Test Of Variables Of Attention Research Articles

A 5-week Digital Intervention to Reduce Attention Problems in Children With ADHD: A Double-Blind Randomized Controlled Trial.

Growing evidence suggests digital interventions may provide neurocognitive benefits for children with ADHD. This study aimed to investigate the efficacy of a digital attention intervention in children with ADHD. In this double-blind randomized controlled trial 55 children with ADHD (5-9 years) were allocated to the intervention (N = 28) or control program (N = 27). Both programs were delivered via touchscreen tablets at home 5 days a week for 5 weeks. The primary outcome was change in the Test of Variables of Attention (TOVA) Attention Comparison Score (ACS) from pre- to post-intervention. Participants who received the intervention had significantly greater improvements in the TOVA ACS from pre- to post-intervention than those in the control (p < .044). No intervention effects were observed on secondary outcomes assessing executive functioning, ADHD symptoms, or functional impairment. Collectively these findings provide insufficient evidence for the implementation of digital attention interventions for children with ADHD.

Secondary analyses of sex differences in attention improvements across three clinical trials of a digital therapeutic in children, adolescents, and adults with ADHD

BackgroundAttention-deficit/hyperactivity disorder (ADHD) remains underdiagnosed and undertreated in girls. Inattentive symptoms, often predominant in girls with ADHD, represent a key driver of impairment and often persist into adulthood. AKL-T01 is a regulated digital therapeutic targeting inattention. We examined potential sex differences in the efficacy of AKL-T01 in three separate trials for 1) children, 2) adolescents, and 3) adults.MethodsWe conducted secondary analyses of clinical outcomes by sex in three AKL-T01 randomized clinical trials in ADHD (n1 = 180 children 30.6% female, M(SD) age = 9.71 (1.32); n2 = 146 adolescents; 41.1% female, M(SD) age = 14.34 (1.26); n3 = 153 adults; 69.9% female, M(SD) age = 39.86 (12.84)). Active treatment participants used AKL-T01 for 25 min/day over 4–6 weeks. Primary outcomes included change in attention on the Test of Variables of Attention (TOVA) and symptom change on the clinician-rated ADHD Rating Scale (ADHD-RS). To evaluate study hypotheses, we conducted a series of robust linear regressions of TOVA and ADHD-RS change scores by sex, adjusting for baseline scores.ResultsIn children, girls demonstrated greater improvement in objective attention relative to boys following AKL-T01 (TOVA Attentional Composite Score; Cohen’s d = .36 and Reaction Time Mean Half; Cohen’s d = .54), but no significant sex differences in ADHD rating scale change. We did not observe significant sex differences in outcomes in the adolescent or adult trials. Limitations include binary sex categorization and slight study design variation across the three samples.ConclusionAKL-T01 might notably improve attentional functioning in girls with ADHD relative to boys. Objective attention measures may be particularly important in the assessment of attentional improvement in childhood, given known gender biases in ADHD symptom reporting. We emphasize the importance of considering sex and gender-specific factors in ADHD treatment evaluation.Trial registrationsSTARS ADHD CHILD: ClinicalTrials.gov ID NCT03649074;STARS ADHD ADOLESCENT: ClinicalTrials.gov ID NCT04897074;STARS ADHD ADULT: ClinicalTrials.gov ID NCT05183919.

A novel jigsaw game with eye‐tracking: A multimodel interaction based on psycholinguistics for ADHD therapeutic

AbstractAttention‐deficit hyperactivity disorder (ADHD) causes impulsive or hyperactive behaviors and emotional outbursts or trouble focusing. Simple psychotherapy has difficulty achieving desired therapeutic effects, and ADHD diagnoses in adults and children are increasing. However, e‐health games may mitigate the limitations of traditional methods by providing an ecologically relevant experience. In this paper, inspired by psycholinguistics, multimodal interaction, and he Pupil‐CR method, we have developed a narrative game therapy with eye‐tracking to enhance dyslexia and attention deficit manifestations. Using the situated discourses in the game's interactive narration, ADHD patients can concentrate and reduce anxiety and impulsivity. To evaluate the efficacy in improving attention a controlled trial (N = 48) randomly assigned volunteers in 1:1:1 to an eye‐tracking jigsaw game or two control groups. The principal measure was the average difference in attention comparison score (ACS) of the test of variables of attention (TOVA) preintervention and post‐intervention periods. Based on significant differences observed between the groups, we concluded the eye‐tracking jigsaw game could serve as a viable ADHD intervention for children.

