Selective Attention Dynamics in Adults With Attention-Deficit/Hyperactivity Disorder: A Role for Sensory Processing Asymmetry?

FIGURE 1. Changes in cortical thickness provide one measure of brain maturation. A large longitudinal study found that for most areas of cortex, children with attention deficit hyperactivity disorder (ADHD) reach peak cortical thickness several years later than typically developing children, supporting presence of developmental delay. The rate of cortical thinning also differed between the group who continued to meet diagnostic criteria into adulthood (persistent ADHD) and those who did not (remitted ADHD). Areas of cortex in which the rate of thinning correlated with adult symptom level (green, more symptoms associated with more thinning) are approximated on medial and lateral simplified representations of cortex. An earlier study also identified multiple areas in which cortex was thinner in adults with persistent ADHD compared with controls (orange). In addition, this study noted some areas of thicker cortex in remitted ADHD when compared with persistent ADHD (blue).

Treatment Controversies in Adult ADHD.

Prospective Follow-up Studies of ADHD: Helping Establish a Valid Diagnosis in Adults

Introduction Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder characterized by inattention and hyperactivity-impulsivity, significantly affecting children’s development. Exercise intervention has gained attention as a non-pharmacological approach. This study explores the effects of exercise on improving attention in children with ADHD, aiming to promote their development and social inclusion, aligned with the ISAPA 2025 symposium theme “‘Inclusivizing’ our world.” Methodology A single-case experimental design was used, divided into pre-intervention (B1) and post-intervention (B2) phases. The participant, an 8-year-old boy diagnosed with ADHD, underwent 11 weeks of intervention, with three 60-minute sessions per week. The program was designed based on the child’s motor skills and attention. Data from the d2 Test and classroom observations were analyzed using independent samples t-tests and regression analysis to evaluate the effects. Data randomness was tested by autocorrelation analysis. All analyses were done in SPSS 26.0. Results Regression analysis showed significant improvement in both selective and sustained attention with increased exercise frequency(y selective attention B1=8.85-0.46x, y selective attention B2=12.96-0.56x, y sustained attention B1=2.65+0.15x, y sustained attention B2=6.76+0.28x). Independent samples t-tests indicated that attention in B2 was significantly better than in B1 (T selective = 11.407, T sustained = -6.380, p all < 0.01). The d2 Test of Attention showed that the concentration index increased from 98.5 to 112.3, and the error detection rate decreased by 15.2%. Conclusions The study suggests that exercise intervention may improve attention in a child with ADHD, with a potential cumulative effect. Due to the small sample size, further research is needed to validate these findings. References Vacher, C., Goujon, A., Romo, L., & Purper-Ouakil, D. (2020). Efficacy of psychosocial interventions for children with ADHD and emotion dysregulation: a systematic review. Psychiatry research, 291, 113151. Glod, C. (2016). Diagnosis and treatment of ADHD in young adults. European Psychiatry, (33), S790-S791. Mahmoud, M. B., Ali, N. B., Fray, S., Chebbi, S., & Fredj, M. (2021). Utility of EEG on attention deficit–hyperactivity disorder (ADHD). Epilepsy & Behavior, 114, 107583.

ABSTRACTThe aim of this study is to investigate whether sluggish cognitive tempo (SCT) symptoms are associated with neurocognitive task performance and ratings of real-world executive functioning (EF) in preschoolers at risk for attention-deficit/hyperactivity disorder (ADHD). The associations between parent- and teacher-rated SCT symptoms and neuropsychological task performance and ratings of EF in 61 4-year-old preschool children (51 boys, 10 girls) with self-regulation difficulties were examined, with regression analyses controlling for the effects of ADHD inattention symptoms. In the study sample, higher teacher-rated SCT symptoms are significantly associated with poorer performance on tasks of visual-perceptual abilities, auditory and visual attention, sustained and selective attention, inhibitory control, pre-numerical/numerical concepts, and slower processing speed, but SCT symptoms are not significantly associated with working memory, attention shifting or cognitive flexibility when controlling for ADHD inattention. Higher parent-rated SCT symptoms are significantly associated with visual-perceptual abilities. ADHD inattention symptoms are more strongly associated than SCT with daily life EF ratings; neither parent- nor teacher-rated SCT symptoms are significantly associated with daily life ratings of inhibition, working memory, or planning/organization after controlling for ADHD inattention. This study suggests that SCT symptoms contribute to EF deficits at least on neurocognitive tasks assessing visual-perceptual/spatial abilities, attention to detail and processing speed, as observed in this sample of young children at risk for ADHD, and may be an important intervention target.

