehearsal conditions. ADD children (a) were deficient in original acquisition, (b) were unable to take sufficient advantage of decreased load conditions, and (c) showed decrements over time that paralleled those of the control group (CG). The results have been interpreted in light of maturational lag and the differences between ADD and aggressive groups.

Aggression↗

Attentional and perceptual disturbances in children with Tourette's syndrome, attention deficit disorder, and epilepsy.

Perceptual, motor, and neuromaturational competence were assessed using a battery of tasks with three groups of children with diagnosed disorders of Tourette's syndrome (TS), attentional deficit with no known organic substrate (Constitutional AD), and attentional deficit disorder in children with epilepsy (E-ADD). The purpose was to determine how the three groups related to each other on these measures and to establish clinical validation of the test battery. As predicted, the control and the TS groups did much better than the ADD and seizure groups. The TS group differed from the controls on only a handful of measures, whereas the constitutional ADD and E-ADD children were far more deviant than the TS children. The E-ADD children as a group suffered difficulties in virtually every area.

Adolescent↗

Spatial orienting and focused attention in attention deficit hyperactivity disorder.

Seventeen children with attention deficit disorder (ADHD) and 10 normal controls performed two tasks while event-related potentials were recorded. ADHD subjects took part in two more sessions under methylphenidate (MP) or placebo. In the spatial orienting task, invalidly cued targets elicited a longer reaction time (RT) and a P3 that was longer in latency and greater in amplitude than did validly cued targets. Performance was similar for both groups, but the early portion of P3 (300-400 ms) was lower in amplitude for invalidly cued targets in ADHD subjects. MP increased accuracy without affecting RT and shortened P3 peak latency and increased the amplitude of its early portion. In the focused attention task, accuracy was greater for controls and MP, but there were no RT differences. Attended stimuli elicited greater amplitude P1, N1, and P3 than did nonattended stimuli, but these measures were unaffected by diagnosis or medication.

Attention↗

Methylphenidate and attentional training. Comparative effects on behavior and neurocognitive performance in twin girls with attention-deficit/hyperactivity disorder.

The effectiveness of four doses (5-mg, 10-mg, 15-mg, 20-mg) of methylphenidate (MPH) and attentional training (AT) were evaluated using neurocognitive instruments (Continuous Performance Test; Matching Unfamiliar Figures Test), narrow- and broad-band rating scales in the context of a double-blind, placebo-control, within-subject reversal design for dizygotic twin girls with Attention-Deficit/Hyperactivity Disorder (ADHD). Both interventions proved effective for improving neurocognitive test performance and behavior, although broad-band ratings revealed dose-response curves different from those obtained from the neurocognitive tests. Implications for clinical management of girls with ADHD are discussed.

Attention↗

Executive processing and attention deficit hyperactivity disorder: an application of the supervisory attentional system.

Children with attention deficit hyperactivity disorder (ADHD) display many behaviors consistent with an underlying deficit in executive processes. This study examines Norman and Shallice's (1986) supervisory attentional system (SAS) as an approximation of executive functioning thought to be impaired in ADHD. Fifteen ADHD children were compared to a clinical control sample of learning disabled (LD) children and control children matched for age, gender, and IQ on a series of tasks designed to tap the functions of the SAS. The tasks assessed either the inhibition of a strongly triggered response (Star Counting Test, Hayling Sentence Completion Test, and the Random Generation Test) or impulsive responding in the absence of strong trigger-schema contingencies (Brixton Spatial Anticipation Test). Analyses revealed that the ADHD group was significantly impaired, in comparison to the LD and control groups, on tasks requiring the inhibition of a strongly triggered response. Further support for the fractionation of the SAS is provided by the differential performance of the groups on these tasks.

Arousal↗

ERP differences in visual attention processing between attention-deficit hyperactivity disorder and control boys in the absence of performance differences.

Event-related potentials (ERPs) were recorded during a visual two-choice reaction time (RT) task in attention-deficit hyperactivity disorder (ADHD) and control boys selected using strict inclusion and exclusion criteria. No group differences were found in mean RT and correct responses. Although early occipital ERPs were not affected in the ADHD group, the peak latency of early anterior ERPs (N1, P1, N2) was significantly delayed. ADHD showed a larger effect of stimulus type on the frontal negativity (N530) and the posterior late negativity (nSW) and a smaller effect of stimulus type on anterior N2 and posterior P3b amplitude. The development of N530 and P450 amplitude across blocks of five trials was analyzed using orthogonal polynomial trend analysis of variance software. In the control group, P450 amplitude to "frequent" stimuli reduced across blocks. In the ADHD group, N530 amplitude increased for "rare" stimuli across blocks. It is suggested that the ADHD group showed a lack of automatization of the categorization process with increasing time on task for which they compensated by controlled attentional processes.

Attention↗