Attention-deficit/hyperactivity Disorder Impairment Research Articles

The role of working memory and organizational skills in academic functioning for children with attention-deficit/hyperactivity disorder.

Children with attention-deficit/hyperactivity disorder (ADHD) exhibit difficulties with organizational skills such as task planning, managing materials, and organizing activities that have downstream consequences on academic functioning. At the same time, deficits in working memory have been linked with both the organizational skills difficulties and academic underachievement and underperformance observed in children with ADHD and have been hypothesized to account for the link between organizational and academic functioning. However, the extent to which working memory and organizational skills independently versus jointly contribute to ADHD-related academic difficulties remains unclear. The present study is the first to examine the unique and shared roles of working memory and organizational skills for explaining ADHD-related underachievement and underperformance in a clinically evaluated sample of 309 children with and without ADHD (Mage = 10.34, SD = 1.42; 123 girls; 69.6% White Not Hispanic or Latino). Bias-corrected, bootstrapped latent path analyses revealed that working memory and organizational skills together accounted for 100% of the academic achievement (d = -1.09) and 80.6% of the academic performance (d = -0.58) difficulties exhibited by children with ADHD. Working memory (d = -0.95 to -0.26), organizational skills (d = -0.30 to -0.11), and shared variance across working memory and organizational skills (d = -0.13 to -0.06) each independently predicted ADHD-related difficulties in both academic achievement and performance outcomes. These findings are consistent with models suggesting that working memory has downstream consequences for functional impairments in ADHD, as well as evidence that organizational skills and working memory are each important predictors of ADHD-related academic functioning. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Variable Attention Stimulus Trait (VAST) Spectrum Traits: A Brief Discussion on Attentional Control & Emotional Regulation in Attention Deficit-Hyperactivity Disorder (ADHD)

Attention Deficit-Hyperactivity Disorder (ADHD) was first identified in 1902 by a British pediatrician, Sir George Still, as an abnormal defect in children’s moral control that caused poor control of their behavior despite their average and/or above intellectual capacity. It was not until the late 20th century when the American Psychiatric Association formally recognized ADHD as a mental disorder, whose hallmarks are excessive amounts of inattention, hyperactivity, and impulsivity. Also known as the triad of impairments in ADHD, these symptoms are pervasive, impairing in multiple contexts, and otherwise age-inappropriate. Only recently, Hallowell and Ratey (2021) introduced the concept of Variable Attention Stimulus Trait (VAST) in their book ADHD 2.0 to describe the condition. They argued that VAST/ADHD is unrelated to intelligence and has nothing to do with the deficit of attention. VAST/ADHD describes about how each brain/mind is uniquely wired affecting the way one deals with stimulation and attention. In this paper, the authors have chosen to explore two of the traits on the VAST/ADHD spectrum - (i) attentional control/sustained attention, and (ii) emotional regulation/impulse control - to illustrate the condition of ADHD as a variability of attention rather than a deficit of attention.

STARS Adjunct Trial: Evidence for the Effectiveness of a Digital Therapeutic as Adjunct to Treatment With Medication in Pediatric ADHD

AbstractBackgroundTreatment of attention deficit hyperactivity disorder (ADHD) includes pharmacological and non-pharmacological interventions, both of which have demonstrated short-term efficacy. While efficacious, there are limitations to both modalities of treatment. Due partly to these limitations, there has been considerable interest in additional approaches to augmenting ADHD management. Digital therapeutics may offer improved access, minimal side effects, and low potential for abuse, while providing targeted treatment options for improving cognitive functions such as attention. AKL-T01 (EndeavorRx®) is the first and only FDA-cleared nonpharmacological prescription digital therapeutic delivered through a video game interface for the treatment of ADHD.ObjectiveThe objective is to summarize the data from a clinical trial in support of FDA clearance using AKL-T01 adjunctively in children currently taking stimulant medication for ADHD.MethodsThe STARS-Adjunct Trial was a multicenter, 12-week, open-label study of AKL-T01 in 206 children aged 8 to 14 years with a confirmed diagnosis of primarily inattentive or combined-type ADHD. The study included two cohorts: (1) subjects currently treated with ADHD medication (n=130) and (2) subjects not on any ADHD medication (n=76). Subjects had an ADHD Impairment Rating Scale (IRS) score ≥3 at baseline, and both cohorts used AKL-T01 for approximately 25 minutes per day, 5 days per week, over two 4-week treatment periods separated by a 4-week treatment pause.ResultsAKL-T01 significantly improved (lowered) ADHD-related impairment as measured with the IRS (clinician rated) after the first 4-week treatment in both cohorts (P< 0.001). Results show that effects persist during a 4-week treatment pause and further improve with a second 4-week treatment period. A majority of parents and children indicated a perceived improvement in ability to pay attention after the trial. Most common device-related adverse events were decreased frustration tolerance, headache, and irritability which ranged from mild to moderate. No serious adverse events were reported.ConclusionsThis study adds to and extends the clinical evidence base for AKL-T01, a video game-based treatment for improving attentional functioning in 8–12-year-old children with ADHD. Continued evaluation of the effects of AKL-T01 on other important aspects of functioning, like academic and social functioning, health utilization, and health outcomes, would continue to add to the evidence base that the effects observed in this and previous studies have substantial clinical and functional impact.FundingAkili Interactive

