Reductions In Inattention Research Articles

Can ayahuasca reduce inattention, hyperactivity and impulsivity? A pilot study

Background The potential benefits of ayahuasca on mental health conditions are well documented. This pilot study is the first to explore whether there is an association with ayahuasca use and reductions in inattention, hyperactivity and impulsivity, the core features of attention-deficit/hyperactivity disorder. Methods In this exploratory, observational pilot study, the Adult Attention-Deficit/Hyperactivity Disorder Self-Report Scale was administered to 49 adults (23 males, 24 females, two participants did not report their sex) prior to and following the completion of ayahuasca retreats facilitated by the Ayahuasca Foundation in Iquitos, Peru. Only four participants self-reported having a diagnosis of attention-deficit/hyperactivity disorder. Participants attended either an 8-day (four to five ceremonies), 2-week (six ceremonies), 3-week (eight ceremonies) or 4-week (three to 11 ceremonies) retreat. Results Inattention, hyperactivity/impulsivity and total scores significantly reduced following an ayahuasca retreat, irrespective of the length of that retreat and the number of ceremonies participants attended. Conclusions This pilot study is the first to find reductions in self-reported inattention, hyperactivity and impulsivity in a sample of mostly non-attention-deficit/hyperactivity disorder adults following the use of ayahuasca. However controlled trials are required to determine causality. Research and clinical implications are considered.

Does attending preschool in an economically advantaged or disadvantaged neighborhood moderate the effects of the preschool edition of promoting alternative thinking strategies®?

Early interventions that foster the participation, engagement, and development of children attending preschools, including those in economically disadvantaged (low-income) neighborhoods, are of high priority. One such intervention is a universal socioemotional learning (SEL) program called Promoting Alternative Thinking Strategies (PATHS®) which aims to promote social emotional competence and positive adjustment in children, in general, and may have unique benefits for children attending preschool in low incomes areas. In the SEL field, areas in need of exploration include the possible role that neighborhood income level (i.e., all residents’ income in a postal code that a preschool is located in) could have for children’s social emotional competence and positive adjustment and how neighborhood income level may relate to benefits of an intervention such as PATHS. The study aims were to investigate 1) the baseline group differences in social emotional competence and adjustment depending on the neighborhood income level and 2) to determine if neighborhood income level moderated the effects of PATHS on children’s social emotional competence and adjustment from pre to posttest. Participants were 275 children aged four to five years old, from the preschools randomized into an immediate intervention (n = 145 children) or a wait-list control group (n = 130 children). Overall, 42.9% (n = 118) of the children attended preschools in economically disadvantaged neighborhoods and 57.1% (n = 157) of the children attended preschools in economically advantaged neighborhoods. Children’s social emotional competence and adjustment were assessed through child tasks, child observations and teacher reports. The moderation of intervention effects by the preschools’ neighborhood income was tested in a series of just-identified structural equation models (SEM) that explored interaction effects (income*PATHS interactions). At baseline, relative to children attending preschool in economically advantaged preschools, children attending preschool in economically disadvantaged neighborhoods showed lower levels of inhibitory control, working memory, task orientation and higher levels of inattention. Children attending preschools in economically disadvantaged neighborhoods participating in PATHS also showed reductions in inattention, social withdrawal and anxiety compared to control group children also attending preschool in disadvantaged neighborhoods. Additionally, PATHS children from advantaged neighborhoods improved their prosocial behavior, but not their social independence, relative to control group children who also attended preschool in advantaged neighborhoods. Offering PATHS as an SEL intervention in early childhood education and care settings could help to reduce disparities among children in a number of key outcomes.