Impact of Emotions on Test of Variables of Attention(TOVA) Performance in a Pediatric Clinical Population: A Retrospective Study.

Continuous Performance Tests, like the Test of Variables of Attention (TOVA), are commonly used to assess attention processes in clinical settings. Although a few previous studies have explored the effects of emotions on the outcome of such tests, the results are scarce and contradictory at times. Through this retrospective study, we aimed to explore the correlation between performance on the TOVA and parent-reported emotional symptoms in youth. We used preexisting datasets of Mood and Feelings Questionnaire, Screen for Child Anxiety Related Disorders, and Vanderbilt Attention-Deficit/Hyperactivity Disorder Diagnostic Rating Scale as well as preexisting results from the TOVA test from 216 patients aged between 8 and 18years. Pearson's correlation coefficients, as well as linear regression models, were computed to examine the association between depressive and anxiety symptoms and the four indices of TOVA (response time variability, response time, commission errors, and omission errors). Additionally, we used generalized estimating equations to determine whether the reported emotional symptoms affect the TOVA outcome differently as the test progresses. Our results showed no significant effect of the reported emotional symptoms on the TOVA results even when controlling for sex or reported inattention and hyperactivity. TOVA results do not seem to be affected by emotional symptoms in youth. This being said, future studies should also explore other factors that can affect the performance on the TOVA, like motor disability, sleepiness, or neurodevelopmental disorders affecting cognitive abilities.

Effectiveness of a psychoeducational group intervention developed by primary care nurses on symptom control of pediatric patients with ADHD. ADHD parent study

ABSTRACT Attention Deficit Hyperactivity Disorder (ADHD) is a common childhood disorder with an estimated prevalence of 5%. The purpose of this study is to evaluate the effectiveness of a psychoeducational intervention performed by primary care nurses on parents of children with ADHD. We recruited participants composed of parents and children between 6 and 12 years with ADHD. We conducted a two-branch randomized control trial. The intervention programme consisted of nine group sessions (5-12 parents) with a duration of 10 months. The primary outcomes were the attention tasks measured with the Test of Variables of Attention (TOVA) and the ADHD symptomatology. Forty-eight children were included in the study. The average age of the parents was 42.6 years (standard deviation, SD: 6.3), and of the children 10.1 years (SD: 1.9), 81.3% were boys. TOVA and the symptoms after the intervention showed no statistically changes in both groups. The intervention group showed more knowledge of ADHD (17.3 vs 11.5, p = 0.008) and knowledge of drugs (6.1 vs. 4.5, p = 0.005) than the control group after the intervention. A psychoeducational intervention performed by primary care nurses on parents of children with ADHD did not show any modification in the attention tasks, and only changed the knowledge of ADHD of the parents that received the intervention.

The Relationship Between Bilingualism and Control Aspect of Intelligence: A Study of Persian-speaking Individuals.