Different patterns of frontal and temporoparietal activities related to distinct inhibitory functions in adhd

IntroductionInhibition is a core component of executive functions but is not a unitary construct. Instead, different inhibitory processes have specific behavioral effects and neural bases. Three important inhibitory functions explored by the literature are 1) interference control (i.e., inhibition of distractive information); 2) inhibition of prepotent responses and 3) inhibition of ongoing responses. These functions were described in the self-regulation theory as the possible main impairment in attention-deficit hyperactivity disorder (ADHD) and since then they have shown an association with several psychiatric disorders.ObjectivesThe current study investigated the neural bases of interference control, inhibition of prepotent responses, and inhibition of ongoing responses as they were assessed by a Stroop-matching/stop-signal task developed by our group.MethodsThe Stroop-matching/stop-signal employs different conditions to create the demands for each inhibition which allows the assessment of these functions using a single protocol. Brain activations were acquired using fNRIS in a block-design method. The concentration of oxygenated hemoglobin (HbO). The first level analysis of HbO signals used a general linear model (GLM) to estimate individual brain activations. The second level analysis was performed using a linear mixed model to generate brain activations at the group level. Alpha level = 0.05 and the false discovery rate was applied when necessary. The sample was composed of 25 young adults (mean age = 21.8, SD = 4.39).Resultstask Interference control showed activation in the left and right temporoparietal junction (TPJ), the right dorsolateral prefrontal cortex (DPLFC), and inferior frontal gyrus (IFG); inhibition of prepotent responses showed increased activity in the right IFG and left DLPFC; the suppression of ongoing responses showed a deactivation of the IFG and DLPFC bilaterally.ConclusionsThese results indicate that the three inhibitory functions assessed present distinct brain patterns of function. The lateralization role was evident in DLPFC and IFG activities and recruitment of parietal areas seems to be limited to interference control in this protocol. Also, the stop-signal demand led to the deactivation of areas associated with the resolution of the primary Stroop-matching task. This study elucidates the role of brain mechanisms associated with specific inhibitory processes that are impaired in psychiatric disorders such as ADHD.Financial support: FAPESP [grant 2019/20757-5, 2019/21773-4, 2020/14800-2]; CAPES Proex [grant 0426/2021, 23038.006837/2021-73]; Mackpesquisa; CNPq [grant 307443/2019-1]Disclosure of InterestNone Declared

Pilot study to explore poor visual searching capabilities in children with ADHD: a tablet-based computerized test battery study

Aim: The frequent visual attention deficiency reported in children with attention-deficit/hyperactivity disorder (ADHD) could represent a relevant biomarker but robust estimates of such cognitive impairment in clinical populations remained challenging. To assess visual attention impairment in children ADHD using a new design tablet-based computerized test battery which allowed objective recording of visual search performances. Methods: Forty-nine children with ADHD and their IQ- and age-matched typically developmental (TD) children were enrolled in the study. Visual attention abilities were estimated by using the computerized modified barrage test developed by Metrisquare. We analyzed the time spent to achieve the whole battery and, the errors and omissions done by each child during each of the three sub-tasks. Results: We observed a significant association between the load of sustained attention requested to perform a sub-task and the numbers of errors and omissions made by the children whatever the group considered. During the most stringent sub-task in term of visual attention engagement, children with ADHD displayed more significant errors and omissions when compared to IQ- and age-matched controls. This effect was not mediated by the time spent to perform the task since we did not report any significant difference between groups. Conclusion: The different performance of the most stringent sub-task observed in children with ADHD could be due to their deficient neural activity in frontal areas responsible of visual endogenous attention needed for difficult visual searching tasks. This cognitive battery could be a useful instrument to estimate visual attention impairment in children with ADHD. HIGHLIGHTS We assessed if a new design tablet-based computerized test battery would allow objective recording of visual search performances. We observed that children with ADHD made significantly more errors and omissions with respect to age-, sex- matched controls during the most stringent sub-task in terms of visual attention engagement The tablet-based computerized test battery could be a promising tool to objectively estimate abnormal attention search impairment in ADHD.