Is it possible to promote executive functions in university students? Evidence of effectiveness of the πFEx-Academics

Executive functions (EF) impact the success of university students. These skills appear to have a predictive role in academic performance. The aim of this study was to investigate the effectiveness of an intervention program in EF aimed at university students, the πFex-Academics, seeking to verify whether there are gains in EF, a reduction in inattention and hyperactivity indicators and a transfer to reading comprehension. Participants were two professors and their respective classes, totaling 129 students. The classes were divided into: experimental group (EG) (n = 66) and control group (CG) (n = 63). All students underwent a pre- and post-intervention assessment. The program implementation process was mediated by the EG professor. Although no direct gains were identified in the indices of EF difficulties, greater gains in the EG were verified in the hyperactivity/impulsivity and reading comprehension indices, when compared to the CG. These findings are promising, demonstrating the first evidence of the effectiveness of the πFex-Academics. The incorporation of interventions into the university context can provide various benefits for students, with improved behavior and written language processing, necessary for the best possible academic success. Activities of EF mediation for higher education learning can be incorporated into extension courses or the curriculum of university courses.

The Effect of Viloxazine Extended-Release Capsules on Functional Impairments Associated with Attention-Deficit/Hyperactivity Disorder (ADHD) in Children and Adolescents in Four Phase 3 Placebo-Controlled Trials.

PurposeThe ADHD Rating Scale (ADHD-RS) assesses 18 symptoms of inattention and hyperactivity/impulsivity and has been used in many clinical trials to evaluate the treatment effect of drugs on ADHD. The fifth edition of this scale (ADHD-RS-5) also assesses the impact of inattention and hyperactivity/impulsivity symptoms on six domains of functional impairment (FI): family relationships, peer relationships, completing/returning homework, academic performance at school, controlling behavior at school, and self-esteem. Here, we report the effect of viloxazine extended-release capsules (viloxazine ER), a novel nonstimulant treatment for ADHD in children and adolescents (ages 6–17 years), on FI from a post hoc analysis of four randomized, double-blind, placebo-controlled Phase 3 clinical trials (N=1354).Patients and MethodsADHD-RS-5 investigator ratings of ADHD symptoms and FIs were conducted at baseline and weekly post-baseline for 6–8 weeks in the four trials. Change from baseline (CFB) in ADHD-RS-5 FI scores (Total score [sum of 12 FI items] and Inattention and Hyperactivity/Impulsivity subscale scores [sum of 6 corresponding FI items]) and the 30% and 50% Responder Rates (ADHD-RS-5 FI Total score) were compared between viloxazine ER and placebo.ResultsThe reduction (improvement) in ADHD-RS-5 FI scores (Total and subscale scores) and the percentage of responders (30% and 50%) at Week 6 were significantly greater in each viloxazine ER dose group vs placebo. In the 100–400 mg/day viloxazine ER groups, improvements were found as early as Week 1 (100-mg/day) or Week 2 (200-, 400-mg/day) of treatment. Analysis of individual items of ADHD-related FIs demonstrated that the effect of viloxazine ER was observed across all domains of impairment.ConclusionSignificant improvements observed in ADHD-related FIs are consistent with the reduction in inattention and hyperactivity/impulsivity symptoms demonstrated in the viloxazine ER Phase 3 pediatric trials. Therefore, viloxazine ER provides clinically meaningful improvement of ADHD symptoms and functioning in children and adolescents with ADHD, starting as early as Week 1–2 of treatment.

Examining Associations Between Physical Activity and Academic Performance in a Large Sample of Ontario Students: The Role of Inattention and Hyperactivity.

Participation in physical activity (PA) is a modifiable factor that contributes to academic success, yet the optimal dose (ie,frequency) and mechanisms underlying the effect require further exploration. Using data from 19,886 elementary and 11,238 secondary school students across Ontario, Canada, this study examined associations between PA participation frequency, academic achievement, and inattention and hyperactivity. Among elementary students, there was a positive association between PA frequency and academic achievement. Participating in 1 to 2 days per week of PA related to higher academic achievement compared with no days, whereas 7 days per week had the largest associations. For secondary students, a minimum of 3 to 4 days per week was associated with higher academic achievement with no significant benefit of additional days. Indirect effects of inattention and hyperactivity were found for both groups, suggesting that the benefits of PA on academic achievement may be partly explained by reductions in inattention and hyperactivity, especially for secondary school students. Students may experience academic benefits from PA even if they are not meeting the guidelines of exercising daily. These benefits may occur, in part, through reductions in inattention and hyperactivity. Further work is needed to determine the temporality and mechanism of these associations.

