Journal of Attention Disorders最新文献

The moderate brain arousal (MBA) model posits that individuals with (elevated traits of) ADHD have lower levels of neural noise and that auditory random noise can elicit stochastic resonance (SR) and increase neural noise, which improves their cognitive performance. Indeed, research shows that auditory random noise, such as white noise, improves cognitive performance in individuals with (elevated traits of) ADHD. However, the assumptions regarding neural noise in ADHD and the requirement of SR have been insufficiently examined due to a lack of studies incorporating both a second non-random auditory condition and an index of neural noise. Therefore, 69 neurotypical adults completed the ASRS to assess ADHD traits and underwent eyes-closed resting-state EEG, subdivided into three 2-min blocks: silence, continuous auditory pink noise (a random signal), and a continuous 100 Hz pure tone (a non-random signal). We then analyzed the aperiodic slope of the EEG power spectral density, a proposed direct measure of neural noise. Pink noise affected the aperiodic slope differently based on ADHD traits; specifically, it increased the slope in individuals with elevated ADHD traits, indicating a decrease in neural noise. Crucially, the same effect was observed for the pure tone. These findings challenge the MBA model by demonstrating that both random (pink noise) and non-random (pure tone) signals reduce neural noise in individuals with elevated ADHD traits, contradicting the proposed mechanism of stochastic resonance, as well as the direction of effects suggested by the MBA model. These findings warrant further investigation, also in a clinical ADHD sample.

Objective: It is often argued that executive functioning (EF) tasks and EF questionnaires measure the same construct at different levels of analysis. However, item content on EF questionnaires varies by publisher/rater, indicating a striking lack of consensus on what EF represents when measured via questionnaires. In two separate samples spanning early and middle childhood, and utilizing a multi-method multi-rater approach, we systematically compare the concurrent validity of different questionnaire-based conceptualizations of EF.

Methods: Parents and teachers of children aged 8 to 12 years (N = 226) and 5 to 7 years (N = 152) completed indices marketed as EF on the Behavioral Rating Inventory of Executive Function (BRIEF); Conners' Rating Scale; and the Behavior Assessment System for Children (BASC). Their associations with performance on tasks of working memory (WM) and inhibition were compared against established indices of inattention, impulsivity, and academic underachievement on the same forms.

Results: Across samples, parent and teacher ratings of academic difficulty were most strongly associated with performance, particularly for WM. EF indices were no better (and were sometimes worse) at predicting concurrent EF than established indices of inattention/impulsivity.

Conclusions: Developers of EF scales must either improve the divergent validity of their scales against established indices of attention/impulsivity or improve the convergent validity with tests of EF. Otherwise, the clinical utility of questionnaire-based EF remains questionable. Implications for theory development and research are discussed.

Objective: Proneness to boredom has been reported in ADHD populations; however, no study to date has examined potential mediators of ADHD-related boredom. The current study investigated whether individuals with ADHD traits exhibit higher levels of boredom propensity relative to their peers without ADHD traits and explore if attention control and working memory mediate the relationship between ADHD and proneness to boredom.

Method: Young adults (M_age = 19.1, SD = 1.3) with (n = 31) and without (n = 57) ADHD traits completed self-report measures (i.e., boredom proneness, current ADHD symptoms, and childhood indicators of ADHD) and six counterbalanced performance-based cognitive measures (i.e., three attention control and three working memory tasks).

Results: Young adults with ADHD traits exhibited large magnitude effect size differences in proneness to boredom relative to their peers without ADHD traits (d = 2.09). In addition, proneness to boredom and ADHD trait group status were related to worse performance on attention control and working memory factors. Both attention control and working memory factors partially mediated the relation between ADHD and boredom, accounting for 5.8% and 6.4% of the variance in ADHD-related boredom, respectively.

Conclusion: Executive attention processes related to difficulty controlling attention and using working memory may provide a partial explanation for why individuals with ADHD traits experience boredom.

Objective: Experiences of "auditory hyper-reactivity" and decreased sound tolerance, which can be separated into phenotypes such as hyperacusis and misophonia, are prevalent in autism and ADHD and impact quality of life and wellbeing. Furthermore, atypical patterns of attention regulations-including hyper-focus and inattention-are common in both autism and ADHD. Prior research also suggests sensory hyper-reactivity can cause anxiety, and anxiety can be associated with hyper-vigilance. It is currently unclear whether hyper-focusing on stimuli, having one's attention captured by them, or being hyper-vigilant toward them could lead to sensory hyper-reactivity. Therefore, this study investigates relationships among hyper-focus, inattention, hyper-vigilance, auditory hyper-reactivity, and anxiety.

Method: Four hundred ninety-two adults (122 ADHD-only, 130 autistic-only, 141 autistic + ADHD, and 99 comparison) completed questionnaires indexing hyper-focus, inattention, and various forms of auditory hyper-reactivity; participants also completed a psychoacoustic measure by rating the pleasantness of misophonic trigger sounds.