Effects of Caffeine Consumption on Attention Deficit Hyperactivity Disorder (ADHD) Treatment: A Systematic Review of Animal Studies.

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity. ADHD impairments arise from irregularities primarily in dopamine (DA) and norepinephrine (NE) circuits within the prefrontal cortex. Due to ADHD medication’s controversial side effects and high rates of diagnosis, alternative/complementary pharmacological therapeutic approaches for ADHD are needed. Although the number of publications that study the potential effects of caffeine consumption on ADHD treatment have been accumulating over the last years, and caffeine has recently been used in ADHD research in the context of animal models, an updated evidence-based systematic review on the effects of caffeine on ADHD-like symptoms in animal studies is lacking. To provide insight and value at the preclinical level, a systematic review based on PRISMA guidelines was performed for all publications available up to 1 September 2021. Caffeine treatment increases attention and improves learning, memory, and olfactory discrimination without altering blood pressure and body weight. These results are supported at the neuronal/molecular level. Nonetheless, the role of caffeine in modulating ADHD-like symptoms of hyperactivity and impulsivity is contradictory, raising discrepancies that require further clarification. Our results strengthen the hypothesis that the cognitive effects of caffeine found in animal models could be translated to human ADHD, particularly during adolescence.

A Common CDH13 Variant Is Associated with Low Agreeableness and Neural Responses to Working Memory Tasks in ADHD.

The cell—cell signaling gene CDH13 is associated with a wide spectrum of neuropsychiatric disorders, including attention-deficit/hyperactivity disorder (ADHD), autism, and major depression. CDH13 regulates axonal outgrowth and synapse formation, substantiating its relevance for neurodevelopmental processes. Several studies support the influence of CDH13 on personality traits, behavior, and executive functions. However, evidence for functional effects of common gene variation in the CDH13 gene in humans is sparse. Therefore, we tested for association of a functional intronic CDH13 SNP rs2199430 with ADHD in a sample of 998 adult patients and 884 healthy controls. The Big Five personality traits were assessed by the NEO-PI-R questionnaire. Assuming that altered neural correlates of working memory and cognitive response inhibition show genotype-dependent alterations, task performance and electroencephalographic event-related potentials were measured by n-back and continuous performance (Go/NoGo) tasks. The rs2199430 genotype was not associated with adult ADHD on the categorical diagnosis level. However, rs2199430 was significantly associated with agreeableness, with minor G allele homozygotes scoring lower than A allele carriers. Whereas task performance was not affected by genotype, a significant heterosis effect limited to the ADHD group was identified for the n-back task. Heterozygotes (AG) exhibited significantly higher N200 amplitudes during both the 1-back and 2-back condition in the central electrode position Cz. Consequently, the common genetic variation of CDH13 is associated with personality traits and impacts neural processing during working memory tasks. Thus, CDH13 might contribute to symptomatic core dysfunctions of social and cognitive impairment in ADHD.

Deficits in Working Memory and Theory of Mind May Underlie Difficulties in Social Perception of Children with ADHD.

Children with attention deficit hyperactivity disorder (ADHD) are prone to peer rejection and disliking due to difficulties in social perception and interaction. To address social perception impairments in ADHD, we examined children with ADHD in a noisy biological motion (BM) direction discrimination paradigm in association with sociocognitive factors including emotion regulation, theory of mind (TOM), and working memory compared to healthy controls. Our results showed that children with ADHD were poorer in discriminating BM direction in noisy environments (F (1, 36) = 4.655, p=0.038). Moreover, a significant correlation was found between working memory and TOM with BM discrimination in an ADHD group (r = 0.442, p=0.01, and r = 0.403, p=0.05, respectively). Our findings could suggest that social perception in noisy scenarios may be affected by memory and social cognitive abilities of children with ADHD.