The study of the relationship between bilingualism and the possible impact it might have on the control aspect of intelligence of adults in general and preschool children, in particular, has always been the subject of controversy for researchers. This research, following the related findings and gaps in the literature and inspired by Craik and Bialystok's (2005) framework, tries to divulge whether bilingualism could be related to the control aspect of intelligence. As our secondary goal, we also tried to see whether there are correlations between different tests assessing control. In this descriptive correlational study, via the convenience sampling method, we selected our participants. Methods: In doing so, 10 age-gender-matched Mazandarani-speaking monolinguals and the same matched bilinguals have been selected. Moreover, the literacy and socioeconomic status of subjects have been controlled. The tests for assessing subjects' executive control included day-night Stroop, the dimensional change card sort (DCCS), test of variables of attention (TOVA), and the computerized attention network test (ANT). Our participants' performance in language proficiency task as well as control tasks was demonstrated. Furthermore, via the conduction of the Pearson correlation statistics, the relationships between the participants' performance in diverse control tasks and language task were investigated. The results showed that bilinguals outperform monolinguals in all control tests except DCCS. Bilingualism could provide children with an executive control advantage promoting them in tasks demanding thought and action control. Language proficiency is not necessarily related to an advanced attentional control.Mazandarani-speaking monolinguals and bilinguals perform equally in the "knowledge" domain of intelligence.Bilinguals' performance in the control task of intelligence was better than their monolingual counterparts.It was corroborated that intelligence is not a homogeneous psychological construct.Generally, in tasks requiring suppression, bilinguals outperform monolinguals. The investigation of the relationship between control aspect of intelligence and the statue of monolingualism or bilingualism has always been the subject of controversy. "Control" aspect signifies the ability of an individual to suppress the provoking stimuli, that is, to ignore the external stimuli in favor of an intended linguistic or non-linguistic element. Our major objective in this research was to compare the performance of Mazandarani-speaking bilinguals and monolinguals in diverse control as well as vocabulary assessment tasks. Specifically, we wanted to see whether bilingual children could perform better than monolingual children in tasks requiring the inhibition capability. Furthermore, we attempted to investigate whether there were correlations between different control assessment tasks. Extending previous researches, we administered two additional cognitive tasks, namely, test of variables of attention (TOVA) and day and night task to evaluate our participants' control capability. In linguistic (vocabulary) proficiency assessment task, Peabody picture vocabulary task (PPVT), we did not find bilinguals' advantage over monolinguals. In contrast, bilinguals outperformed their monolingual counterparts in all other control tasks except dimensional change card sort (DCCS). Meanwhile, strong correlations between most control tasks were observed. The results corroborated that bilingual children outperformed their monolingual counterparts in tasks demanding strong thought and action control. Also, the conduction of most control tasks might be more challenging for monolinguals, and bilingual children, thanks to their linguistic statutes, could ignore irrelevant response or stimuli more easily, and perform better in the majority of cognitive control demanding tasks.

Associations between time-weighted postnatal methylmercury exposure from fish consumption and neurodevelopmental outcomes through 24 years of age in the Seychelles Child Development Study Main Cohort

PurposeMethylmercury (MeHg) is a known neurodevelopmental toxicant in sufficient dosage and is universally found in fish. Current fish advisories for children are based on epidemiology studies examining prenatal exposure with a premise that MeHg exposure resulting from children eating fish could also be neurotoxic and have long-term consequences. However, the evidence that this assumption is true is limited. We investigated postnatal MeHg exposure from regular fish consumption using time weighted Hg measurements to determine if there are neurotoxic consequences. MethodsWe examined 85 neurodevelopmental outcomes measured from ages 9–24 years in the Seychelles Child Development Study Main Cohort (n = 312–550) and examined their association with time-weighted measures of postnatal MeHg exposure in childhood and early adulthood. Postnatal MeHg exposure measured in the first cm of participants’ hair samples collected at seven evaluations were used to create two time-weighted (TW) average MeHg exposure metrics, one for childhood (TW-C) and the other for early adulthood (TW-A). TW-C was based on Hg measures at three ages between 6 months and 5.5 years, and TW-A was based on Hg measured at up to four ages between 17 and 24 years. We examined the association between each of these exposure metrics and the neurodevelopmental outcomes using linear regression with adjustment for covariates known to influence neurodevelopmental outcomes. ResultsThere were 14 statistically significant associations between a postnatal metric and an endpoint. Six were associated with the TW-C and eight with the TW-A. Thirteen were adverse. Only the TW-C association at 9 years with the Bender Gestalt error score showed improvement. TW-C was adversely associated at 9 years with the Continuous Performance Task risk score, at 22 years with the Boston Naming Test (BNT) total and no cues scores, and at 24 years with the Test of Variables of Attention (TOVA) auditory response time variability and visual response time mean on the logarithmic scale. TW-A was adversely associated at 17 years with the Wisconsin Card Sorting Test % total errors, the Woodcock-Johnson passage comprehension, and the CANTAB rapid visual information processing false alarms, and at 22 years with the BNT total and no cue scores, the CANTAB rapid visual information processing false alarms and the intra-extra dimensional shift total errors and trials. ConclusionThese findings suggest that postnatal MeHg exposure may be adversely associated with neurodevelopmental outcomes in early adulthood. However, the associations are statistical and of unknown, if any, clinical significance. The results need confirmation in other cohorts.