Result: Per questionnaires, auditory hyper-reactivity was markedly elevated in both autistic and ADHD participants relative to comparison participants (.46 ≤ Cliff's δ ≤ .84), whereas differences between autism and ADHD alone were small (.05 ≤ |Cliff's δ| ≤ .21) and not consistent in sensitivity analyses. Path analysis suggested hyper-vigilance, hyper-focus, and inattention were related to auditory hyper-reactivity, which was related to anxiety, which was related to hyper-vigilance, potentially reflecting a cyclic relationship. However, psychoacoustic misophonia was only modestly related to self-reported misophonia scores (.22 ≤ Spearman's ρ ≤ .31), and contributed little to the auditory hyper-reactivity composite included in the path analysis.

Conclusion: These findings generally support the idea that attention may be connected to many neurodivergent people's auditory hyper-reactivity, but also emphasize the need for improved measurement of sensory experiences.

Purpose: Attention is proposed to consist of three discrete neurofunctional networks, though evidence suggests that two of these - the alerting and cognitive control networks - are interdependent. The neural mechanism(s) underlying this interdependence have not been identified; however, the locus coeruleus - norepinephrine (LC-NE) system may provide a potential explanation for this interaction. Further, both alerting-cognitive control interdependence and LC-NE activity may be altered in autistic individuals, and thus may provide a unique window into the relationship between the LC-NE system and network interdependence. The objective of the current study was to utilize electrophysiological and pupillary indices of LC-NE activity to examine the associations between attentional network interdependence, LC-NE activity, and autism and ADHD traits.

Methods: A total of 77 neurotypical undergraduate students completed two tasks: (1) a resting eye-tracking task to measure pupil diameter (tonic LC activity), and (2) a cued-flanker task to measure cue-related pupil diameter response (cue PDR; phasic LC activity) and attentional network interdependence using behavioral, electrophysiological, and pupillometric indices. Autistic and ADHD traits were measured by self-reported questionnaires.

Results: Consistent with prior reports, our behavioral and electrophysiological results support network interdependence. Phasic LC activity was positively related to alerting-cognitive control interdependence. Finally, the tonic and phasic LC-NE indices were linked to distinct ADHD subscales but not to autistic traits.

Conclusion: These findings expand our understanding of neurofunctional mechanism associated with alerting-cognitive control interdependence and demonstrate that LC-NE activation may be associated with ADHD rather than with autistic traits.

Objective: This study aimed to assess the impact of exercise on hyperactivity/impulsivity, inhibitory control, and inhibition-related event-related potential (ERP) components in individuals with ADHD.

Method: A systematic search identified relevant studies, and methodological quality was assessed using the Revised Cochrane Risk-of-Bias tool for randomized trials (RoB 2) and the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I), with data analysis conducted using Stata software.

Results: A total of 36 studies (38 comparisons) were included, comprising 10 acute and 26 chronic exercise interventions. Exercise yielded a small-to-moderate improvement in inhibitory control but showed no significant effects on hyperactivity/impulsivity or inhibition-related N2 and P3 components. Subgroup analyses of inhibitory control revealed significant moderating effects of age (children/adolescents), intervention type (chronic interventions), frequency (three sessions per week), control condition (sedentary or no-intervention groups), and study quality (studies with moderate or high risk of bias).

Conclusion: Exercise enhances inhibitory control in individuals with ADHD, with the effect being especially pronounced in children and adolescents. Chronic interventions and a frequency of three sessions per week appear to be most beneficial. However, it shows no significant effect on hyperactivity/impulsivity or inhibition-related N2 and P3 components. The impact of exercising should not be overestimated.

Objective: Blood-brain barrier permeability (BBB) has been suggested to be involved in the etiopathogenesis of ADHD. Claudin-5, β-catenin and paxillin are important molecules with different roles in this barrier. Alterations in these molecules may disrupt the neurodevelopmental process by affecting various critical processes in the developing brain. Therefore, this study aimed to evaluate whether the peripheral levels of these molecules differ in children and adolescents with ADHD.

Method: A total of 90 patients with ADHD aged between 8 and 18 years and 60 healthy controls were included in this study. The severity of ADHD symptoms was determined with the Atilla Turgay Scale. Child Anxiety-Depression Scale-Revised was completed to evaluate additional psychiatric problems of the patients. Serum levels of biochemical parameters were measured using enzyme-linked immunosorbent assay kits.

Results: Serum claudin-5 levels were significantly lower and β-catenin levels were significantly higher in the ADHD group compared to the control group. However, there was no significant difference in paxillin serum levels between the groups.

Conclusion: This study suggests that claudin-5 and beta-catenin may play a role in the pathogenesis of ADHD. These proteins may affect the brain by causing a dysregulation in BBB permeability or through other mechanisms.