Cognitive Training Deep Dive: The Impact of Child, Training Behavior and Environmental Factors within a Controlled Trial of Cogmed for Fragile X Syndrome.

Children with fragile X syndrome (FXS) exhibit deficits in a variety of cognitive processes within the executive function domain. As working memory (WM) is known to support a wide range of cognitive, learning and adaptive functions, WM computer-based training programs have the potential to benefit people with FXS and other forms of intellectual and developmental disability (IDD). However, research on the effectiveness of WM training has been mixed. The current study is a follow-up “deep dive” into the data collected during a randomized controlled trial of Cogmed (Stockholm, Sweden) WM training in children with FXS. Analyses characterized the training data, identified training quality metrics, and identified subgroups of participants with similar training patterns. Child, parent, home environment and training quality metrics were explored in relation to the clinical outcomes during the WM training intervention. Baseline cognitive level and training behavior metrics were linked to gains in WM performance-based assessments and also to reductions in inattention and other behaviors related to executive functioning during the intervention. The results also support a recommendation that future cognitive intervention trials with individuals with IDD such as FXS include additional screening of participants to determine not only baseline feasibility, but also capacity for training progress over a short period prior to inclusion and randomization. This practice may also better identify individuals with IDD who are more likely to benefit from cognitive training in clinical and educational settings.

An Evaluation of Yoga and Meditation to Improve Attention, Hyperactivity, and Stress in High-School Students.

Objective: Problems with attention and stress are common in children and predict academic difficulties and other behavioral and emotional problems. Mind-body interventions such as yoga and meditation improve attention and reduce stress. In this study, we examined the impact of Hatha yoga on attention and stress in ninth graders. Design: A total of 174 ninth graders from a Texas high school were enrolled in the study. Teachers assigned students to a yoga group (YG) or control group (CG) based on their class schedule. The YG participated in 25-min Hatha yoga classes twice weekly over 12 weeks (n = 123). The CG included 51 students. Student self-reports on measures of inattention and hyperactivity (the strengths and weaknesses of ADHD [attention-deficit/hyperactivity disorder] symptoms and normal behavior rating scale for ADHD) and stress (perceived stress scale) were obtained at baseline and at 12 weeks. Results: There were no significant differences in baseline levels of inattention (p = 0.86), hyperactivity (p = 0.25), and perceived stress (p = 0.28) between the YG and CG. Regarding inattention scores, there was a significant interaction of group and time (b = -1.09, standard error [SE] = 0.30, p < 0.001). Pairwise t-tests showed a significant reduction in inattention for the YG (d = 0.27) but a significant increase in inattention for the CG. Regarding hyperactivity, there was no significant interaction of group and time (b = -0.43, SE = 0.26, p = 0.1). Pairwise t-tests demonstrated a significant reduction in hyperactivity for the YG (d = 0.22), but not the CG. The interaction of group and time was not significant in predicting the slope of change in perceived distress (b = -0.93, SE = 1.19, p = 0.43). Pairwise t-tests did not show a significant reduction in perceived distress for either group. Conclusion: These findings suggest that Hatha yoga may improve attention and hyperactivity in high school students.

