Lack of educational impact of video game addiction in children and adolescents diagnosed with ADHD: A cross-sectional study.

Introduction: The use of video games has become widespread worldwide. Excessive use of video games is increasingly becoming a matter of concern, particularly in patients diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). Currently, internet gaming disorder (IGD) is not included within the DSM-5-chapter Disorders related to substances and addictive disorders. Methods: This is a post-hoc descriptive naturalistic study comparing children and adolescents diagnosed with ADHD with and without IGD. We used the 85% cut-off point of the test ADITEC-V for video game addiction to split our sample of ADHD patients into those with IGD (>=85%) and those without IGD (<85%). Results: 13 (25%) out of the 51 children and adolescents with ADHD included in our study had an IGD. Patients with IGD had a first contact with internet, smartphones, and videogames at a very early age (5.67 ± 3.31, 6.33 ± 4.60, and 7.50 ± 2.61, respectively). However, only age at first contact with the internet was statistically significantly different when comparing ADHD patients with and without IGD (8.68 ± 2.71 vs. 5.67 ± 3.31, t = 3.166, df = 47, p = 0.01). Different neurodevelopmental, clinical, and neuropsychological measures converging in impulsivity is a risk factor for IGD. Unexpectedly, we found no association between IGD and poor academic achievement. Discussion: Future studies may include randomized controlled trials for treating IGD, the study of social adjustment as a protective factor against developing an IGD, and the role of serious and non-serious video games in the development of an IGD, among others. Additional research is clearly needed on IGD.

Effectiveness of a Personalized, Chess-Based Training Serious Video Game in the Treatment of Adolescents and Young Adults With Attention-Deficit/Hyperactivity Disorder: Randomized Controlled Trial.

BACKGROUND: Compared with traditional approaches, gaming strategies are promising interventions for the treatment of attention-deficit/hyperactivity disorder (ADHD). We developed a serious game, The Secret Trail of Moon (TSTM), for ADHD treatment. OBJECTIVE: The main objective of this clinical trial was to demonstrate the effectiveness of an add-on, either TSTM or Therapeutic Chess (TC), in previously optimally drug-titrated, clinically stable patients with ADHD. METHODS: This study is a prospective, unicentric, randomized clinical trial in clinically stable patients with ADHD, aged 12 to 22 years. The TSTM (n=35) and TC groups (n=34) performed 12 weekly sessions of their respective treatments. The control group (CG) patients (n=35) were called by phone every week, but they received no cognitive intervention. The primary end point was the change from baseline to end point in the parent "Behavior Rating Inventory of Executive Function-2" (BRIEF-2; patients' parents) in the per-protocol population (31 serious videogame: 24 TC and 34 CG). RESULTS: Our study failed to probe clear-cut improvements in the global score of the BRIEF-2. However, the TC group showed improvements in measures of emotional control, emotional regulation, and inattention. The TSTM group showed improvements in measures of emotional regulation, inattention, and school context. CONCLUSIONS: TSTM and TC did not improve executive function symptoms, but they improved ADHD symptomatology related to emotional regulation. Further studies with bigger samples are required to confirm these preliminary findings. TRIAL REGISTRATION: ClinicalTrials.gov NCT04355065; https://clinicaltrials.gov/ct2/show/NCT04355065.

A Virtual Reality Serious Videogame Versus Online Chess Augmentation in Patients with Attention Deficit Hyperactivity Disorder: A Randomized Clinical Trial.

Objective: Serious videogames and virtual reality (VR) have gained increasing interest for treating attention deficit hyperactivity disorder (ADHD). "The Secret Trail of Moon" (TSTM) study is a clinical trial devoted to testing the efficacy of TSTM, a VR serious videogame developed to train in five major cognitive skills usually compromised in patients with ADHD. This study is a three-arm nonequality trial comparing TSTM to online chess training and a control group (CG). This study aims to demonstrate that augmentation with either TSTM or online chess is efficacious in clinically drug-stable patients with ADHD. Materials and Methods: This study is prospective, unicentric, and randomized with a CG. One hundred five patients with ADHD, ages 12-22 years old, and pharmacologically stable were enrolled. Patients were randomized into three groups: TSTM group, online chess group (therapeutic chess [TC]), and CG. Objective and subjective measures of the patient and parents are included. Patient visits differ for each group. TSTM group patients have 15 face-to-face visits: preinclusion visit, inclusion visit, 12 training visits, and final visit. TC and CG patients have 3 face-to-face visits (preinclusion, initial visit, and final visit) and 12 e-mail or phone communications during training (TC) or follow-up (CG group). This study was approved by the local Institutional Review Board (IRB). Results: Not applicable. This is a study protocol. Conclusion: This is the first study testing an augmentation strategy using either a serious videogame or chess in clinically drug-treated patients with ADHD. Using VR serious videogames present with several advantages over traditional videogames. Trial Registration: NCT04355065.