Le trouble déficit de l’attention/hyperactivité à l’âge adulte : concept, tableau clinique, stratégies diagnostiques et thérapeutiques

Background and Aims This study aims to compare the effectiveness of two computerized cognitive training applications, “Brain Train” and" CogniPlus”, in improving the response inhibition, selective attention, and visual-spatial processing speed of children with attention deficit/hyperactivity disorder (ADHD). Methods This is a quasi-experimental. Participants were 45 elementary school students diagnosed with ADHD who were selected by a convenience sampling method. The students were divided randomly into three groups: intervention group 1 (n=15, receiving training by Brain Train), intervention group 2 (n=15, receiving training by CogniPlus) and control (n=15). Each intervention group separately received training for two months, three session per week, each for 50-60-minutes. Performance of three groups were evaluated in response inhibition, selective attention, and visual-spatial processing in pre-test and post-test phases using Stroop test, the integrated visual and auditory continuous performance test (IVA+Plus), and visual-spatial processing subscale of the Stanford-Binet Intelligence Scales. Collected data were analyzed using the analysis of covariance. Results Results showed a significant difference between the two intervention groups in the study variables (P&lt;0.05), but there was no significant difference between two intervention groups in improving selective attention and response inhibition (P&gt;0.05). However, in visual-spatial processing, the group received training by Brain Train application showed a significant improvement more than the group received training by CogniPlus (P&lt; 0.05). Conclusion Computerized cognitive training applications can improve the cognitive skills of children with ADHD, where the Brain Train application is more effective than Cogniplus regarding the visual-spatial processing ability.

Objective Attention deficit hyperactivity disorder (ADHD) is linked to time perception deficits, with theories such as Scalar Expectancy Theory (SET) and Dynamic Attending Theory (DAT) offering different explanations. SET suggests time perception relies on a pacemaker-counter system influenced by working memory, whereas DAT highlights the role of attention in modulating time perception. This study examines the impact of attention, working memory, and motor response on time perception in children with ADHD. Method This study included 94 children (47 with ADHD, 47 typically developing), aged 7–12, matched by age and gender. Participants completed computerized tasks assessing time perception (Time Wall), sustained attention (CPT), selective attention and reaction time (Go/No-Go), and working memory (Corsi Block). ADHD diagnoses followed Diagnostic and Statistical Manual of Mental Disorders-V-Text Revision (DSM-5-TR) criteria. Data were analyzed using independent t-tests and linear regression models. Results Children with ADHD demonstrated significantly greater time perception inaccuracy than controls. Regression analyses revealed that in the ADHD group, selective attention, and reaction times in sustained and selective attention significantly predicted time perception deficits. In contrast, only age predicted inaccuracy in the control group. These findings underscore the unique cognitive mechanisms contributing to time perception deficits in ADHD. Conclusion Time perception deficits in children with ADHD appear to be primarily influenced by selective attention and motor response speed, rather than sustained attention or working memory. These findings support DAT, highlighting the importance of attention and reaction time in ADHD-related time perception deficits. Interventions targeting these factors may be essential for improving timing accuracy in ADHD children.

Attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are associated with attentional impairments, with both commonalities and differences in the nature of their attention deficits. This study aimed to investigate the neural correlates of ADHD and ASD traits in healthy individuals, focusing on the functional connectivity (FC) of attention-related large-scale brain networks (LSBNs). The participants were 61 healthy individuals (30 men; age, 21.9 ± 1.9 years). The Adult ADHD Self-Report Scale (ASRS) and Autism Spectrum Quotient (AQ) were administered as indicators of ADHD and ASD traits, respectively. Performance in the continuous performance test (CPT) was used as a behavioural measure of sustained attentional function. Functional magnetic resonance imaging scans were performed during the resting state (Rest) and auditory oddball task (Odd). Considering the critical role in attention processing, we focused our analyses on the default mode (DMN), frontoparietal (FPN), and salience (SN) networks. Region of interest (ROI)-to-ROI analyses (false discovery rate < 0.05) were performed to determine relationships between psychological measures with within-network FC (DMN, FPN, and SN) as well as with between-network FC (DMN-FPN, DMN-SN, and FPN-SN). ASRS scores, but not AQ scores, were correlated with less frequent commission errors and shorter reaction times in the CPT. During Odd, significant positive correlations with ASRS were demonstrated in multiple FCs within DMN, while significant positive correlations with AQ were demonstrated in multiple FCs within FPN. AQs were negatively correlated with FPN-SN FCs. During Rest, AQs were negatively and positively correlated with one FC within the SN and multiple FCs between the DMN and SN, respectively. These findings of the ROI-to-ROI analysis were only partially replicated in a split-half replication analysis, a replication analysis with open-access data sets, and a replication analysis with a structure-based atlas. The better CPT performance by individuals with subclinical ADHD traits suggests positive effects of these traits on sustained attention. Differential associations between LSBN FCs and ASD/ADHD traits corroborate the notion of differences in sustained and selective attention between clinical ADHD and ASD.

A review of fronto-striatal and fronto-cortical brain abnormalities in children and adults with Attention Deficit Hyperactivity Disorder (ADHD) and new evidence for dysfunction in adults with ADHD during motivation and attention

Background: High incidence of learning disorders has caught the psychologists’ attention in recent years. Objectives: The objective of this study was to compare divided, sustained and selective attention in children with attention deficit hyperactivity disorder, children with a specific learning disorder and normal children. Methods: The studywas a descriptive, causal-comparative and fundamental research. The population consisted of all childrenwith attention deficit hyperactivity disorder (ADHD) and children with specific learning psychology (SLD), aged 7 to 12 years old, who referredtocounselingandpsychiatric clinics inTehranin2016, aswell asnormalprimary school children. 36childrenwithattention deficit hyperactivity disorder and 47 children with specific learning difficulties were selected through convenience sampling, and 43 ordinary primary school children with cluster-randomly sampling method. Continuous performance test, word color Stroop test and theWechsler scaleswere used as the instruments of the study. Descriptive and inferential statistics alongwithmultivariate analysis of variance in Spss-21were used to analyze data. Results: The results of this study showed that weakness in divided, selective and sustained attention in children with attention deficit hyperactivity disorder and children with specific learning disorder ismore than normal children (P < 0.05). However, there was no significant difference between these variables in children with attention deficit hyperactivity disorder and children with specific learning disorder (P < 0.01). Conclusions: The results showed that the rate of comorbidity was very high in children with attention deficit - hyperactivity disor- der and children with specific learning disorder.

Background: Attention-Deficit Hyperactivity Disorder (ADHD) is a common disorder, affecting 4% to 5% of South African children. Recent studies reveal that 30% to 70% of children continue to experience problems related to ADHD in adulthood. Adults are becoming increasingly aware of adult ADHD as a result of public awareness campaigns in the media. Their first line of action is to visit their family physician (GP), but the question that arises is whether these practitioners are ready to take on patients with ADHD. The aims of this study were to determine the familiarity, attitudes and practices of general practitioners (GPs) in South Africa with regard to ADHD in both children and adults, and whether there are differences in children and adults with regard to depression and generalised anxiety disorders as comorbid disorders. The study also briefly explored the training models of GPs in South Africa. Methods: The research questions were addressed by means of a survey approach, using quantitative measures. An e-mail message with a covering letter, explaining the purpose of the research project, provided a link to a web-based questionnaire. It was relayed to 6 704 GPs on the database of the company MEDpages, which managed the distribution. A questionnaire attached to an e-mail message was sent to all departments of Family Health at universities in the country to obtain information with regard to the training models of GPs. The questionnaire was completed by 229 respondents. The data were statistically analysed using Statistica Version 7.0. Results: The most significant outcome of the study revealed a considerable need among GPs to increase their knowledge base with regard to ADHD (87% with regard to children and 89% with regard to adults). As they were of the opinion that they should be able to diagnose and manage ADHD in both children (90%) and adults (85%) a significant need for a screening tool (83%) was also found. The GPs’ knowledge and training with regard to depression and generalised anxiety disorders were significantly more extensive with regard to adults than to children. Training with regard to ADHD in adults was almost non-existent. With regard to children the most important barriers were uninformed parents (70%), limited funds (61%), uninformed teachers (58%), and with regard to adults these barriers were uninformed patients (64%), lack of knowledge on ADHD in adults on the part of the GPs (63%), and consultation time (58%). Although GPs did seem to have an awareness of the important role of the psychologist in the diagnosis and effective management of patients with ADHD, their referral practices generally involved a limited interdisciplinary approach. Conclusion: It is recommended that the limited knowledge base of GPs with regard to ADHD should be addressed by adapting the curriculum of undergraduate medical students and providing opportunities for continued medical education that focuses on the diagnosis and management of ADHD, in both children and adults. GPs should acknowledge the educational psychologist as an equal partner within a multidisciplinary team.

