Attentional Functions In Children Research Articles

Nitrogen dioxide exposure, attentional function, and working memory in children from 4 to 8 years: Periods of susceptibility from pregnancy to childhood

BackgroundAir pollution exposure during pregnancy and childhood has been linked to executive function impairment in children, however, very few studies have assessed these two exposure periods jointly to identify susceptible periods of exposure. We sought to identify potential periods of susceptibility of nitrogen dioxide (NO2) exposure from conception to childhood on attentional function and working memory in school-aged children. MethodsWithin the Spanish INMA Project, we estimated residential daily NO2 exposures during pregnancy and up to 6 years of childhood using land use regression models (n = 1,703). We assessed attentional function at 4–6 years and 6–8 years, using the Conners Kiddie Continuous Performance Test and the Attention Network Test, respectively, and working memory at 6–8 years, using the N-back task. We used distributed lag non-linear models to assess the periods of susceptibility of each outcome, adjusting for potential confounders and correcting for multiple testing. We also stratified all models by sex. ResultsHigher exposure to NO2 between 1.3 and 1.6 years of age was associated with higher hit reaction time standard error (HRT-SE) (0.14 ms (95 % CI 0.05; 0.22) per 10 μg/m3 increase in NO2) and between 1.5 and 2.2 years of age with more omission errors (1.02 (95 % CI 1.01; 1.03) of the attentional function test at 4–6 years. Higher exposure to NO2 between 0.3 and 2.2 years was associated with higher HRT-SE (10.61 ms (95 % CI 3.46; 17.75) at 6–8 years only in boys. We found no associations between exposure to NO2 and working memory at 6–8 years. ConclusionOur findings suggest that NO2 exposure during the first two years of life is associated with poorer attentional function in children from 4 to 8 years of age, especially in boys. These findings highlight the importance of exploring long-term effects of traffic-related air pollution exposure in older age groups.

Development of attentional networks during childhood and adolescence: A functional MRI study.

Attention ability is one of the most important cognitive functions. It develops mainly during school age. However, the neural basis for the typical development of attentional functions has not been fully investigated. To clarify the development of the aforementioned function and its neural basis, this study examined brain function in children and adolescents during the performance of an attention network test (ANT) using functional magnetic resonance imaging. One hundred and sixty‐three volunteers (8‐23 years, 80 female) participated in this study. Using a modified version of ANT, we assessed the efficiency of two attentional functions—orienting and executive attention—by measuring how reaction time is affected by spatial cue location and flanker congruency and examined the functional brain areas—attentional networks—associated with two attentional functions. Consistent with the findings of previous studies, the superior parietal lobule, visual association cortex, left precentral gyrus, and supplementary motor area were activated during the orienting attention, while the anterior cingulate cortex, visual association cortex, lateral prefrontal cortex, thalamus, and caudate were activated during the executive attention. Moreover, negative correlations with age were found for activations in the inferior frontal gyrus, dorsomedial prefrontal cortex, and caudate nucleus in the orienting attention, while no correlations with age related to executive attention were found. In conclusion, this study revealed common and distinct features in the neural basis of the attentional functions in children and adolescents compared with that of adults and their developmental changes with age.

The Use of Lower or Higher Than Recommended Doses of Folic Acid Supplements during Pregnancy Is Associated with Child Attentional Dysfunction at 4-5 Years of Age in the INMA Project.

We assessed the association between the use of lower- and higher-than-recommended doses of folic acid supplements (FAs) during pregnancy and attentional function in boys and girls at age of 4–5. We analyzed data from 1329 mother-child pairs from the mother-child cohort INfancia y Medio Ambiente Project (INMA) study. Information on FAs use during pregnancy was collected in personal interviews at weeks 12 and 30, and categorized in <400, 400–999 (recommended dose), and ≥1000 μg/day. Child attentional function was assessed by Conners’ Kiddie Continuous Performance Test. Multivariable regression analyses were used to estimate incidence rate ratios (IRR) and beta coefficients with 95% confidence intervals (CI). Compared to recommended FAs doses, the periconceptional use of <400 and ≥1000 μg/day was associated with higher risk of omission errors—IRR = 1.14 (95% CI: 1.01; 1.29) and IRR = 1.16 (95% CI: 1.02; 1.33), respectively. The use of FAs < 400 μg/day and ≥1000 μg/day was significantly associated with deficits of attentional function only in boys. FAs use < 400 μg/day was associated with higher omission errors with IRR = 1.22 and increased hit reaction time (HRT) β = 34.36, and FAs use ≥ 1000 μg/day was associated with increased HRT β = 33.18 and HRT standard error β = 3.31. The periconceptional use of FAs below or above the recommended doses is associated with deficits of attentional function in children at age of 4–5, particularly in boys.

