Abstract
The development of cognitive interventions in attention-deficit/hyperactivity disorder (ADHD) often requires the assessment of multiple cognitive functions. However, experimental settings consisting of various tasks are particularly strenuous for patients and can thus result in poor data quality. For the economical assessment of working memory and response inhibition, this study aims to validate a combined n-back/nogo paradigm by comparing it to single task versions and to demonstrate its applicability for ADHD research. Twenty-five healthy individuals and 34 ADHD patients between 9 and 16 years participated in this event-related potential (ERP) study. Healthy controls underwent single task versions of a 2-back working memory task and a go/nogo response inhibition task as well as the introduced combined 2-back/nogo task. This combined task demonstrated a comparable ERP structure for working memory and response inhibition aspects as single task versions. Behaviorally, higher working memory performance during the combined paradigm indicated lower task difficulty, while high correlations between combined and single task versions still indicated valid working memory measures. For response inhibition performance, different task versions resulted in similar outcomes. The application of the combined n-back/nogo paradigm in ADHD patients revealed the expected working memory and response inhibition deficits, increased omission errors, reaction times, and standard deviation of reaction time, as well as diminished n-back P3 and nogo P3 amplitudes. We conclude that the combined n-back/nogo task is an effective paradigm for the economical assessment of working memory and response inhibition deficits in ADHD on a behavioral and neurophysiological level.
Highlights
Attention-deficit/hyperactivity disorder (ADHD) is one of the most frequent disorders in child and adolescent psychiatry, with a worldwide prevalence of about 3.4% (Polanczyk et al, 2015)
Better working memory performance was found during the combined n-back/nogo task than during the single n-back task [combined n-back/nogo: 73.83%, single n-back: 55.70%, t(24) = 6.91, p < 0.001, d = 1.11]
Response inhibition performance was not significantly different between task versions [combined n-back/nogo: 87.44%, single go/nogo: 83.02%, t(24) = 1.76, p = 0.091, d = 0.44] Further, we found a borderline significant trend toward a reduced number of omission errors in the combined n-back/nogo task compared to the single n-back task [t(24) = −2.04, p = 0.053, d = 0.43]
Summary
Attention-deficit/hyperactivity disorder (ADHD) is one of the most frequent disorders in child and adolescent psychiatry, with a worldwide prevalence of about 3.4% (Polanczyk et al, 2015). Additional to the core symptoms of inattention, hyperactivity, and impulsivity defined in (DSM-5; American Psychiatric Association, 2013), 62% of ADHD patients are affected by significant impairments of working memory and 27% suffer from inhibitory dysfunctions (Kofler et al, 2019) These deficits are associated with long-term consequences as academic underachievements, social problems and even addiction (Groman et al, 2009; Rinsky and Hinshaw, 2011; Simone et al, 2018). Experimental settings consisting of various tasks are challenging for ADHD patients who are unable to stay concentrated and calm over longer time periods (Dekkers et al, 2017) In imaging studies, this is a highly relevant obstacle because data quality is suffering when patients start to fidget or move. We applied the approach of merging different tasks (Ruchsow et al, 2008; Lee et al, 2010; Scharinger et al, 2015; Alderson et al, 2017) to a combined working memory and a response inhibition paradigm
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