Digital Intervention for Cognitive Deficits in Major Depression: A Randomized Controlled Trial to Assess Efficacy and Safety in Adults.

The authors evaluated AKL-T03, an investigational digital intervention delivered through a video game-based interface, designed to target the fronto-parietal network to enhance functional domains for attentional control. AKL-T03 was tested in adult patients with major depressive disorder and a demonstrated cognitive impairment at baseline. Adults ages 25-55 years on a stable antidepressant medication regimen with residual mild to moderate depression and an objective impairment in cognition (as measured using the symbol coding test) were enrolled in a double-blind randomized controlled study. Participants were randomized either to AKL-T03 or to an expectation-matched digital control intervention. Participants were assessed at baseline and after completion of their 6-week at-home intervention. The primary outcome measure was improvement in sustained attention, as measured by the Test of Variables of Attention (TOVA). AKL-T03 (N=37) showed a statistically significant medium-effect-size improvement in sustained attention compared with the control intervention on the TOVA primary outcome (N=37) (partial eta-squared=0.11). Additionally, a composite score derived from all cognitive measures demonstrated significant improvement with AKL-T03 over the control intervention. Individual secondary and exploratory endpoints did not demonstrate statistically significant between-group differences. No serious adverse events were reported, and two patients (5.5%) in the AKL-T03 group reported an intervention-related adverse event (headache). Treatment with AKL-T03 resulted in significant improvement in sustained attention, as well as in cognitive functioning as a whole, compared with a control intervention. AKL-T03 is a safe digital intervention that is effective in the treatment of cognitive impairment associated with major depression. Further research will be needed to understand the clinical consequences of this treatment-induced change.

Early Childhood Vigilance Test (ECVT) of attention in younger HIV-exposed Ugandan children predicts Tests of Variables of Attention (TOVA) at school age.

Objective: Evaluate a computerized-based attention test in early infancy in predicting neurocognitive school-age performance in human immunodeficiency virus (HIV)-exposed uninfected children. Method: Thirty-eight Ugandan HIV-exposed/uninfected children (17 boys, 21 girls) were evaluated with the Early Childhood Vigilance Test (ECVT) of attention between 3 and 5 years of age, which is a 6-min 44 s animation with colorful animals that greet the child and move across the screen. Attention was proportion of total animation time viewing a computer screen, as well as the proportion of time tracking the moving animal using eye tracking. These children were then again tested at least 2 years later (between 5 and 9 years of age) with the Kaufman Assessment Battery for Children, 2nd Edition (KABC-II) and the visual computerized Tests of Variables of Attention (TOVA). Results: Irrespective of whether scored by webcam video scoring or using automated eye tracking to compute proportion of time viewing the animation, ECVT attention was significantly correlated with all TOVA outcomes for vigilance attention. This was still the case when the correlation was adjusted for type of caregiver training for the mother, child gender, socioeconomic status (SES), and quality of Home Observational Measurement Evaluation (HOME) environment-especially for the TOVA response time variability to signal (p = .03). None of the ECVT attention performance measures correlated significantly with any of the KABC-II cognitive ability outcomes. Conclusion: Attention assessment in early childhood is predictive of school-age computer-based measures of attention and can be used to gauge the effects of factors of early risk and resilience in brain/behavior development in African children affected by HIV. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Reduced Power in Fronto-Parietal Theta EEG Linked to Impaired Attention-Sampling in Adult ADHD.