Training teachers in classroom management to improve mental health in primary school children: the STARS cluster RCT

BackgroundPoor mental health in childhood is common, persistent and associated with a range of adverse outcomes that include persistent psychopathology, as well as risk-taking behaviour, criminality and educational failure, all of which may also compromise health. There is a growing policy focus on children’s mental health and the role of schools in particular in addressing this.ObjectivesTo evaluate whether or not the Incredible Years®(IY) Teacher Classroom Management (TCM) training improved children’s mental health, behaviour, educational attainment and enjoyment of school, improved teachers’ mental health and relationship with work, and was cost-effective in relation to potential improvements.DesignA two-arm, pragmatic, parallel-group, superiority, cluster randomised controlled trial.SettingA total of 80 UK schools (clusters) were recruited in three distinct cohorts between 2012 and 2014 and randomised to TCM (intervention) or teaching as usual [(TAU) control] with follow-ups at 9, 18 and 30 months. Schools and teachers were not masked to allocation.ParticipantsEighty schools (n = 2075 children) were randomised: 40 (n = 1037 children) to TCM and 40 (n = 1038 children) to TAU.InterventionsTCM was delivered to teachers in six whole-day sessions, spread over 6 months. The explicit goals of TCM are to enhance classroom management skills and improve teacher–student relationships.Main outcome measuresThe primary planned outcome was the teacher-reported Strengths and Difficulties Questionnaire Total Difficulties (SDQ-TD) score. Random-effects linear regression and marginal logistic regression models using generalized estimating equations were used to analyse outcomes.ResultsThe intervention reduced the SDQ-TD score at 9 months [adjusted mean difference (AMD) –1.0, 95% confidence interval (CI) –1.9 to –0.1;p = 0.03] but there was little evidence of effects at 18 months (AMD –0.1, 95% CI –1.5 to 1.2;p = 0.85) and 30 months (AMD –0.7, 95% CI –1.9 to 0.4;p = 0.23). Planned subgroup analyses suggested that TCM is more effective than TAU for children with poor mental health. Cost-effectiveness analysis using the SDQ-TD suggested that the probability of TCM being cost-effective compared with TAU was associated with some uncertainty (range of 40% to 80% depending on the willingness to pay for a unit improvement in SDQ-TD score). In terms of quality-adjusted life-years (QALYs), there was evidence to suggest that TCM was cost-effective compared with TAU at the National Institute for Health and Care Excellence thresholds of £20,000–30,000 per QALY at 9- and 18-month follow-up, but not at 30-month follow-up. There was evidence of reduced disruptive behaviour (p = 0.04) and reductions in inattention and overactivity (p = 0.02) at the 30-month follow-up. Despite no main effect on educational attainment, subgroup analysis indicated that the intervention’s effect differed between those who did and those who did not have poor mental health for both literacy (interactionp = 0.04) and numeracy (interactionp = 0.03). Independent blind observations and qualitative feedback from teachers suggested that teachers’ behaviour in the classroom changed as a result of attending TCM training.LimitationsTeachers were not masked to allocation and attrition was marked for parent-reported data.ConclusionsOur findings provide tentative evidence that TCM may be an effective universal child mental health intervention in the short term, particularly for primary school children who are identified as struggling, and it may be a cost-effective intervention in the short term.Future workFurther research should explore TCM as a whole-school approach by training all school staff and should evaluate the impact of TCM on academic progress in a more thorough and systematic manner.Trial registrationCurrent Controlled Trials ISRCTN84130388.FundingThis project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full inPublic Health Research; Vol. 7, No. 6. See the NIHR Journals Library website for further project information. Funding was also provided by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula (NIHR CLAHRC South West Peninsula).

Association of Behavior in Boys From Low Socioeconomic Neighborhoods With Employment Earnings in Adulthood