Cognitive and Attentional Function in Children with Hypoplastic Left Heart Syndrome: A Pilot Study.

While survival for children with hypoplastic left heart syndrome (HLHS) has improved, compromised cardiac output and oxygen delivery persist, and children show cognitive deficits. Most research has assessed young children on broad cognitive indices; less is known about specific indices in older youth. In this pilot study, cognitive function and attention in youth ages 8 to 16years with HLHS (n = 20) was assessed with the Wechsler Intelligence Scale for Children - Fifth Edition (WISC-V) and NIH Toolbox Cognition Battery (NTCB); parents completed the Child Behavior Checklist. Children scored significantly lower than normative means on the WISC-V Full Scale IQ, Verbal Comprehension, Visual Spatial, Working Memory, and Processing Speed indices, and the NTCB Fluid Cognition Composite; effect sizes ranged from medium to large. Attention problems had a large significant effect. Child age corresponded to lower visual spatial scores. Findings highlight the importance of assessing multiple cognitive indices for targeted intervention and investigating age and disease factors as potential correlates in larger samples.

Deliberate Soccer Practice Modulates Attentional Functioning in Children.

The main purpose of this study was to explore the association between the regular practice of open-skill sports (i.e., soccer) and executive control, along with other attentional functions (i.e., alerting and orienting) during preadolescence. The study was conducted on 131 participants (70 non-athletes and 61 soccer players). To measure cognitive performance, participants performed the Attentional Network Test—Interactions (ANT-I) task. Compared to non-athletes, soccer players showed overall faster responses and better executive control (e.g., reduced interference from distractors). Overall, our results provide new empirical evidence supporting the positive association between regular sports practice and cognitive performance, and more specifically executive functions. However, is important to note that the relationship between regular sport practice and cognition is complex and multifactorial. Our findings can be partly explained by the “cardiovascular fitness hypothesis” and the “cognitive component skills approach,” suggesting that an externally paced sport environment with high physical fitness and perceptual–cognitive demands may be an appropriate setting to optimize the development of cognitive functioning during early adolescence.

Prenatal and postnatal exposure to NO2 and child attentional function at 4–5 years of age

BackgroundPrenatal and postnatal exposure to air pollution has been linked to cognitive impairment in children, but very few studies have assessed its association with attentional function. ObjectivesTo evaluate the association between prenatal and postnatal exposure to nitrogen dioxide (NO2) and attentional function in children at 4–5years of age. MethodsWe used data from four regions of the Spanish INMA—Environment and Childhood—Project, a population-based birth cohort. Using land-use regression models (LUR), we estimated prenatal and postnatal NO2 levels in all of these regions at the participants' residential addresses. We assessed attentional function using the Kiddie-Conners Continuous Performance Test (K-CPT). We combined the region-specific adjusted effect estimates using random-effects meta-analysis. ResultsWe included 1298 children with complete data. Prenatal exposure to NO2 was associated with an impaired standard error of the hit reaction time (HRT(SE)) (increase of 1.12ms [95% CI; 0.22 a 2.02] per 10μg/m3 increase in prenatal NO2) and increased omission errors (6% [95% CI; 1.01 to 1.11] per 10μg/m3 increase in prenatal NO2). Postnatal exposure to NO2 resulted in a similar but borderline significant increase of omission errors (5% [95% CI; =0.99 to 1.11] per 10μg/m3 increase in postnatal NO2). These associations did not vary markedly between regions, and were mainly observed in girls. Commission errors and lower detectability were associated with prenatal and postnatal exposure to NO2 only in some regions. ConclusionsThis study indicates that higher exposure to ambient NO2, mainly during pregnancy and to a lesser extent postnatally, is associated with impaired attentional function in children at 4–5years of age.