Objective To explore the characteristics of resting-state functional connectivity in male adults with attention deficit hyperactivity disorder (ADHD) and the relationship with clinical symptoms. Method Forty-seven male adult ADHD patients diagnosed by DSM-Ⅳ-TR and 47 healthy controls matched with sex, age and IQ were enrolled by clinical interviews. All subjects underwent structural MRI scan and resting-state functional MRI scan. All subjects were rated the ADHD symptom severity with the ADHD symptom rating scale. A two independent-samples t-test was used to analyze the differences of the resting-state functional connectivity strength (FCS) between the male adult ADHD group and the healthy control group. Results Compared with healthy controls, adult ADHD patients had shown the reduced FCS in the right middle temporal gyrus(t=-3.42), inferior temporal gyrus (t=-3.32), right middle occipital gyrus (t=-3.11) and inferior occipital gyrus (t=-4.44,P<0.05 after multiple correction). The FCS of right inferior occipital gyrus in ADHD group had a tendency to negatively correlated with the severity of symptoms (r=-0.403, P<0.05). A trend of negative correlation between the FCS in the right inferior occipital gyrus in ADHD group and the attention deficit score was found (r=-0.507, P<0.05). Conclusion Abnormalities in resting-state brain function connectivity are prominent in male adult ADHD patients. Occipitallobe dysfunction may be more related to the severity of the ADHD symptoms. Temporal lobe and occipital lobe seem to be crucial to the pathogenesis of adult male ADHD. Key words: Attention deficit disorder with hyperactivity; Magnetic resonance imaging; Adult; Functional connectivity

Distinct episodic memory impairments in subtypes of schizophrenia

Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) share impairments in top-down and bottom-up modulation of attention. However, it is not yet well understood if co-occurrence of ASD and ADHD reflects a distinct or additive profile of attention deficits. We aimed to characterise alpha oscillatory activity (stimulus-locked alpha desynchronisation and prestimulus alpha) as an index of integration of top-down and bottom-up attentional processes in ASD and ADHD. Children with ASD, ADHD, comorbid ASD+ADHD, and typically-developing children completed a fixed-choice reaction-time task ('Fast task') while neurophysiological activity was recorded. Outcome measures were derived from source-decomposed neurophysiological data. Main measures of interest were prestimulus alpha power and alpha desynchronisation (difference between poststimulus and prestimulus alpha). Poststimulus activity linked to attention allocation (P1, P3), attentional control (N2), and cognitive control (theta synchronisation, 100-600 ms) was also examined. ANOVA was used to test differences across diagnostics groups on these measures. Spearman's correlations were used to investigate the relationship between attentional control processes (alpha oscillations), central executive functions (theta synchronisation), early visual processing (P1), and behavioural performance. Children with ADHD (ADHD and ASD+ADHD) showed attenuated alpha desynchronisation, indicating poor integration of top-down and bottom-up attentional processes. Children with ADHD showed reduced N2 and P3 amplitudes, while children with ASD (ASD and ASD+ADHD) showed greater N2 amplitude, indicating atypical attentional control and attention allocation across ASD and ADHD. In the ASD group, prestimulus alpha and theta synchronisation were negatively correlated, and alpha desynchronisation and theta synchronisation were positively correlated, suggesting an atypical association between attentional control processes and executive functions. ASD and ADHD are associated with disorder-specific impairments, while children with ASD+ADHD overall presented an additive profile with attentional deficits of both disorders. Importantly, these findings may inform the improvement of transdiagnostic procedures and optimisation of personalised intervention approaches.