Attention-deficit/hyperactivity disorder (ADHD) in adults is understudied, especially regarding neural mechanisms such as oscillatory control of attention sampling. We report an electroencephalography (EEG) study of such cortical mechanisms, in ADHD-diagnosed adults during administration of Test of Variables of Attention (TOVA), a gold-standard continuous performance test for ADHD that measures the ability to sustain attention and inhibit impulsivity. We recorded 53 adults (28 female, 25 male, aged 18–60), and 18 matched healthy controls, using 128-channel EEG. We analyzed sensor-space features established as neural correlates of attention: timing-sensitivity and phase-synchrony of response activations, and event-related (de)synchronization (ERS/D) of α and θ frequency band activity; in frontal and parietal scalp regions. TOVA test performance significantly distinguished ADHD adults from neurotypical controls, in commission errors, response time variability (RTV) and d′ (response sensitivity). The ADHD group showed significantly weaker target-locked and response-locked amplitudes, that were strongly right-lateralized at the N2 wave, and weaker phase synchrony (longer reset poststimulus). They also manifested significantly less parietal prestimulus 8-Hz θ ERS, less frontal and parietal poststimulus 4-Hz θ ERS, and more frontal and parietal prestimulus α ERS during correct trials. These differences may reflect excessive modulation of endogenous activity by strong entrainment to stimulus (α), combined with deficient modulation by neural entrainment to task (θ), which in TOVA involves monitoring stimulus spatial location (not predicted occurrence onset which is regular and task-irrelevant). Building on the hypotheses of θ coding for relational structure and rhythmic attention sampling, our results suggest that ADHD adults have impaired attention sampling in relational categorization tasks.

The Relationship Between Central Auditory Tests and Neurocognitive Domains in Adults Living With HIV.

Objective: Tests requiring central auditory processing, such as speech perception-in-noise, are simple, time efficient, and correlate with cognitive processing. These tests may be useful for tracking brain function. Doing this effectively requires information on which tests correlate with overall cognitive function and specific cognitive domains. This study evaluated the relationship between selected central auditory focused tests and cognitive domains in a cohort of normal hearing adults living with HIV and HIV– controls. The long-term aim is determining the relationships between auditory processing and neurocognitive domains and applying this to analyzing cognitive function in HIV and other neurocognitive disorders longitudinally.Method: Subjects were recruited from an ongoing study in Dar es Salaam, Tanzania. Central auditory measures included the Gap Detection Test (Gap), Hearing in Noise Test (HINT), and Triple Digit Test (TDT). Cognitive measures included variables from the Test of Variables of Attention (TOVA), Cogstate neurocognitive battery, and Kiswahili Montreal Cognitive Assessment (MoCA). The measures represented three cognitive domains: processing speed, learning, and working memory. Bootstrap resampling was used to calculate the mean and standard deviation of the proportion of variance explained by the individual central auditory tests for each cognitive measure. The association of cognitive measures with central auditory variables taking HIV status and age into account was determined using regression models.Results: Hearing in Noise Tests and TDT were significantly associated with Cogstate learning and working memory tests. Gap was not significantly associated with any cognitive measure with age in the model. TDT explained the largest mean proportion of variance and had the strongest relationship to the MoCA and Cogstate tasks. With age in the model, HIV status did not affect the relationship between central auditory tests and cognitive measures. Age was strongly associated with multiple cognitive tests.Conclusion: Central auditory tests were associated with measures of learning and working memory. Compared to the other central auditory tests, TDT was most strongly related to cognitive function. These findings expand on the association between auditory processing and cognitive domains seen in other studies and support evaluating these tests for tracking brain health in HIV and other neurocognitive disorders.

A-30 Measures of Attention and Inhibitory Control: Comparing the TOVA to the NIH Toolbox Flanker Test in Children and Adolescents with ADHD

