Behavioral Distraction Research Articles

Deviance Distraction and Stimulus-Specific Adaptation in the Somatosensory Cortex Reduce with Experience.

Automatic detection of a surprising change in the sensory input is a central element of exogenous attentional control. Stimulus-specific adaptation (SSA) is a potential neuronal mechanism detecting such changes and has been robustly described across sensory modalities and different instances of the ascending sensory pathways. However, little is known about the relationship of SSA to perception. To assess how deviating stimuli influence target signal detection, we used a behavioral cross-modal paradigm in mice and combined it with extracellular recordings from the primary somatosensory whisker cortex. In this paradigm, male mice performed a visual detection task while task-irrelevant whisker stimuli were either presented as repetitive "standard" or as rare deviant stimuli. We found a deviance distraction effect on the animals' performance: Faster reaction times but worsened target detection was observed in the presence of a deviant stimulus. Multiunit activity and local field potentials exhibited enhanced neuronal responses to deviant compared with standard whisker stimuli across all cortical layers, as a result of SSA. The deviant-triggered behavioral distraction correlated with these enhanced neuronal deviant responses only in the deeper cortical layers. However, the layer-specific effect of SSA on perception reduced with increasing task experience as a result of statistical distractor learning. These results demonstrate a layer-specific involvement of SSA on perception that is susceptible to modulation over time.SIGNIFICANCE STATEMENT Detecting sudden changes in our immediate environment is behaviorally relevant and important for efficient perceptual processing. However, the connection between the underpinnings of cortical deviance detection and perception remains unknown. Here, we investigate how the cortical representation of deviant whisker stimuli impacts visual target detection by recording local field potential and multiunit activity in the primary somatosensory cortex of mice engaged in a cross-modal visual detection task. We find that deviant whisker stimuli distract animals in their task performance, which correlates with enhanced neuronal responses for deviants in a layer-specific manner. Interestingly, this effect reduces with the increased experience of the animal as a result of distractor learning on statistical regularities.

On the relationship of arousal and attentional distraction by emotional novel sounds

Unexpected and task-irrelevant sounds can impair performance in a task. It has been shown that highly arousing emotional distractor sounds impaired performance less compared to moderately arousing neutral distractor sounds. The present study tests whether these differential emotion-related distraction effects are directly related to an enhancement of arousal evoked by processing of emotional distractor sounds.We disentangled costs of orienting of attention and benefits of increased arousal levels during the presentation of highly arousing emotional and moderately arousing neutral novel sounds that were embedded in a sequence of repeated standard sounds. We used sound-related pupil dilation responses as a marker of arousal and RTs as a marker of distraction in a visual categorization task in 57 healthy young adults. Multilevel analyses revealed increased RT and increased pupil dilation in response to novel vs. standard sounds. Emotional novel sounds reduced distraction effects on the behavioral level and increased pupil dilation responses compared to neutral novel sounds. Bayes Factors revealed strong evidence against an inverse proportional relationship between behavioral distraction effects and sound-related pupil dilation responses for emotional sounds. Given that the activity of the locus coeruleus has been linked to both changes in pupil diameter and arousal, it may embody an indirect relationship as a common antecedent by the release of norepinephrine into brain networks involved in attention control and control of the pupil. The present study provides new insights into the relation of changes in arousal and attentional distraction during the processing of emotional task-irrelevant novel sounds.

Driver’s emotion and behavior classification system based on Internet of Things and deep learning for Advanced Driver Assistance System (ADAS)

Classification of driver’s emotion is an important issue that can be used to increase awareness of driving habits of drivers as many drivers are overconfident and are unaware of their bad driving habits. If the drivers driving behaviors are identified automatically, the drivers can be aware of their bad habits which can assist them to avoid potential car accidents. Many researches have suggested many methods or techniques that can be helpful in determining driver’s behavior but there is no comprehensive method existed that can cater almost all types of distractions which occur while driving. In this paper the emotional as well as behavioral distraction states of the driver are analyzed and classified using advance deep learning algorithms like convolutional neural networks (CNN) and visual geometry group (VGG16). The handling of both the emotional and behavioral states can be helpful in developing a comprehensive driver’s detection system in an efficient manner addressing the previous limitations or challenges that are needed to be solved. The results show that the accuracy of CNN was far better than that of VGG16 but the training time of VGG16 was far less than that of CNN This system can be further integrated with the in-vehicle driving systems or built-in safety systems.