Attention and reading performance in children with ADHD, reading disorder and the combined condition

Attention Deficit Hyperactivity Disorder (ADHD) and Dyslexia co-occur more often than expected by chance. Both disorders can have severe negative impact on children’s development. The aim of the present study was to compare attention and reading performance in children with ADHD, dyslexia and the comorbid condition. Ninety-nine German children in 3rd and 4th grade with ADHD (n = 26), dyslexia (n = 22) and the comorbid condition (n = 24) compared to a healthy control group (n = 27) were assessed with a model oriented assessment battery for reading and attention. Additionally, comorbid problems were examined. Children with ADHD were characterized by difficulties in decoding and reading comprehension, while children with dyslexia showed impairments in their attentional performance. Psychometric data revealed that children with dyslexia showed both externalizing and internalizing symptoms, while children with the comorbid condition scored the highest on all psychopathological dimensions. The results suggest, that reading problems in children with ADHD might be an epiphenomenon of the task used dependent on time constraints inherent to the task. Impairments of attentional functions in children with dyslexia emphasize the importance of a sufficient diagnostic procedure for subclinical ADHD symptoms as possible comorbid disorder. Future studies should focus the impact of early treatment of attentional deficits on reading acquisition.

Assessing new dimensions of attentional functions in children prenatally exposed to environmental contaminants using an adapted Posner paradigm

Chronic exposure to methylmercury (MeHg), lead (Pb) and polychlorinated biphenyls (PCBs) has been associated with a range of attention deficits in children, but it is not known whether selective spatial attention is also altered. We modified the classic Posner paradigm, which assesses visuospatial attention, to also assess vigilance and impulsivity. This paradigm is based on the well-documented findings that a target will be detected more quickly if a visual cue indicates beforehand where it will appear, and more slowly if the cue indicates a false spatial location. In our task, visual distractors were introduced, in addition to the classic Posner trials, to assess impulsivity, and a central smiley face, whose eye-movement cued the location of the targets, to measure spatial attention. This task was administered to 27 school-age Inuit children (mean age=11.2years) from Nunavik (Arctic Quebec, Canada), in which pre- and postnatal exposures to environmental contaminants had been documented from birth. After controlling for the impact of confounding variables, multivariable regressions revealed that prenatal exposures to PCBs and Pb were significantly associated with greater inattention and impulsivity, respectively, while current exposure to Pb was significantly associated with longer reaction times. Although a significant correlation was observed between cord blood PCB concentration and decreased visuospatial performance, no significant association was found after adjustment for confounders. No effect was found for Hg exposures. These results suggest that our adapted Posner paradigm is sensitive in detecting a range of attention deficits in children exposed to environmental contaminants; implications for future studies are discussed.

A Componential Analysis of Visual Attention in Children With ADHD

Objective: Inattentive behaviour is a defining characteristic of ADHD. Researchers have wondered about the nature of the attentional deficit underlying these symptoms. The primary purpose of the current study was to examine this attentional deficit using a novel paradigm based upon the Theory of Visual Attention (TVA). Method: The TVA paradigm enabled a componential analysis of visual attention through the use of a mathematical model to estimate parameters relating to attentional selectivity and capacity. Children’s ability to sustain attention was also assessed using the Sustained Attention to Response Task. The sample included a comparison between 25 children with ADHD and 25 control children aged 9-13. Results: Children with ADHD had significantly impaired sustained attention and visual processing speed but intact attentional selectivity, perceptual threshold and visual short-term memory capacity. Conclusion:The results of this study lend support to the notion of differential impairment of attentional functions in children with ADHD.

Multiple Object Tracking in Autism Spectrum Disorders

Difficulties in visual attention are often implicated in autism spectrum disorders (ASD) but it remains unclear which aspects of attention are affected. Here, we used a multiple object tracking (MOT) task to quantitatively characterize dynamic attentional function in children with ASD aged 5-12. While the ASD group performed significantly worse overall, the group difference did not increase with increased object speed. This finding suggests that decreased MOT performance is not due to deficits in dynamic attention but instead to a diminished capacity to select and maintain attention on multiple targets. Further, MOT performance improved from 5 to 10years in both typical and ASD groups with similar developmental trajectories. These results argue against a specific deficit in dynamic attention in ASD.