Abstract Objective The Attention Comparison Score for the Test of Variables of Attention (TOVA) was developed as a “single score” method of differentiating individuals with Attention-Deficit/Hyperactivity Disorder (ADHD) from controls (Leark, Greenburg, Kindschi, Dupuy &amp; Hughes, 2008). Recent literature has documented that a more nuanced interpretation of TOVA scores, including the Attention Comparison Score, Commission Errors, and Omission Errors, can be more useful in describing the nature of impairment (e.g., sustained attention and/or inhibitory control) experienced by individuals diagnosed with ADHD (Winstone, Logid, Foley &amp; Nicholls, 2019). The NIH Toolbox Cognition battery also assesses attention and inhibitory control by means of a Flanker Test. The current study examines whether the TOVA Attention Comparison Score predicts performance on the NIH Toolbox Flanker Test, and if adding TOVA Commission Error and Omission Error variables would predict greater amounts of variance on the Flanker Test in a pediatric sample. Method A sample of 64 pediatric patients (62.7% male, 37.3% female) diagnosed with ADHD aged 4–17 years (M = 11.25; SD = 3.74) was administered the NIH Toolbox Cognition Battery and TOVA as part of a comprehensive neuropsychological evaluation in a private practice in Scottsdale, Arizona. Results Our data found support that the more nuanced approach of adding commission and omission information better predicted Flanker scores than the Attention Comparison Score alone. Conclusion Based on the findings, clinicians utilizing the TOVA as a means of assessing for ADHD in pediatric populations should consider omission and commission errors to better understand attention and inhibitory control abilities.

Mood and Proneness to Boredom Are Associated with Poorer Continuous Performance Test Results, Which May Improve with Methylphenidate Treatment, in Attention-Deficit/Hyperactivity Disorder

Objectives: This study aimed to evaluate the relationship between baseline test of variables of attention (TOVA) performance, attention-deficit/hyperactivity disorder (ADHD) symptom severity, mood symptoms, proneness to boredom in children with ADHD, and to assess the responses of the various scales to methylphenidate treatment. Methods: Thirty-three children and adolescents with ADHD, aged 7-18 years, were assessed at baseline with TOVA and treated for 3 months thereafter with methylphenidate. The ADHD Rating Scale (ADHD-RS), Short Boredom Proneness Scale (SBPS), Children's Depression Inventory (CDI) scale, and CDI-academic and social subscale (CDI-AS) were administered to all participants at baseline and after 3 months of methylphenidate (MPH) treatment. Results: The baseline TOVA reaction time (RT) and RT variability parameters correlated with baseline SBPS and CDI-AS scores as well as with baseline total CDI scores. Significant improvements were found in ADHD-RS, SBPS, and CDI-AS scores after MPH treatment. The alteration in ADHD-RS correlated with parallel changes in SBPS and CDI-AS scores. Conclusions: Mood and proneness to boredom correlate with poor attention-span in children with ADHD. Improvement in ADHD levels after MPH treatment correlates with a parallel decrease in mood symptoms related to academic achievement and social functioning.

What can we learn about performance validity from TOVA response profiles?

ABSTRACT Given the functional impairments associated with Attention Deficit/Hyperactivity Disorder (AD/HD), a valid diagnosis is important. However, particularly when carried out in adulthood, the diagnostic process can be challenging and is complicated by conclusive evidence that a proportion of individuals referred for evaluation of AD/HD exaggerate or feign their symptoms. Relatively few methods, however, exist to identify such feigning. While continuous performance tests (CPTs) may provide useful information regarding performance validity, the question remains as to whether there are consistent patterns of exaggeration demonstrated by those feigning AD/HD. Thus, this study used cluster analysis to determine whether valid and reliable performance clusters would emerge based on CPT performance. Using archival data from a university-based AD/HD screening clinic, we investigated the performance of 305 adults on the Test of Variables of Attention (TOVA). Three profiles emerged, including one cluster who demonstrated exceptionally low performance on the TOVA, exceptionally high reports of AD/HD symptomology, and higher rates of failure on symptom and performance validity tests. The implication from our analysis is that this group most likely represents individuals who were exaggerating or magnifying their difficulties. The results reaffirm previous research showing that performance profiles on a continuous performance test can be used as an indicator of credible performance.