Functional near-infrared spectroscopy in developmental psychiatry: a review of attention deficit hyperactivity disorder.

Research has linked executive function (EF) deficits to many of the behavioral symptoms of attention deficit hyperactivity disorder (ADHD). Evidence of the involvement of EF impairment in ADHD is corroborated by accumulating neuroimaging studies, specifically functional magnetic resonance imaging (fMRI) studies. However, in recent years, functional near-infrared spectroscopy (fNIRS) has become increasingly popular in ADHD research due to its portability, high ecological validity, resistance to motion artifacts, and cost-effectiveness. While numerous studies throughout the past decade have used fNIRS to examine alterations in neural correlates of EF in ADHD, a qualitative review of the reliability of these findings compared with those reported using gold-standard fMRI measurements does not yet exist. The current review aims to fill this gap in the literature by comparing the results generated from a qualitative review of fNIRS studies (children and adolescents ages 6-16years old) to a meta-analysis of comparable fMRI studies and examining the extent to which the results of these studies align in the context of EF impairment in ADHD. The qualitative analysis of fNIRS studies of ADHD shows a consistent hypoactivity in the right prefrontal cortex in multiple EF tasks. The meta-analysis of fMRI data corroborates altered activity in this region and surrounding areas during EF tasks in ADHD compared with typically developing controls. These findings indicate that fNIRS is a promising functional brain imaging technology for examining alterations in cortical activity in ADHD. We also address the disadvantages of fNIRS, including limited spatial resolution compared with fMRI.

Functional impairments in ADHD in function of anxiety, depressive and somatic complains in Brazilian young adults

IntroductionComorbidities between Anxiety Disorders, Depressive Disorders or Somatic Symptoms, and Attention Deficit Hyperactivity Disorder (ADHD) can cause variability in the functional impairments faced by young adults. Knowing the possible configurations resulting from these comorbidities is important for a better understanding of the cases, diagnostic processes, and proposed treatments.ObjectivesTo verify associations between indicators of the aforementioned mental disorders, and symptoms of inattention or hyperactivity-impulsivity, and functional impairments in different areas of life, related to ADHD.MethodsThere were 27 participants (23 women, age m = 22.5 sd = 1.8, education m = 15.7 sd = 2.2), with complaints of inattention and hyperactivity-impulsivity compatible with ADHD, screened with ASRS-18 score> 24 and WASI IQ> 79, and assessed by DIVA-2.0 (symptoms of ADHD), ASR-ASEBA (depressive, anxiety and somatic problems), EPF-ADHD (functional impairments in the academic, professional, affective, domestic, social, health, financial, traffic areas and legal risk). Spearman’s Correlation analysis was performed in the SPSS program (significance p <0.05).ResultsIncrease in depressive problems associated with increased symptoms of inattention (rho=0.386, p=0.049) and hyperactivity-impulsivity (rho = 0.406, p = 0.036). Increased somatic problems associated with increased functional impairment in health (rho=0.458, p=0.016). Increase in depressive problems associated with increased losses in the academic (rho=0.437, p=0.023), affective (rho=0.408, p=0.034), domestic (rho=0.550, p=0.002), social (rho=0.445, p=0.002), financial (rho=0.389, p=0.045) and health (rho=0.514, p=0.006).ConclusionsADHD with comorbidities can have a peculiar clinical evolution with specific characteristics, including diagnosis, management, and response to treatment. These subgroups with different intervention needs demand outlining needs and personalized treatment.DisclosureNo significant relationships.

The role of stress coping strategies for life impairments in ADHD

Attention-deficit/hyperactivity disorder (ADHD) is commonly accompanied by functional impairments within personal, professional, and social context as well as further psychological distress. The role of perceived stress has been examined in this regard, although little is known about the influence of stress coping strategies. We examined the dynamics between ADHD symptomatology, stress coping strategies, and life impairments in a sample of 230 clinical and non-clinical adult individuals. ADHD was associated with low probability of choosing adaptive but high probability of implementing maladaptive stress coping strategies as well as with increased life impairments. Adaptive stress coping showed little effects beyond the associations between ADHD and life impairments, whereas some maladaptive coping strategies increased current life impairments over and above the effects of ADHD and further psychological distress. The present findings emphasize the need of professional support in adults with ADHD and the necessity to include stress coping strategies in respective treatment approaches aimed at reducing life impairments.