Differential effects of methylphenidate and atomoxetine on attentional processes in children with ADHD: An event-related potential study using the Attention Network Test

Methylphenidate (MPH) and atomoxetine (ATX) are effective medications in the treatment of attention deficit/hyperactivity disorder (ADHD). The aim of this study was to investigate differential effects of MPH and ATX on attentional functions at the performance and the neuronal level in children with ADHD. Using the Attention Network Test (ANT), differential effects of both medications on the noradrenergic alerting network and the dopaminergic executive attention network were considered. Nineteen children with ADHD performed the ANT three times while event-related potentials (ERPs) were recorded. The baseline testing was conducted without medication. In two medication blocks of 8 weeks each, medication was individually titrated for each child (cross-over design, balanced order). At the end of the medication blocks the testing was repeated. While both medications comparably reduced ADHD symptomatology, MPH had some advantages over ATX with regard to performance measures on the ANT and the underlying neuronal mechanisms. Compared with ATX, MPH led to a larger reduction in reaction time variability, which was accompanied by an MPH-related increase in the contingent negative variation (CNV) compared to the baseline testing. Contrary to our expectations, specific alerting network effects were not observed with ATX. Due to the chosen study design, it remains unresolved to what extent e.g. shortened reaction times and smaller conflict scores that were observed with both medications reflect practice or medication effects. The differential pattern of MPH vs. ATX effects on attentional functions in children with ADHD may be explained by the dopaminergic effects of MPH within the cortico-striato-thalamo-cortical circuit.

Training of attention functions in children with attention deficit hyperactivity disorder

Pharmacological treatment of children with ADHD has been shown to be successful; however, medication may not normalize attention functions. The present study was based on a neuropsychological model of attention and assessed the effect of an attention training program on attentional functioning of children with ADHD. Thirty-two children with ADHD and 16 healthy children participated in the study. Children with ADHD were randomly assigned to one of the two conditions, i.e., an attention training program which trained aspects of vigilance, selective attention and divided attention, or a visual perception training which trained perceptual skills, such as perception of figure and ground, form constancy and position in space. The training programs were applied in individual sessions, twice a week, for a period of four consecutive weeks. Healthy children did not receive any training. Alertness, vigilance, selective attention, divided attention, and flexibility were examined prior to and following the interventions. Children with ADHD were assessed and trained while on ADHD medications. Data analysis revealed that the attention training used in the present study led to significant improvements of various aspects of attention, including vigilance, divided attention, and flexibility, while the visual perception training had no specific effects. The findings indicate that attention training programs have the potential to facilitate attentional functioning in children with ADHD treated with ADHD drugs.

Attentional functions in children and adolescents with ADHD, depressive disorders, and the comorbid condition

Attention-deficit hyperactivity disorder (ADHD) and depressive disorders (DDs) often co-occur in children and adolescents, but evidence on the respective influence of these disorders on attention parameters is inconsistent. This study examines the influence of DDs on ADHD in a model-oriented approach that includes selectivity and intensity attention parameters. Ten- to fifteen-year-olds with ADHD (n=63), DDs (n=61), ADHD+DDs (n=64), and healthy controls (n=64) completed a battery of tests including five neuropsychological tasks (i.e., alertness, sustained attention, divided attention, go/no-go, and attentional set-shifting). All clinical groups showed attentional problems, especially in more complex attentional tasks and in the intensity aspects of attention. We observed the most severe attentional impairments in children with ADHD that was independent from a comorbid DD. The clinical groups were significantly different from the healthy control group, especially in more complex attentional tasks and in the intensity aspects of attention. Some differences between ADHD, DDs and ADHD+DDs groups were detected on neuropsychological attentional performance, but the effects were not strong enough to differentiate the clinical groups from each other.