Strategies for Controlling Unwanted Intrusive Thoughts and Insomnia Severity in Urban-Residing Young Adult African Americans

ABSTRACT Introduction Poor sleep is common in our society, particularly for African Americans, and is associated with adverse mental and physical health outcomes. Unwanted, intrusive thoughts contribute to sleep disturbances and can be engendered by living in stressful urban environments, which are disproportionately inhabited by African Americans. Studies of other populations have shown that cognitive coping strategies to manage intrusive thoughts vary in their adaptiveness. Objective To examine the relationship between thought control strategies and insomnia severity in urban residing young-adult African Americans. Method Sixty-four young adult African Americans completed a demographic questionnaire, the Thought Control Questionnaire for Insomnia-revised, and the Insomnia Severity Index. Results There were moderate to strong positive correlations of aggressive suppression, worry, behavioral distraction, and social avoidance with ISI scores. Poor sleepers endorsed greater use of worry and aggressive suppression than good sleepers. Results from a multiple linear regression analysis revealed that aggressive suppression, social avoidance, and behavioral distraction significantly predicted insomnia severity, and aggressive suppression was the strongest predictor in the model. Conclusions These results extend findings of aggressive suppression as a correlate of insomnia severity to an urban-residing young adult African American sample. Future research should identify adaptive approaches and the utility of modifying maladaptive strategies.

Distraction of Children Undergoing Vaccination

Abstract Vaccination is a procedure considered painful for children; therefore, the healthcare team should provide conditions for adequate pain assessment and control. This study sought to evaluate whether behavioral distraction procedures contribute to reduce pain perception and anxiety indicators in children during vaccination. One hundred and four children between three and 12 years attending a Health Center in the Federal District participated in the study. Children were divided into four groups: baseline, groups with balloons, cards and tablets. Data were obtained by means of sociodemographic questionnaires, the Monica and Friends Pain Scale and the Observational Scale of Distress Behavior. The collected data were measured using the SPSS Statistics program. Results show that the intervention groups had lower averages, concerning pain levels, incidence of competing behaviors and duration of vaccine procedures, compared to baseline.

The Jordanian Version of the Thought Control Questionnaire Insomnia-Revised (TCQI-R).

Individuals suffer from insomnia through the presence of extraneous thoughts. Furthermore, there are cognitive and behavioral aspects, which afflict a person when they have insomnia. In this context, there are strategies to address these thoughts. The Thought Control Questionnaire: Insomnia-Revised (TCQI-R) is a self-reporting instrument that aims to evaluate the strategies used by individuals to control their thoughts when suffering from insomnia. This study aimed to translate and adapt the TCQI-R to the Jordanian society. In this study, the questionnaire was applied to a sample of 361 participants aged between 19 and 61 years, of which 210 were women (58%). The principal component analysis determined five components: reappraisal, cognitive distraction, aggressive suppression, worry, and behavioral distraction. Each of the total scores of the questionnaire (α = 0.90) and its five components (Cronbach’s α between 0.75 and 0.83) demonstrated high internal consistency. The results of the triple analysis of variance established that the instrument can distinguish between depressed and non-depressed people, anxious and non-anxious people, and people who suffer from insomnia and those who do not. Additionally, the results revealed significant statistical correlations between each of the total scores of the questionnaire and its five components as well as with the related scales. Finally, multiple regression analysis demonstrated the ability of the TCQI-R to predict depression, anxiety, and insomnia, and the prediction ratio for the overall score were 32.4%, 36.6%, and 42.6%, respectively. This indicates that worry and cognitive distraction were the most powerful strategies in dealing with insomnia. This instrument has the ability to assess and diagnose intrusive thoughts and adjust the strategies used to overcome insomnia.