Validation of the German Version of the Mind Excessively Wandering Scale (MEWS-G).

Increasing evidence shows that unintentional mind wandering is linked to Attention Deficit Hyperactivity Disorder (ADHD) and that its frequency contributes to symptom severity and functional impairment in ADHD. However, empirical data on mind wandering in adult ADHD are still scarce, and a validated scale to assess mind wandering in German adult ADHD patients is lacking. The primary aim of this study is to assess the psychometric properties of the German version of the recently published Mind Excessively Wandering Scale (MEWS-G) in terms of factorial structure and factor stability, internal consistency and construct validity. Analyses were performed in 128 adults with ADHD, clinical and healthy controls. As described for the original English 15-item version of the scale, we found lowest item-total-correlations for items 6, 10 and 14 with item-total correlation of all: 0.54/ADHD: 0.32 (item 6), all: 0.55/ADHD: 0.39 (item 10) and all: 0.11/ADHD: -0.04 (item 14). Item-total correlations for the remaining items were 0.65-0.86 and Cronbach Alpha was 0.96 indicating good internal consistency of the 12-item version of scale, on which we based all further analyses. Principal component analysis indicated a one- and two- factorial scale structure respectively explaining 71.7 % and 78.7 % of variance. Both factors showed good stability with lower stability of the factor-2 solution if sample size was reduced. The two-factorial solution also had many cross-loadings and a strong correlation of both factors in confirmatory factorial analysis (rf1f2=0.87). It probably describes related and interdependent, but not distinct facets of mind wandering, which strongly argues for the one factorial structure of the scale. Mean MEWS-G score in ADHD was 23.77±7.85 compared to 7.64±7.27 in controls (p<.0001). According to ROC, the optimal cut-off point to discriminate ADHD and controls is at MEWS-G score=13. On the symptom level, MEWS-G score was correlated with ADHD, depressive and total psychiatric symptom scores, on the personality level with neuroticsm and negatively with conscientiousness and on the functional level with social interaction difficulties and impaired self-efficacy. In summary, our study shows that MEWS-G is a reliable, valid instrument to assess spontaneous mind wandering in adult ADHD and to discriminate between ADHD and controls.

A-041 Everyone is Worse than Average: Base Rates of ADHD Impairments Among College Students.

Abstract Objective Individuals presenting with concerns of Attention Deficit Hyperactivity Disorder (ADHD) report non-specific symptoms and may seek academic or disability accommodations. However, simply having a diagnosis is not equivalent to having a disability that justifies accommodations. The legal definition of disability is poorly understood by clinicians. Guidance for determining the need for accommodations promotes self-report as the primary source of information in decision making and suggests using “most people in the general population” as a reference point when making decisions. Unfortunately, this benchmark is not well defined, and the population base rates of functional impairments commonly reported in ADHD evaluations have not been established. The present study sought to evaluate the base rates of commonly self-reported impairments among non-treatment seeking college students. Method Undergraduate students (N = 282; 72.3% female; 90.1% Caucasian) completed an online inventory of 32 education-related functional impairments commonly reported during ADHD evaluations. Students indicated how frequently they experienced symptoms on a 6-point scale (Never to Very Often). Results College students reported education impairments at a startlingly high rate. Of the 32 impairments, 22 were endorsed as “often” or higher by over 25% of students, and 30 were endorsed as “sometimes” or higher by over 25% of students. Conclusions Results suggest that functional impairments reported in ADHD evaluations that may be used in accommodation decision making are very common among college students. Common impairments included difficulty focusing or concentrating, needing to study more than others, and difficulty sitting in class. Results shed light on the need for clearer guidelines for determining accommodations.

Event-related brain-oscillatory and ex-Gaussian markers of remission and persistence of ADHD.