Impact of anxiety disorders on attentional functions in children with ADHD

Introduction The impact of internalizing comorbid disorders on cognitive functions in attention-deficit hyperactivity disorder (ADHD) is hardly understood. While inconsistent findings exist with respect to the modulating effect of anxiety on impulsivity in ADHD, only few neuropsychological studies focused on other attention parameters. This is the first study that examines the influence of anxiety disorders (ANX) on ADHD in a model-oriented approach including selectivity and intensity parameters of attention. Methods Children with ADHD, ADHD + ANX and healthy controls ( n = 34 for each group, all aged 8–15 years) participated in five neuropsychological tasks (alertness, sustained attention, divided attention, go/no-go and set-shifting). Group differences were evaluated using analysis of variance (ANOVA) for each dependent variable, with group as independent variable. Results Data indicated that children with ADHD performed worse than healthy controls with regard to almost all parameters of attention. While ANX had no mitigating effect on impulsivity in ADHD, performance in sustained attention and selective attention tasks of children with ADHD + ANX was better than that of children with ADHD only. Limitations Since the present data were derived from a large neuropsychological data base which focused primary on children with ADHD and different comorbidities no comparison to a “pure” ANX group was possible. Conclusions These findings might indicate that ADHD + ANX constitute a cognitively distinct subtype, with possible individual symptomatology, development and therapeutic needs. Further investigations are needed to clarify the specificity of these findings and to disentangle the impact of trait versus state anxiety on neuropsychological performance in children with ADHD.

Attentional and executive functioning following mild traumatic brain injury in children using the Test for Attentional Performance (TAP) battery

The interpretation of the data regarding cognitive outcome in children who have suffered from mild traumatic brain injury (MTBI) remains currently controversial. The aim of the present study is to explore attentional and executive functioning in 6–12-year-old children who experienced a MTBI. A total of 15 children with MTBI and 15 matched noninjured children participated in the study. Attentional tasks using the Test for Attentional Performance battery were administered one year after the injury. In comparison to the noninjury children, MTBI children performed less accurately on selective attentional and updating tasks. These preliminary findings support the view that MTBI can have an impact on specific attentional functioning in children one year postinjury.

Attentional functions in children and adolescents with attention-deficit/hyperactivity disorder with and without comorbid tic disorder

Although the coexistence of attention-deficit/hyperactivity disorder (ADHD) and tic disorder (TD) is common, the nature of association is yet not fully understood. Thus, the aim of the present study was to explore attentional dysfunction in children with pure ADHD compared to children with comorbid ADHD + TD. Three groups of 20 children each, aged 8-15 years with either ADHD, ADHD + chronic tic disorder or Tourette syndrome (ADHD + TD) and a healthy control group were compared in their performance on three computerized attention tasks. Tasks of sustained attention, selective attention and interference control were employed. In addition, parental ratings of ADHD symptom severity and behaviour problems were obtained. Both clinical groups were rated as equally inattentive, however, externalising symptoms were more severe in the ADHD group. Objective measures of attentional performance revealed differences between the groups: whereas the ADHD group was markedly impaired in sustaining attention and selective attention/inhibitory control, the ADHD + TD group only showed marginal deficits in selective attention/inhibitory control. Possible explanations for the superior performance of the comorbid group are discussed: In particular, the results may indicate that in some patients, the tic disorder produces behavioural symptoms of ADHD, but not the broad neurocognitive deficits that usually are associated with ADHD. Alternatively, compensatory neural mechanisms of TD patients may result in a better neuropsychological performance of comorbid patients relative to patients suffering from pure ADHD.

The Influence of Risperidone on Attentional Functions in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder and Co-Morbid Disruptive Behavior Disorder

This study aims to examine the influence of risperidone on various attentional functions, including intensity and selectivity aspects of attention plus inhibitory control in children with attention deficit/hyperactivity disorder (ADHD) with co-morbid Disruptive Behavior Disorders (DBD) and normal IQ. Children with ADHD and DBD, aged 8-15 years, were treated with risperidone (mean daily dose: 1.5 mg; n = 23) and examined with three attentional paradigms before and after a 4-week treatment period. Age- and IQ-matched normal controls (n = 23) were also tested without medication on the same two occasions. No influence of the medication could be detected for any neuropsychological variable, neither as a positive enhancement nor as adverse side effects. However, clinical symptoms of ADHD and DBD assessed on the IOWA Conners Scale significantly improved after the 4-week treatment period. Divergent behavioral and cognitive effects of risperidone on ADHD symptoms were observed, with a significant reduction in behavioral symptoms, whereas no positive treatment effects were found on laboratory tasks of impulsivity. Thus, the cognitive effects of risperidone seem to differ from the cognitive effects of stimulant treatments in children with ADHD + DBD. However, no negative impact of risperidone was observed on attentional functions either, i.e., there was no slowing of cognitive speed.