375 Thought Control Strategies and Insomnia Severity in young-adult urban residing African Americans

Abstract Introduction Poor sleep is common in our society, particularly for African Americans. Unwanted, intrusive thoughts at bedtime contribute to sleep disturbances, and the nature of intrusive thoughts may be influenced by perception of threat among people living in stressful urban environments. Research has suggested that strategies to control intrusive thoughts vary in their adaptiveness and may be modifiable. These findings need to be confirmed in populations residing in stressful urban environments where perceived threats contribute to intrusive thoughts.The present study attempts to replicate prior research examining the relationship between thought control strategies and insomnia in urban residing young-adult African Americans. Methods Sixty-three young-adult African Americans completed the Thought Control Questionnaire for Insomnia-Revised and the Insomnia Severity Index (ISI). Results Thought control strategies previously associated with insomnia were significantly correlated with the ISI (aggressive suppression r=0.51, p<0.01 social avoidance r=0.32, p<.01, behavioral distraction r=0.386, p<0.01 and worry r=0.51, p<0.01). We did not find significant associations between the thought control strategy previously associated with healthy sleep and the ISI (cognitive distraction r= 0.20, p>0.05). In a grouped comparison between good sleepers and those with insomnia worry was the only subscale that was endorsed significantly greater among those with insomnia (t(61)=-2.91, p<.05) Conclusion These preliminary data replicate prior findings that suggest that aggressive suppression and worry are maladaptive thought control strategies. in a young-adult African American sample. Future research with a larger sample is needed to identify strategies that can improve sleep in this population. Support (if any) 5R01HL136626 from the National Heart Lung and Blood Institute

Distraction by auditory novelty during reading: Evidence for disruption in saccade planning, but not saccade execution.

Novel or unexpected sounds that deviate from an otherwise repetitive sequence of the same sound cause behavioural distraction. Recent work has suggested that distraction also occurs during reading as fixation durations increased when a deviant sound was presented at the fixation onset of words. The present study tested the hypothesis that this increase in fixation durations occurs due to saccadic inhibition. This was done by manipulating the temporal onset of sounds relative to the fixation onset of words in the text. If novel sounds cause saccadic inhibition, they should be more distracting when presented during the second half of fixations when saccade programming usually takes place. Participants read single sentences and heard a 120 ms sound when they fixated five target words in the sentence. On most occasions (p = .9), the same sine wave tone was presented (“standard”), while on the remaining occasions (p = .1) a new sound was presented (“novel”). Critically, sounds were played, on average, either during the first half of the fixation (0 ms delay) or during the second half of the fixation (120 ms delay). Consistent with the saccadic inhibition hypothesis (SIH), novel sounds led to longer fixation durations in the 120 ms compared to the 0 ms delay condition. However, novel sounds did not generally influence the execution of the subsequent saccade. These results suggest that unexpected sounds have a rapid influence on saccade planning, but not saccade execution.

European Portuguese Validation of the Thought Control Questionnaire Insomnia-Revised (TCQI-R)