Attention-deficit/hyperactivity disorder (ADHD) often persists into adolescence and adulthood, but the processes underlying persistence and remission remain poorly understood. We previously found that reaction time variability and event-related potentials of preparation-vigilance processes were impaired in ADHD persisters and represented markers of remission, as ADHD remitters were indistinguishable from controls but differed from persisters. Here, we aimed to further clarify the nature of the cognitive-neurophysiological impairments in ADHD and of markers of remission by examining the finer-grained ex-Gaussian reaction-time distribution and electroencephalographic (EEG) brain-oscillatory measures in ADHD persisters, remitters and controls. A total of 110 adolescents and young adults with childhood ADHD (87 persisters, 23 remitters) and 169 age-matched controls were compared on ex-Gaussian (mu, sigma, tau) indices and time-frequency EEG measures of power and phase consistency from a reaction-time task with slow-unrewarded baseline and fast-incentive conditions ('Fast task'). Compared to controls, ADHD persisters showed significantly greater mu, sigma, tau, and lower theta power and phase consistency across conditions. Relative to ADHD persisters, remitters showed significantly lower tau and theta power and phase consistency across conditions, as well as lower mu in the fast-incentive condition, with no difference in the baseline condition. Remitters did not significantly differ from controls on any measure. We found widespread impairments in ADHD persisters in reaction-time distribution and brain-oscillatory measures. Event-related theta power, theta phase consistency and tau across conditions, as well as mu in the more engaging fast-incentive condition, emerged as novel markers of ADHD remission, potentially representing compensatory mechanisms in individuals with remitted ADHD.

Effects of Aberrant miR-384-5p Expression on Learning and Memory in a Rat Model of Attention Deficit Hyperactivity Disorder.

Attention deficit hyperactivity disorder (ADHD) is a common neuropsychiatric disorder characterized by inattention, hyperactivity, and impulsivity. It may be accompanied by learning difficulties and working memory deficits. Few studies have examined the role of miRNAs in cognitive dysfunction in ADHD. This study investigated the effects of aberrant miR-384-5p expression on learning and memory in a widely used ADHD rat model. Lentiviral vectors were injected into the lateral ventricles of the rats to increase or decrease miR-384-5p level. To determine whether aberrant miR-384-5p expression affects learning and memory, spontaneous activity and cognitive function were assessed with the open field and Morris water maze tests. In the place navigation experiment of the Morris water maze test, time, and total swimming distance to reach the platform decreased compared to the control group when miR-384-5p was overexpressed, whereas down-regulation of miR-384-5p had the opposite effect. There were no obvious changes in brain tissue morphology following miR-384-5p overexpression or inhibition; however, dopamine (DA) receptor D1 (DRD1) level has decreased and increased, respectively, in the prefrontal cortex (PFC). The luciferase activity of the wild-type DRD1 group has decreased in luciferase reporter assay. Cyclic AMP response element-binding protein (CREB) phosphorylation has increased, and DA transporter (DAT) level has decreased in the PFC of spontaneously hypertensive rats (SHR) by miR-384-5p overexpression. On the other hand, miR-384-5p suppression increased DRD1 and decreased DAT and CREB protein levels relative to control rats. These findings suggest that miR-384-5p may play a critical role in learning and memory impairment in ADHD.

Associations of intellectual ability, inhibitory control, impulsiveness, cognitive flexibility and functional impairment in adults with ADHD Symptoms

Introduction: Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder with persistent levels of inattention, hyperactivity or impulsivity. Recommendations for ADHD diagnosis involve: six or more symptoms (or five considering adults), early childhood onset, presence of symptoms in two or more contexts and presence of functional impairment. Cognitive deficits, that affect inhibitory control, cognitive flexibility and impulsiveness, are present in ADHD and affect the course of the disorder. On the other hand, intellectual skill is a factor of protection to improve the development in people with ADHD. This article explores how traits relate to functional impairments are relevant to ADHD description in terms of behavioral expression of the cognitive profile. Method: Forty-nine adults, between 20 and 68 years old, with symptoms of inattention and hyperactivity/impulsivity compatible with ADHD, with more than 4 years of schooling and absence of chronic illness, took part of this study. We collected data using screening instruments (ASRS-18, MMSE, and WASI) and main instruments (FDT, BIS-11, and EPF-ADHD). Results: The results have shown that higher intellectual indexes were associated with lower frequencies of academic impairment, while higher impulsivity levels, cognitive flexibility difficulties and inhibitory control, were associated with academic and social impairment. Conclusion: The results show that cognitive deficits were associated to impairment, in different life areas, of people with ADHD, and that some factors, as intellectual abilities, may prevent impairment in ADHD.