Psychometric properties of the reading comprehension test ECOMPLEC.Sec.

BACKGROUND: ECOMPLEC.Sec is a reading comprehension test for secondary students, conceived from a multidimensional perspective in line with large-scale educational surveys such as PISA or PIRLS. The objective of this study was to validate the theoretical model of ECOMPLEC.Sec. A bifactor model that postulates the existence of a general reading comprehension factor and three specific factors provided a good fit to the data. METHOD: 1,912 adolescents (13-18 years) participated in this study. Data analysis included construct validity via confirmatory factor analysis, and factors were regressed onto observed covariates for the interpretation of the constructs. Reliability was calculated from a non-linear SEM in order to justify the interpretability of the observed scale and subscale scores. RESULTS: The bifactor model exhibited a significantly better fit to the data than the second-order model. Furthermore, construct validity analysis suggests the existence of specific reading comprehension factors. Finally, the reliability study also supports the idea of using a total score to obtain a measure of reading comprehension. CONCLUSIONS: ECOMPLEC.Sec displays a valid parsimonious factor structure, as well as metric properties that make it a suitable tool to assess reading comprehension.

Prevalence of disability in a composite ≥75 year-old population in Spain: a screening survey based on the International Classification of Functioning.

BACKGROUND: The prevalence and predictors of functional status and disability of elderly people have been studied in several European countries including Spain. However, there has been no population-based study incorporating the International Classification of Functioning, Disability and Health (ICF) framework as the basis for assessing disability. The present study reports prevalence rates for mild, moderate, and severe/extreme disability by the domains of activities and participation of the ICF. METHODS: Nine populations surveyed in previous prevalence studies contributed probabilistic and geographically defined samples in June 2005. The study sample was composed of 503 subjects aged ≥75 years. We implemented a two-phase screening design using the MMSE and the World Health Organization-Disability Assessment Schedule 2nd edition (WHO-DAS II, 12 items) as cognitive and disability screening tools, respectively. Participants scoring within the positive range of the disability screening were administered the full WHO-DAS II (36 items; score range: 0-100) assessing the following areas: Understanding and communication, Getting along with people, Life activities, Getting around, Participation in society, and Self-care. Each disability area assessed by WHO-DAS II (36 items) was reported according to the ICF severity ranges (No problem, 0-4; Mild disability, 5-24; Moderate disability, 25-49; Severe/Extreme disability, 50-100). RESULTS: The age-adjusted disability prevalence figures were: 39.17 ± 2.18%, 15.31 ± 1.61%, and 10.14 ± 1.35% for mild, moderate, and severe/extreme disability, respectively. Severe and extreme disability prevalence in mobility and life activities was three times higher than the average, and highest among women. Sex variations were minimal, although life activities for women of 85 years and over had more severe/extreme disability as compared to men (OR = 5.15 95% CI 3.19-8.32). CONCLUSIONS: Disability is highly prevalent among the Spanish elderly. Sex- and age-specific variations of disability are associated with particular disability domains.

Instrumental activities of daily living in the screening of dementia in population studies: a systematic review and meta-analysis.

BACKGROUND: Despite the fact that the current definitions of dementia in the DSM-IV and ICD-10 require functional deterioration for the diagnosis of dementia, it is not necessary a formal evaluation of functional capacity. OBJECTIVES: To examine the efficiency of functional assessment as a method of screening dementia in population studies. METHODS: This systematic review was based on information from MEDLINE, EMBASE, Index Médico Español (IME), and related articles. The studies included are population studies of patients over 65, in which normal and demented (established diagnosis) subjects are compared. In all of them, subjects were evaluated using the instrumental activities of daily living scale (IADL) as the method of screening for dementia. RESULTS: Two thousand three hundred and three abstracts and bibliographical references were reviewed. The authors of the selected studies were contacted and asked about other ongoing studies or indexes not included in our review in order to complete a meta-analysis. Finally, five studies were selected (n = 11.960). A meta-analysis was performed, with a statistical Q* value of 0.88 (SE 0.26). CONCLUSIONS: The functional assessment of the IADL showed an acceptable efficiency for the screening of dementia in the population studies included in this review, although few studies have verified this efficiency (sensitivity and specificity of the scales used). Further research is necessary in this field to be able to draw definitive conclusions.