Attentional functioning in children with ADHD – predominantly hyperactive-impulsive type and children with ADHD – combined type

Although particular importance has been attributed to attention deficits in attention deficit hyperactivity disorder (ADHD), there is no consensus as to the exact nature of inattention in ADHD or which components of attention are affected. The present study was based on a neuropsychological model of attention and assessed various components of attention in 23 children with ADHD/predominantly hyperactive-impulsive type (ADHD-H), 32 children with ADHD/combined type (ADHD-C) and healthy children (N(1) = 23 and N(2) = 32). A computerized test battery consisting of reaction time tasks of low complexity was used for the assessment of attention (alertness task, vigilance task, divided attention task, visual scanning task, incompatibility task, test of crossmodal integration, flexibility task). In comparison to healthy participants, patient groups were impaired in measures of vigilance, divided attention, selective attention and flexibility but not in measures of alertness. Analysis of the test performance of patient groups revealed no differences between children with ADHD-H and children with ADHD-C. The results of the present study suggest that both children with ADHD-H and children with ADHD-C are seriously impaired in attentional functioning. Children with ADHD-H and children with ADHD-C produced comparable results in measures of attention.

Development of attentional networks: An fMRI study with children and adults

Data on the development of the attentional systems remain scarce. We used structural and event-related functional magnetic resonance imaging to investigate differences in the neural mechanisms associated with alerting, reorienting, and executive control of attention between children (ages 8 to 12 years) and adults, while controlling for effects of performance and brain morphology. Behaviorally, children exhibited a numerically smaller alerting effect and significantly larger invalidity (reorienting) and interference (executive control of attention) effects. Neurally, children showed significantly reduced brain activation in a priori defined regions-of-interest in right-sided frontal–midbrain regions during alerting, in the right-sided temporo-parietal junction during reorienting of attention, and in the dorsolateral prefrontal cortex during executive control of attention. In addition, children activated significantly more brain regions outside the a priori defined regions-of-interest, such as the superior frontal gyrus during reorienting and the superior temporal gyrus during executive control of attention. Functional group differences overlapped with structural group differences in gray matter volume in particular within the frontopolar areas. The data suggest that there is a transition from functional yet immature systems supporting attentional functions in children to the more definitive adult networks and that the differences observed may reflect both developmental changes in cognitive strategies and morphology.

Differential Effects of Methylphenidate on Attentional Functions in Children With Attention-Deficit/Hyperactivity Disorder

To examine the effects of methylphenidate on different attentional functions and behavior in children with attention-deficit/hyperactivity disorder (ADHD). A total of 60 ADHD children aged between 8 and 12 years completed a randomized, double-blind, placebo-controlled, within-subject crossover trial with two doses of methylphenidate (0.25 and 0.5 mg/kg body weight) and placebo. A comprehensive neuropsychological test battery was applied, including tests of alertness and sustained, focused, and divided attention as well as two executive tests, the stop-signal paradigm and a visual set-shifting task. A linear improvement was identified for both medication conditions in the alertness and focused and sustained attention task, but no significant improvement was found for divided attention. Quadratic trends were found for both executive tasks. Responders defined by behavior ratings did not differ from nonresponders. Results indicate that attentional functions are influenced differentially by methylphenidate: intensity-dimension functions are best influenced by higher doses, executive functions by moderate doses, and selectivity-dimension functions by variable doses. In addition, divergent results from behavior rating scales and from attentional paradigms emphasize that clinicians have to decide what constitutes an appropriate clinical response. A more comprehensive assessment of attention may help to find an individually optimal dose for the treatment of attentional dysfunctions.