Individuals with insomnia complaints often report intrusive thoughts. In this sense, strategies to cope with cognitive arousal are a key topic to be addressed. The TCQI-R is a self-reporting instrument aimed at evaluating the strategies used by individuals to control their thoughts during insomnia episodes. The aim of this study was to translate and adapt the thought control questionnaire insomnia-revised (TCQI-R) for the Portuguese population. In the current study, a community-dwelling sample of 802 participants was recruited, aged between 18 and 66 years, of whom 163 were men and 639 women (80%). The principal component analysis found five components: reappraisal, cognitive distraction, aggressive suppression, worry and behavioral distraction. Both the general questionnaire (α = 0.91) and the components showed good internal consistency (Cronbach’s α between 0.74 and 0.84). Through the analyses carried out, it was possible to conclude that the instrument has a good discriminatory capacity between individuals with and without "insomnia". It was also found that the use of worry and aggressive suppression strategies was associated with greater insomnia severity, anxiety, depression, and thought catastrophizing, whereas the use of cognitive distraction strategy was associated with lower severity of insomnia, anxiety, depression, and thought catastrophizing. The results of the current study are in line with the published literature on the TCQI-R. The TCQI-R seems to be a useful tool for the assessment of intrusive thoughts’ control strategies.

Age-related modulations of alpha and gamma brain activities underlying anticipation and distraction.

Attention operates through top-down (TD) and bottom-up (BU) mechanisms. Recently, it has been shown that slow (alpha) frequencies index facilitatory and suppressive mechanisms of TD attention and faster (gamma) frequencies signal BU attentional capture. Ageing is characterized by increased behavioral distractibility, resulting from either a reduced efficiency of TD attention or an enhanced triggering of BU attention. However, only few studies have investigated the impact of ageing upon the oscillatory activities involved in TD and BU attention. MEG data were collected from 14 elderly and 14 matched young healthy human participants while performing the Competitive Attention Task. Elderly participants displayed (1) exacerbated behavioral distractibility, (2) altered TD suppressive mechanisms, indexed by a reduced alpha synchronization in task-irrelevant regions, (3) less prominent alpha peak-frequency differences between cortical regions, (4) a similar BU system activation indexed by gamma activity, and (5) a reduced activation of lateral prefrontal inhibitory control regions. These results show that the ageing-related increased distractibility is of TD origin.

Is deviance distraction immune to the prior sequential learning of stimuli and responses?

Past studies show that novel, task-irrelevant auditory stimuli, presented in the context of an otherwise repeated standard sound, capture participants' attention away from a focal task, resulting in behavioral distraction. While evidence has shown that making novel sounds predictable reduces or eliminates distraction, it remains unknown whether predictable target stimuli can also shield participants from novelty distraction. Using a serial reaction time task, we installed the learning of a sequence of target stimuli before testing the impact of novel sounds on performance for this sequence compared with a new one. In the learning phase, participants pressed response buttons corresponding to visual cues appearing in one of four spatial locations arranged horizontally. Unbeknownst to participants, the sequence of locations followed a pattern during several blocks before being replaced by a new pattern. The data provided solid evidence of sequence learning for the repeated sequence. In the auditory distraction phase, auditory distractors were presented immediately before each visual target. Novel sounds lengthened response times compared to the standard sound (novelty distraction), equally for learned and new sequences. We conclude that the anticipation of target stimuli and responses does not shield participants from novelty distraction and that the latter is an obligatory attentional effect.

Emotional and Behavioural Distraction by a Social Robot for Children Anxiety Reduction During Vaccination

Social Assistive Robots are starting to be widely used for paediatric health-care. In this setting, the development of effective strategies to engage and remain compelling during the interaction is still an open research area since, in the case of an incoming medical procedure, children could be in an anxiety state. In this work, the proposed strategy relies on the use of a social robot interacting with the children and applying distraction strategies that are used in human–human interaction. Additionally, the robot displays emotional behaviours to attract the children attention. We present the results of a 2 months study (N = 139) conducted in a Health-Vaccines Centre, where the effects of the distraction provided by a social robot, showing such interactive behaviours interleaved with emotional ones, are compared with the same distracting strategies without any emotional social cues and with the case without the robot. Such emotional behaviours are selected with a positive or negative valence according to the initial anxiety state of the children (e.g., low or high). Outcome criteria for the evaluation of the intervention included the parents reported fear, anxiety and happiness at different stages of the interaction, self-report of the perceived pain, and an external behavioural evaluation of the pain. Results showed that the robot distraction strategies were able to reduce fear and anxiety, and increase happiness in every condition. Moreover, children perceived less pain with respect to the case of no robot. Finally, results showed that the initial children anxiety has an impact on the ability of the robot to be engaging.