Identifying early childhood behavioral problems associated with economic success/failure is essential for the development of targeted interventions that enhance economic prosperity through improved educational attainment and social integration. To test the association between kindergarten teacher-rated assessments of inattention, hyperactivity, opposition, aggression, and prosociality in boys with their employment earnings at age 35 to 36 years as measured by government tax return data. A 30-year prospective follow-up study analyzing low socioeconomic neighborhoods in Montreal, Quebec, Canada. Boys aged 5 to 6 years attending kindergarten in low socioeconomic neighborhoods were recruited. Teacher-rated behavioral assessments were obtained for 1040 boys. Data were collected from April 1984 to December 2015. Analysis began January 2017. Mixed-effects linear regression models were used to examine the association between teacher ratings of inattention, hyperactivity, opposition, aggression, and prosociality at age 6 years and individual earnings obtained from government tax returns at age 35 to 36 years. The IQ of the child and family adversity were adjusted for in the analysis. Complete data were available for 920 study participants (mean age at follow-up was 36.3 years). Mean (SD) personal earnings at follow-up were $28 865.53 ($24 103.45) (range, $0-$142 267.84). A 1-unit increase in inattention (mean [SD], 2.66 [2.34]; range, 0-8) at age 6 years was associated with decrease in earnings at age 35 to 36 years of $1295.13 (95% CI, -$2051.65 to -$538.62), while a unit increase in prosociality (mean [SD], 8.0 [4.96]; range, 0-20) was associated with an increase in earnings of $406.15 (95% CI, $172.54-$639.77). Hyperactivity, opposition, and aggression were not significantly associated with earnings. Child IQ was associated with higher earnings and family adversity with lower earnings in all models. A 1-SD reduction in inattention at age 6 years was associated with a theoretical increase in annual earnings of $3040.41, a similar magnitude to an equivalent increase in IQ. Teacher ratings of inattention and prosociality in kindergarten boys from low socioeconomic neighborhoods are associated with earnings in adulthood after adjustment for hyperactivity, aggression, and opposition, which were not associated with earnings. Interventions beginning in kindergarten that target boys' inattention and enhance prosociality could positively impact workforce integration and earnings.

Parent and child neurocognitive functioning predict response to behavioral parent training for youth with ADHD.

Parental cognitive functioning is thought to play a key role in parenting behavior and may inform response to behavioral intervention. This open-label pilot study examined the extent to which parent and child cognition impacted response to behavioral parent training for children with ADHD. Fifty-four participants (27 parent-child dyads; Mages = 10.6 and 45.2 for children and parents, respectively) completed tasks assessing visuospatial and phonological working memory, inhibitory control, and choice-reaction speed at pre-treatment. Drift diffusion modeling decomposed choice-reaction time data into indicators of processing speed (drift rate) and response caution (boundary separation). Parents completed a 10-week manualized behavioral parent training program. Primary outcomes were pre- and post-treatment child ADHD and conduct problem severity, and parent-reported relational frustration and parenting confidence. Bayesian multiple regressions assessed parent and child cognitive processes as predictors of post-treatment outcomes, controlling for pre-treatment behavior. Better child visuospatial and phonological WM and higher parental response caution were associated with greater reductions in inattention. For conduct problems, better parental self-regulation (stronger inhibitory control and greater response caution) predicted fewer post-treatment conduct problems. Higher parental response caution also predicted lower post-treatment relational frustration and higher parental confidence. Bayesian evidence supported no relation between parent and child cognitive functions and treatment-related changes in hyperactivity. This pilot study demonstrates that cognitive processes central to etiologic theories of ADHD and models of parenting behavior can be successfully integrated into treatment outcome research to inform which families are most likely to benefit from behavioral interventions. This study demonstrates the feasibility of bridging the translational research gap between basic and applied clinical science and facilitates research on the role of cognition in psychosocial interventions.

Transcranial direct current stimulation improves clinical symptoms in adolescents with attention deficit hyperactivity disorder.

