Abstract
Emerging evidence suggests that children with attention deficit and hyperactivity disorder (ADHD) present more difficulties in standing and walking balance than typically developing children. Most of previous studies have assessed these functions using postural and sensory organization tests showing differences in balance performance between control and ADHD children. However, to date, it is unknown whether these balance alterations are accompanied with vestibular dysfunction. The principal aim of this study is to evaluate vestibular otolith function in ADHD and matched control children. We assessed vestibular otolith function in children with ADHD and controls using the subjective visual vertical (SVV) bucket test and cervical vestibular-evoked myogenic potentials (cVEMPs). In addition, gait and balance were evaluated using the dynamic gait index (DGI) and computerized posturography. Non-significant differences between groups were obtained in SVV evaluation. DGI results show lower scores for overall test performance in children with ADHD (p < 0.001), while computerized postural recordings showed significant differences for the limit of stability between groups (p = 0.02). cVEMPs in response to 500 Hz tone bursts presented at 100 dB were absent or reduced in children with ADHD, as revealed by differences in P1 and N1 peak-to-peak amplitudes between groups (p < 0.01). These findings suggest that vestibular brainstem reflexes are altered in a subset of children with ADHD. We propose to include cVEMP reflexes in the clinical evaluation of ADHD patients.
Highlights
Attention deficit and hyperactivity disorder (ADHD) is a neuropsychiatric condition characterized by the presence of inattention, hyperactivity, and impulsivity [1] associated to disturbances in the maturation process of executive functions [2]
Controls had a mean total sensory processing measure (SPM) score of 19.2 ± 0.4 points, while children diagnosed with ADHD had a mean total SPM score of 32.5 ± 1.8 points, which was significantly worse for ADHD children than for controls (Mann–Whitney U Statistic = 0.0, p < 0.001)
We propose that altered cervical vestibular-evoked myogenic potentials (cVEMPs) responses reflect a vestibular impairment that contributes to the ADHD phenotype, and the vestibular pathways should be added to the brain network affected in ADHD patients [5]
Summary
Attention deficit and hyperactivity disorder (ADHD) is a neuropsychiatric condition characterized by the presence of inattention, hyperactivity, and impulsivity [1] associated to disturbances in the maturation process of executive functions [2]. Great research efforts have been devoted to unravel the physiopathology of this group of symptoms [4] being one of the most currently accepted theories the deficit in dopaminesignaling mechanisms affecting prefrontal cortex, basal ganglia, and amygdala circuits, which participate in executive functions [5]. Buderath and colleagues [12] observed a reduction in the cerebellar volume of ADHD children with balance disorders using volumetric magnetic resonance imaging and static and dynamic posturography. Together, these studies link ADHD diagnosis with a possible cerebellar dysfunction that may contribute to balance and gait disorders in a subset of ADHD patients
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