Применение природных средств в комплексной профилактике и лечении респираторных инфекций у детей

In pediatric practice, much attention is paid to natural components used for the prevention and treatment of respiratory infections. Nasal drops Tamba Tuya (Adonis LLC, Russia) contain extracts of peloid from lake Tambukan, thuja, essential oils of fir, lavender, vitamin E, dexpanthenol, dihydroquercetin, glycerol, olive oil, and peach oil. These components are effective for the prevention and treatment of rhinitis, adenoiditis, bacterial complications, as well as for prevention of adverse reactions from decongestants. We have developed a method of its application that has not only local, but also systemic effects in children. Step 1: nasal rinsing with saline solutions; step 2: instilling Tamba Tuya drops (1–2 drops in each nostril) three times a day; step 3: infriction of the drops into the skin on the temples for 2–3 minutes as aromatherapy, which ensures penetration of the drug components through the skin into the blood with a systemic effect. Minimum course duration: 2 weeks. The use of the drops from the first days of respiratory infections in 30 children aged 4 to 7 years in the experimental group (30 children were in the control group) ensured milder (76.3% compared to 60% in the control group) and shorter disease (by 2 days). The majority of participants (83.3%) from the experimental group demonstrated rapid resolution of rhinitis symptoms and lower need for decongestants. A total of 86.6% of children in the experimental group and 53.3% of controls showed an improvement in emotional and behavioral responses, including activity, adaptability, intensity, mood, and distraction. Key words: children, prevention, treatment, respiratory infections

Sleep deprivation moderates neural processes associated with passive auditory capture

Sleep loss has a major effect on cognitive tasks that are dependent on the maintenance of active sustained attention. This study examines the effects of sleep deprivation on automatic information processing, more specifically, its effect on processes leading to involuntary auditory attention capture by task-irrelevant auditory events. Two experiments were run. In the first, 13 participants were totally sleep-deprived (TSD); in the second, 16 participants were partially sleep-deprived (PSD), sleeping only four hours. Event-related potentials were recorded while participants discriminated the duration of equiprobable short and long auditory tones. At rare times, a small change to the pitch of these stimuli occurred. This deviant was however irrelevant to the duration detection task. As expected, TSD had a significant effect on the attention-dependent duration detection task; performance was worse and the P3b, associated with ease of detection, was attenuated. PSD had a similar, but reduced effect. Critically, the small pitch deviant resulted in less behavioural distraction following TSD compared to normal sleep.Consistent with this, the P3a, associated with the attention capture process, was significantly reduced following both TSD and PSD. Processes related to the passive switching of attention to potentially critical, but unattended, stimulus events are moderated by sleep deprivation.

Development of a Pictorial Semi-Structured Child Anxiety and Coping Interview (CACI): Preliminary Analysis with School Children aged 5–7 years

This school-based study reports on the development and preliminary analysis of the new pictorial semi-structured Child Anxiety and Coping Interview (CACI). Participants included 195 children (Mage= 6.71;SDage= .76) drawn from 29 primary schools located in Western Sydney, Australia. The study used a mixed qualitative and quantitative design. The CACI was used to elicit the children's self-report on their problems, emotions, coping strategies, and coping self-efficacy. Qualitative content and thematic analysis were used to code the children's nominated coping strategies for their problems in the home and school contexts. The top five most common problems reported were as follows: fear of spiders or insects, fear of the dark, going places without parents, doing badly at school, and heights. The top five most common coping strategies reported by the children were support seeking, behavioural avoidance, solving the problem, facing the challenge, and behavioural distraction. Self-reported negative emotional intensity was highest for fear of the dark. Coping self-efficacy for fear of the dark was also high, suggesting the children found their coping strategies helpful, including those that were maladaptive. The clinical implications of these findings are discussed.