Anodal transcranial direct current stimulation (tDCS) of the prefrontal cortex has repeatedly been shown to improve working memory. As patients with attention deficit hyperactivity disorder (ADHD) are characterized by both underactivation of the prefrontal cortex and deficits in working memory that correlate with clinical symptoms, it is hypothesized that the modulation of prefrontal activity with tDCS in patients with ADHD increases performance in working memory and reduces symptoms of ADHD. To test this hypothesis, fifteen adolescents with ADHD (12-16years old, three girls and 12 boys) were treated according to the randomized, double-blinded, sham-controlled, crossover design with either 1mA anodal tDCS over the left dorsolateral prefrontal cortex or with the sham protocol 5days each with a 2weeks pause between these conditions. Anodal tDCS caused a significant reduction in clinical symptoms of inattention and impulsivity in adolescents with ADHD compared to sham stimulation. The clinical effects were supported by a significant reduction in inattention and hyperactivity in a standardized working memory test (QbTest). The described effects were more pronounced 7days after the end of stimulation, a fact which emphasizes the long-lasting clinical and neuropsychological changes after tDCS. This study provides the first evidence that tDCS may reduce symptoms of ADHD and improve neuropsychological functioning in adolescents and points on the potential of tDCS as a form of treatment for ADHD.

Final data of the effects of the Neuro Emotional Technique (NET) for pediatric Attention-Deficit/Hyperactivity Disorder (AD/HD): A randomized controlled trial

Introduction: The literature reveals that two treatments have been validated as effective treatment modalities for pediatric AD/HD: psychosocial treatments, pharmacological treatments and their combination. However, controversy exists over the efficacy and safety of pharmacological therapies. As a result of this controversy, parents have been seeking complementary and alternative medicine (CAM) such as chiropractic for their children with AD/HD. The objective of this study was to determine whether the addition of the emotional component of NET therapy to an existing treatment program could improve clinical outcomes (i.e. reduce inattention, hyperactivity and impulsivity) in pediatric AD/HD. The purpose of this study was to test anecdotal claims of treatment success made by chiropractors using NET therapy for pediatric AD/HD. Methods: An approved clinical trial was conducted in four private clinics in Sydney, Australia. Children aged 5–12 years who met inclusion criteria were randomised into three groups: Group A (Sham n = 37), Group B (NET therapy n = 59) and Group C (Control n = 32). All groups continued with their existing treatment regimens (i.e. pharmacological and/or psychosocial). Groups A and B had sham and NET protocols added respectively to existing regimens. Psychometric outcome measures were chosen from the Conners’ Rating Scales (CRS), which were scored and interpreted by independent registered clinical psychologists. The psychologists, participants, parents and teachers of groups A and B were all blinded to group allocation. An analysis of covariance was conducted comparing the changes between baseline and final results (i.e. after seven months and 14 interventions) between the active group (NET) and placebo group (sham). Results: Forty-one participants (10 sham; 21 NET; 10 Control) completed the protocol. CRS classified changes of five or more subscale points as significant and thus -5 was chosen as the minimally clinically important difference (MCID). Decreases in global and behavioral indices were indicative of improvements in participants’ behaviors and were considered clinically meaningful results. At the conclusion of the study, only NET therapy group achieved the MCID (>−5). The intention to treat analysis revealed that NET therapy produced significant results for all primary and secondary outcomes: Conners ADHD Index (p = 0.000, CI: −13.03, −3.96); Conners Global Index (p = 0.006, CI: −13.70, −2.46); DSM-IV:Inattentive (p = 0.031, CI: −9.94, −0.49); DSM-IV:Hyperactive/Impulsive (p = 0.003, CI: −13.91, −2.98) and DSM-IV:Total (p = 0.006, CI: −12.75, −2.23). The Cohen's d coefficient revealed medium to high effect sizes (1.08, 0.82, 0.64, 0.89 and 0.82, respectively). These significant results denote improvements in global and behavioral indices (i.e. reductions in inattention, hyperactivity and impulsivity) in participants who received NET therapy. Conclusions: These results provide the first data towards answering the question: Does NET have a potential role to play in the management of pediatric AD/HD? This study has demonstrated clinically meaningful changes and significant results for the emotional component of NET therapy for pediatric AD/HD. Definitive recommendations cannot be made about the intervention at this time until a protocol using the whole spectrum of NET is undertaken.