Attention regulation in women with ADHD and women with bipolar disorder: An ex-Gaussian approach

Attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder (BD) show certain overlapping features, such as increased reaction time variability. Here, we tested whether more detailed ex-Gaussian reaction time distribution measures identify shared or disorder-specific impairments in ADHD and BD. The total assessed sample consisted of 60 women (20 each in ADHD, BD and control groups). We compared the groups on ex-Gaussian measures of mu, sigma, and tau from a flanker task (congruent and incongruent conditions), an oddball task, and a four-choice reaction time task (baseline and fast-incentive conditions of the `fast task'). The ex-Gaussian measures mu and sigma reflect the speed and variability of typical responses, while tau captures variability in infrequent slow responses. Compared to controls, both ADHD and BD groups showed significantly increased tau in the fast task baseline condition. Participants with BD further showed a significantly increased sigma compared to ADHD and control groups in the flanker task incongruent condition. Our findings indicate that the ex-Gaussian approach is informative in detecting shared and disorder-specific cognitive impairments in ADHD and BD that may represent objective markers of these two disorders.

Impairments of large-scale functional networks in attention-deficit/hyperactivity disorder: a meta-analysis of resting-state functional connectivity.

Altered resting-state functional connectivity (rsFC) has been noted in large-scale functional networks in attention-deficit/hyperactivity disorder (ADHD). However, identifying consistent abnormalities of functional networks is difficult due to varied methods and results across studies. To integrate rsFC alterations and search for coherent patterns of intrinsic functional network impairments in ADHD, this research conducts a coordinate-based meta-analysis of voxel-wise seed-based rsFC studies comparing rsFC between ADHD patients and healthy controls. A total of 25 datasets from 21 studies including 700 ADHD patients and 580 controls were analyzed. We extracted the coordinates of seeds and between-group effects. Each seed was then categorized into a seed-network by its location within priori 7-network parcellations. Then, pooled meta-analyses were conducted for the default mode network (DMN), frontoparietal network (FPN) and affective network (AN) separately, but not for the ventral attention network (VAN), dorsal attention network (DAN), somatosensory network (SSN) and visual network due to a lack of primary studies. The results showed that ADHD was characterized by hyperconnectivity between the FPN and regions of the DMN and AN as well as hypoconnectivity between the FPN and regions of the VAN and SSN. These findings not only support the triple-network model of pathophysiology associated with ADHD but also extend this model by highlighting the involvement of the SSN and AN in the mechanisms of network interactions that may account for motor hyperactivity and impulsive symptoms.

Cognition-Engaging Physical Exercise for Improving Cognitive Impairments in Attention-Deficit Hyperactivity Disorder

Cognitive impairment is a common deficit in psychological, neurological, and psychosomatic disorders. Recent studies suggest physical exercise as a new method for enhancing cognition, but not all types of physical exercises are beneficial to cognition. We propose cognition-engaging physical exercises (CEPEs) framework for purposefully and selectively enhancing cognition, which could have promising clinical implications in behavioral medicine. Here, we present results of the CEPE intervention in a patient with attention-deficit hyperactivity disorder (ADHD) in comparison with a control case who underwent treadmill exercise. Preliminary results show discernible increased accuracy and decreased response time in working memory and response inhibition task performance after CEPE but not treadmill exercise. We discuss the reason why CEPE could be more beneficial as compared to non-CEPE. Moreover, clinical implications of CEPE in behavioral medicine are discussed.

Autonomic arousal profiles in adolescents and young adults with ADHD as a function of recording context

A recent study (James et al. 2016) found that attention-deficit/hyperactivity disorder (ADHD) was associated with hypo-arousal, indexed by low electrodermal activity, during a low-demand reaction-time task, which normalized in a fast-incentive condition. We now investigate if (1) autonomic arousal in individuals with ADHD changes over a long testing session and (2) across time, to clarify if arousal profiles are context-dependent. We also examine (3) how autonomic arousal relates to each ADHD symptom domain, and specificity of arousal profiles to ADHD, by controlling for oppositional defiant/conduct disorder (ODD/CD) symptoms. Skin conductance level and non-specific fluctuations were measured during four successive resting-state and cognitive conditions (Resting-state time 1, Continuous Performance Task, Fast Task: Baseline and Fast-Incentive conditions, Resting-state time 2) from 71 adolescents/young adults with ADHD and 140 controls. Lower arousal was observed in individuals with ADHD only during a slow, low-demanding task, and more fluctuating arousal was observed towards the end of assessment. Both inattentive and hyperactive-impulsive symptoms were associated with arousal levels and fluctuations, independently from ODD/CD. Overall, we extend previous findings showing that under-arousal, but also fluctuating arousal, are context-specific rather than stable impairments in ADHD.