Fronto-central P3a to distracting sounds: An index of their arousing properties

The P3a observed after novel events is an event-related potential comprising an early fronto-central phase and a late fronto-parietal phase. It has classically been considered to reflect the attention processing of distracting stimuli. However, novel sounds can lead to behavioral facilitation as much as behavioral distraction. This illustrates the duality of the orienting response which includes both an attentional and an arousal component. Using a paradigm with visual or auditory targets to detect and irrelevant unexpected distracting sounds to ignore, we showed that the facilitation effect by distracting sounds is independent of the target modality and endures more than 1500 ms. These results confirm that the behavioral facilitation observed after distracting sounds is related to an increase in unspecific phasic arousal on top of the attentional capture. Moreover, the amplitude of the early phase of the P3a to distracting sounds positively correlated with subjective arousal ratings, contrary to other event-related potentials. We propose that the fronto-central early phase of the P3a would index the arousing properties of distracting sounds and would be linked to the arousal component of the orienting response. Finally, we discuss the relevance of the P3a as a marker of distraction.

Distraction by salient stimuli in adults with attention-deficit/hyperactivity disorder: Evidence for the role of task difficulty in bottom-up and top-down processing

The cognitive mechanisms of increased distractibility in attention-deficit/hyperactivity disorder (ADHD) are poorly understood. The current study investigated the influence of two major modulating factors (emotional saliency, task difficulty) on behavioral and electrophysiological parameters underlying distractibility in ADHD. In addition, the attentional focus (indirect and direct processing of distractors) was examined. Thirty-six adults with ADHD and 37 healthy controls completed two experimental tasks while electroencephalography (EEG) data was collected. Task 1 assessed indirect processing of emotional or neutral distractors during a perceptual judgment task with varying task difficulty. Task 2 measured direct processing of the emotional or neutral stimuli and required participants to rate the stimuli regarding valence and arousal. Results showed that adults with ADHD exhibited generally higher behavioral distractibility than healthy controls. Furthermore, the ADHD group exhibited an enhanced bottom-up processing [increased early posterior negativity (EPN) amplitudes] of distractors in trials with high task difficulty as well as enhanced top-down processing [increased late positive potential (LPP) amplitudes] in trials with low task difficulty. However, no group differences were evident in the neural processing of emotional content or between attentional focus conditions. These findings support the notion that distractibility in ADHD results from impairments to both top-down as well as bottom-up processes and underscore the importance of task difficulty as a modulating factor.

Validation of the Pain Coping Questionnaire in Finnish.

The Pain Coping Questionnaire (PCQ), the first validated pain coping measurement developed specifically for children, has lacked proper validation in Finnish. The original PCQ by Reid etal. (Pain 1998; 76; 83-96) comprises eight-first-order and three higher-order scales. The aim herein was to determine the factor structure and validity of the Finnish PCQ translation in Finnish children. Exploratory factor analysis was used for the first-order and higher-order classification of 91 recruited patients aged 8-15. Cronbach's alpha was used for reliability. Relationships between the Children's Depression Inventory, patient-reported pain frequency and pain coping strategies were examined. Analyses were executed with 38 items; one was excluded. A structure of eight-first-order (Internalizing/Catastrophizing [IC], Positive Self-Statements [PSS], Information Seeking [IS], Seeking Social Support [SSS], Cognitive Distraction [CD], Externalizing [EXT], Behavioural Distraction [BD], Problem Solving [PS]) and three higher-order scales (Approach [APP], Emotion-Focused Avoidance [EFA], Distraction [DIS]) proved the most consistent. Four first-order scales (PSS, CD, EXT, BD) emerged as identical to the original solution. Internal consistency reliability coefficients for all individual first- and second-order scales were satisfactory. A higher CDI score was positively related to EFA and negatively to DIS, and pain frequency positively related to APP and EFA. The exploratory factor analysis of the PCQ provided a both culturally and statistically satisfactory structure in the Finnish translation. This supports the reliability and validity of the PCQ in future national use and the value of the questionnaire also outside English-speaking countries. This study showed both culturally and statistically satisfactory factor structure of PCQ in the Finnish translation. This result supports reliability and validity of the PCQ in the national use in the future. The result shows that the PCQ is a reliable method to be used in different linguistic and cultural surroundings and, thus, encourages using it in various countries. The data consist of two patient groups, adolescents with JIA and musculoskeletal pain. Pain and specifically coping with pain are important aspects of clinical work. A valid pain coping scale may enhance distinguishing vulnerable pain coping style in children and adolescent before pain becomes chronic.