Treating Comorbid Childhood Bipolar Disorder and ADHD

Pediatric mania is difficult to distinguish from childhood hyperactivity. Both share 3 common symptoms: distractibility, motoric hyperactivity, and talkativeness. Oftentimes, children are referred from their pediatrician due to a lack of appropriate response to stimulant medication. Pediatricians have learned that merely raising the dose or changing the stimulant does not work. A thorough neuropsychological evaluation often reveals bipolar mania. They may have comorbid bipolar disorder and ADHD. This poster paper will examine measures that can assist in this important differential diagnosis as well as offer treatment options, including medication management. This case study includes three pediatric patients diagnosed with childhood bipolar disorder and ADHD. A comprehensive psychoeducational assessment was conducted for each of the patients, which resulted in this comorbid diagnosis. One of the most helpful measures was the TOVA (i.e., Test of Variables of Attention). When a child's attention and impulsivity scores are normal, and response time and variability scores are abnormal, both on and off medication, that is an indication of a mood disorder, These children also performed poorly on measures of processing speed, and verbal learning and interference tasks. Measures of affect and personality were important diagnostically. A combination of amantadine and either clonidine HCL ER or propranolol, as prescribed by a medical psychologist, were found to be effective in controlling the symptoms of this comorbid diagnosis. An evaluation of children's intellectual, attentional, behavioral, mood, and personality functioning is crucial for a differential diagnosis. In cases of comorbidity, ADHD and childhood bipolar disorder, the sooner the child is on appropriate medications, the better. When just the surface diagnosis of ADHD is medicated, the outcome is often problematic. There may be a poor response to treatment and a higher rate of suicide.

Central Auditory Tests to Track Cognitive Function in People With HIV: Longitudinal Cohort Study.

BackgroundThe development of neurocognitive deficits in people infected with HIV is a significant public health problem. Previous cross-sectional studies have shown that performance on central auditory tests (CATs) correlates with cognitive test results in those with HIV, but no longitudinal data exist for confirmation. We have been performing longitudinal assessments of central auditory and cognitive function on a cohort of HIV-positive and HIV-negative individuals in Dar es Salaam, Tanzania to understand how the central auditory system could be used to study and track the progress of central nervous system dysfunction.ObjectiveThe goal of the project was to determine if CATs can track the trajectory of cognitive function over time in people diagnosed with HIV.MethodsTests of peripheral and central auditory function as well as cognitive performance were performed on 382 individuals over the course of 3.5 years. Visits were scheduled every 6 months. CATs included tests of auditory temporal processing (gap detection) and speech perception in noise (Hearing in Noise Test and Triple Digit Test). Cognitive tests included the Montreal Cognitive Assessment (MoCA), Test of Variables of Attention (TOVA), and subtests from the Cogstate battery. HIV-positive subjects were divided into groups based on their CAT results at their final visit (bottom 20%, top 20%, middle 60%). Primary analyses focused on the comparison between HIV-positive individuals that performed worse on CATs (bottom 20%) and the overall HIV-positive group (middle 60%). Data were analyzed using linear mixed-effect models with time as the main fixed effect.ResultsThe group with the worst (bottom 20%) CAT performance showed a difference in trajectory for the MoCA (P=.003), TOVA (P<.048), and Cogstate (P<.046) over the course of the study period compared to the overall HIV-positive group. A battery of three CATs showed a significant difference in cognitive trajectory over a relatively short study period of 3.5 years independent of age (bottom 20% vs HIV-positive group).ConclusionsThe results of this study support the ability for CATs to track cognitive function over time, suggesting that central auditory processing can provide a window into central nervous system performance. CATs can be simple to perform, and are relatively insensitive to education and socioeconomic status because they only require repeating sentences, numbers, or detecting gaps in noise. These tests could potentially provide a time-efficient, low-cost method to screen for and monitor cognitive decline in patients with HIV, making them a useful surveillance tool for this major public health problem.

Neurodevelopmental assessment at one year of age predicts neuropsychological performance at six years in a cohort of West African Children

ABSTRACT Rural children from Benin, west Africa were evaluated with the Mullen Scales of Early Learning (MSEL) at one year of age and then at six years with the Kaufman Assessment Battery for Children (KABC-II), the visual computerized Tests of Variables of Attention (TOVA), and the Bruininks-Oseretsky Test (BOT-2) of motor proficiency (N = 568). Although both the MSEL and KABC-II were available to the assessors in French, instructions to the mother/child were in local language of Fon. Mothers were evaluated with the Edinburgh Postpartum Depression Scale (EPDS), Caldwell HOME Scale, educational level and literacy, and a Socio-Economic Scale – also in their local language (Fon). After adjusting for maternal factors, MSEL cognitive composite was correlated with KABC-II with moderate effect sizes, but not with TOVA scores. Overall eta-squared effect for the multivariate models were moderately to strongly correlated (.07 to .37). Neurodevelopmental assessments in early childhood adapted cross-culturally are predictive of school-age neuropsychological cognitive ability.