Objective: Although inattention symptoms have been previously linked to cognitive performance in younger samples, few studies have examined links between ADHD symptoms and cognitive performance for middle aged and older adults.

Methods: In this study, we drew from a nationally representative sample from the Health and Retirement Study (HRS) of ~1,400 middle to older adults (M_age = 66.9, SD = 8.4; 41.4% male; 60.7% White) who completed a set of cognitive measures and an ADHD symptomatology questionnaire in the 2016 Wave of the HRS. A multigroup path model was run by examining the association between self-reported ADHD symptom subscale scores for inattention and hyperactivity/impulsivity as well as self-reported depressive symptoms and cognitive outcomes across three groups: middle age, young-old, and middle-old.

Results: Inattention symptoms were significantly associated with Serial 7s and Immediate Recall, however the constrained model was the best fitting model, suggesting no differences in the associations between self-reported inattention symptoms and cognitive outcomes by age.

Conclusion: These results are consistent with previous work on the links between ADHD symptoms and cognitive performance in younger populations and add to the literature on ADHD in later life. This may have implications for clinicians and practitioners as well as future research on older adults with ADHD.

Background: ADHD is associated with oxidative stress (OS), possibly stemming from deficiencies in essential nutrients. Previous randomized controlled trials (RCTs), including Micronutrients for ADHD in Youth (MADDY), demonstrated improved symptoms in response to treatment with multinutrients compared to placebo. It remains unknown whether multinutrient supplementation influences antioxidant status and OS, and if these factors contributed to improvements observed in children with ADHD in the MADDY RCT.

Objectives: Utilizing samples from the MADDY RCT, (1) compare the change in antioxidant (AO) and OS biomarkers after 8 weeks of multinutrient supplementation vs placebo, and (2) evaluate these biomarkers at baseline, and their change after 8 weeks, as moderators/mediators of treatment response.

Methods: Activity of glutathione peroxidase (GPx) and glutathione reductase (GR) enzymes, plus oxidative stress index (OSI) based on ratio of reactive oxygen metabolites (ROM) to biological antioxidant potential (BAP), were measured in plasma at baseline and week 8. Differences between groups were determined using two-sample t-test or Mann-Whitney U-test. Logistic regression models assessed AO/OS biomarkers for mediation/moderation of treatment response.

Results: Plasma from 77 children (aged 9.9 ± 1.7 years; 71% male) treated with multinutrients (n = 45) or placebo (n = 32) was analyzed. After 8 weeks, ROM decreased with multinutrients and increased with placebo (-14.3 vs. +26.8 Carratelli units, p = .017); but no significant differences in OSI, BAP, GPx, and GR between groups. None of the baseline AO/OS biomarker levels were moderators of treatment response. Eight-week change in both OSI and ROM trended toward mediation of treatment response (OR = 0.00058, 95% CI [0.000, 2.30], p = .078 and OR = 0.985, 95% CI [0.968, 1.002], p = 0.086, respectively) but did not reach significance.

Conclusions: Eight weeks of multinutrient supplementation in children with ADHD reduced ROM without significant change in antioxidant status, suggesting decrease in oxidative stress. Given the preliminary signals associating a decrease in OS with symptom improvement following multinutrient supplementation, future research is warranted to understand OS in ADHD pathogenesis.

Clinical trial registry: NCT03252522.

Background: ADHD is one of the most common mental disorders in children and adolescents. While international research on health service utilization, barriers to care, and treatment satisfaction is growing, evidence from Germany remains limited. This study aimed to examine the utilization of mental health care services in a sample of German children and adolescents with an administrative ADHD diagnosis registered with their health insurance company. Treatment satisfaction, belief in treatment efficacy and factors influencing mental health care utilization were examined.

Methods: As part of the consortium project INTEGRATE-ADHD, data from 4,948 children and adolescents were analyzed. Parents of 7- to 17-year-olds participated in an online survey answering questions about their child's ADHD health care utilization, treatment satisfaction and efficacy, and factors influencing utilization using established instruments. Sociodemographic factors, geographic characteristics, ADHD symptom severity, and parental psychopathology were also assessed. Descriptive analyses and multivariate logistic regressions were conducted.

Results: Approximately 40% of the children and adolescents with an administrative ADHD diagnosis were currently receiving ADHD treatment. The majority of parents (76%) were satisfied with the treatment, and 85% considered the treatment effective. Children with more severe ADHD symptoms had a threefold higher likelihood of receiving treatment, while youths with a migration background were less likely to receive mental health care. The most common reasons for not utilizing mental health care included the treatment having already ended, a lack of available treatment options, long waiting times, a lack of motivation among children, or the inability to continue treatment due to the COVID-19 pandemic.

Conclusions: To overcome the identified barriers in ADHD treatment, we recommend improving access to evidence-based ADHD treatment and expanding its implementation to prevent undertreatment and the associated individual suffering and societal costs.