Smartphone-based behavioural intervention alleviates children's anxiety during anaesthesia induction: A randomised controlled trial.

Preoperative anxiety negatively influences children's anaesthetic and surgical experience, and results in postoperative complications, such as emergence delirium and behavioural changes. Nonpharmacological management using alternative therapies that alleviate psychological stress can be as important as pharmacological ones in reducing children's anxiety. Nevertheless, their validity as an effective anxiety-reducing strategy in children remains controversial. To verify whether nonpharmacological strategies, that is, leaflet and distraction with smartphone application presented to parents/guardians and children, respectively, were effective in preventing children's anxiety during anaesthesia induction. Randomised clinical trial. A tertiary care teaching hospital. In total, 84 children (aged 4 to 8 years; American Society of Anesthesiologists I and II) undergoing minor-to-moderate elective surgical procedures and their parents/guardians. Children were randomised into four groups: control group, in which the parent/guardian was verbally informed about the anaesthetic procedure; the informed group, in which the parent/guardian was also provided with an information leaflet about the anaesthetic procedure; the smartphone group, in which the parent/guardian was verbally informed and the child received a smartphone application to play with while in the holding area before entering the operating room and the smartphone and informed group, in which the parent/guardian also received an information leaflet and the child, a smartphone application to play with while in the holding area before entering the operating room. Children's anxiety at two time points: in the holding area of the surgical centre and in the operating room during induction of anaesthesia by facemask. Median (IQR) anxiety levels were greater at time point operating room for children in the control group (55.0; range: 30.0 to 68.4) than in the other groups: informed group, 28.4 (23.4 to 45.0); smartphone group, 23.4 (23.4 to 30.0); smartphone and informed group, 23.4 (23.4 to 25.9). The behavioural distraction strategies using smartphones were effective in preventing an increase in children's anxiety during anaesthesia induction. clinicaltrials.gov identifier: NCT02246062.

Attention Deficit Hyperactivity Disorder and Motor Impairment.

Attention deficit hyperactivity disorder (ADHD) is the most common neurobehavioral disorder during childhood, affecting approximately 3-6% of school-aged children; its cardinal symptoms of high activity, impulsivity, and behavioral distractibility might be assumed to have close relationships to interferences with motor skills. A separate body of literature attests to ways that motor problems can severely impact children's daily lives, as motor problems may occur in 30-50% of children with ADHD. This article critically reviews research on motor impairment in children with ADHD, notable differences in motor performance of individuals with ADHD compared with age-matched controls, and possible neural underpinnings of this impairment. We discuss the highly prevalent link between ADHD and developmental coordination disorder (DCD) and the lack of a clear research consensus about motor difficulties in ADHD. Despite increasing evidence and diagnostic classifications that define DCD by motor impairment, the role of ADHD symptoms in DCD has not been delineated. Similarly, while ADHD may predispose children to motor problems, it is unclear whether any such motor difficulties observed in this population are inherent to ADHD or are mediated by comorbid DCD. Future research should address the exact nature and long-term consequences of motor impairment in children with ADHD and elucidate effective treatment strategies for these disorders together and apart.