Ready for a Learner’s Permit? Clinical Neuropsychological Off-road Tests and Driving Behaviors in a Simulator among Adolescents with ADHD and ASD

ABSTRACT A simulator driving test (SDT) and two neuropsychological tests, the Useful Field of View (UFOV) test and the Test of Variables of Attention (TOVA) were evaluated with regard to validity for fitness to drive on 51 young clients diagnosed with attention deficit hyperactivity disorder (ADHD), 33 of whom also had autism spectrum disorder (ASD), and 38 adolescents without a neurodevelopmental diagnosis. The results show generally much greater variability and significantly poorer performance in the SDT and the TOVA for clients with ADHD/ASD compared with the control group. The SDT results were strongly intratest correlated, but had no interest correlation with either the UFOV test or the TOVA. The greater variability among clients with ADHD/ASD suggests greater effort and susceptibility to motivational issues and decline in sustained attention over several tests. In conclusion, the SDT is sensitive and has good face validity, and the TOVA is sensitive to neuropsychological aspects of safe driving. The SDT and the TOVA thus complement each other, and discrepancy between test scores calls for special consideration.

Clinical features of asthenia in the context of adjustment disorders

To study asthenic symptoms in patients with adjustment disorders and to assess the efficacy of cytoflavin in their treatment. The study included 100 patients, aged 20 to 43 years, with a diagnosis of adjustment disorder. Clinical, neurophysiological and parametric methods were used. An asthenic state scale, the Multidimensional Fatigue Inventory (MFI-20), a digital rating scale (a 10-point variant) and the Headache Impact Test (HIT-6), the Psychological Stress Measure (PSM-25), the Cognitive Emotion Regulation Questionnaire, the Test of Variables of Attention (TOVA) were administered. Cytoflavin was used in a dose of 2 tab. 2 times a day for 25 days for the treatment of patients from the study group. In the study group, 48.0% of patients had a pronounced degree of asthenia, and 52% had a moderate one. The clinical improvement was achieved in 73.0%. In the subgroup with moderate asthenia, the improvement was recorded in 88.5% of cases, in the subgroup of patients with severe asthenia in 56.3% of patients. There was a significant decrease in the severity of indicators on the scales of general asthenia, decreased activity and mental asthenia; a significant decrease in the integral indicator of mental tension, a significant improvement in the indicator of attention, a decrease in the frequency and intensity of headache. The improvement in the functional state of the brain in the form of a decrease in the power of the alpha rhythm in the anterior cerebral cortex was shown. The results of the study allow us to conclude that the use of cytoflavin is effective in the treatment of adjustment disorders.

Relationship between intraindividual auditory and visual attention in children with ADHD

Background and aimMost previous attention-deficit/hyperactivity disorder (ADHD) studies have used only a single sensory modality (usually vision) to investigate attentional problems, although patients with ADHD might display deficits of auditory attention similar to their visual attention. This study explored intraindividual auditory and visual attention in children with and without ADHD to examine the relationship between these two dimensions of attention. MethodsAttentional performances of 140 children (70 children with ADHD and 70 typically developing peers) were measured through the Test of Variables of Attention (TOVA) in the present study. ResultsFor both groups, most attentional indices showed significant differences between the two modalities (d ranging from 0.32 to 0.72). The correlation coefficients of most of the attentional variables in children with ADHD were lower than their typically developing peers. All attentional indices of children with ADHD (ranging from 12.8%–55.7%) were much higher than those of their typically developing peers (ranging from 1.4%–8.6%). ConclusionThese results not only indicate that typically developing children display more consistent attentional performance, but also support the view that children with ADHD may show attention deficiency in one modality but not necessarily in the other.