Validation of the seven-minute screen neurocognitive battery for the diagnosis of dementia in a Spanish population-based sample.

OBJECTIVE: To validate the Seven-Minute Screen Neurocognitive Battery (7MS) in an elderly population-based sample to identify dementia using a new scoring method. METHODS: Five hundred and twenty-seven home-dwelling elderly were assessed with a neurological and neuropsychological exam. The total score of the 7MS was the sum of z scores of its subtests. Dementia was diagnosed according to DSM-IV. The ROC curve and the diagnostic parameters of the 7MS were calculated. RESULTS: The 7MS could be fully applied in 416 cases (78.9%), and 48 were diagnosed as demented independently of the 7MS. The four 7MS subtests correctly classified 97.6% of cases by discriminant analysis; orientation and memory were the most discriminative. Factorial analysis showed a single dimension in the 7MS. The ROC curve area for diagnosis of dementia was 0.996 (95% CI 0.992-1), sensitivity 100%, specificity 95.1%, and diagnostic accuracy 96.8%. All these parameters were higher than those of other cognitive screening tests. Dementia explained 54.9% of the variance of the 7MS, and age 3.1%; sex and education did not have a significant effect. CONCLUSIONS: The 7MS is a valid tool for the diagnosis of dementia, even when cognitive decline is mild, although it may not be appropriate for extensive epidemiological surveys.

[Cognitive assessment in the elderly. Normative data of a Spanish population sample older than 70 years]. / Evaluación cognitiva del anciano. Datos normativos de una muestra poblacional española de más de 70 años.

BACKGROUND AND OBJECTIVE: To define the parameters of normal cognitive performance in an easy to administer neuropsychological battery of a Spanish population sample of elderly over 70 years. SUBJECTS AND METHOD: We examined 527 home dwelling elderly from the longitudinal study Envejecer en Leganés, 71 to 99 years old (mean age [SD] 79 [6.2] years, 51.8% women, 38.7% without formal education), with an extensive clinical survey, a neurological exam and the following neuropsychological battery: Short Portable Mental Status Questionnaire, Mini Mental State Examination, Benton Orientation Test, Bell Test, Verbal Fluency, Clock Drawing Test, Trail Making Test, Free and Cued Figures Recall, Logic Memory, Naming, incidental Recall, Delayed Recall, Similarities, IQCODE Questionnaire Of Jorm and Depression Questionnaire CES-D. 111 cases who rejected the assessment or had sensomotor limitations were excluded. 368 non demented subjects (according to DSM-IV criteria; 88.5% of the de 416 remaining cases) were selected to establish the normative data of every test. RESULTS: The analyzed subsample was representative of the total sample. The normative data for every neuropsychological test were obtained in the total group of non demented subjects and in the subgroups stratified by four age levels and two cultural levels. The mean values, standard deviations, range and percentiles for every test and subgroup are presented. CONCLUSIONS: The normative data obtained in this population sample for a neuropsychological battery easy to administer to poorly educated elderly can be useful to rigourously apply the criteria of dementia and mild cognitive impairment in future clinical and population studies.

Validation of a short cognitive tool for the screening of dementia in elderly people with low educational level.

AIM: To validate the 'Prueba Cognitiva de Leganés' (PCL) as a screening tool for cognitive impairment in elderly people with little formal education. METHODS: The PCL is a simple cognitive test with 32 items that includes two scores of orientation and memory and a global score of 0-32 points. It was applied to a population sample of 527 elderly people over 70 with low educational level, who were independently diagnosed by consensus between two neurologists as having normal cognitive function, age associated cognitive decline (AACD, IPA-OMS criteria) or dementia (DSM-IV criteria). Individuals with severe visual or hearing defects and those who rejected the exam were excluded from the study. The PCL was validated in a sample of 375 individuals: 300 normal, 42 with AACD and 33 with dementia. The sensitivity, specificity, accuracy and likelihood ratios, as well as the ROC curves for dementia and for AACD-dementia, were calculated. The confounding effect of sociodemographic variables was assessed by logistic regression analysis and convergent validity by partial correlations of the PCL with other cognitive tests. Inter-rater reliability was evaluated with the intraclass correlation coefficient. RESULTS: The PCL identified dementia (cut-off < or =22) and AACD-dementia (cut-off < or =26), with the following diagnostic parameters, respectively: sensitivity 93.9%-80%, specificity 94.7%-84.3%, positive likelihood ratio 17.8-5.1, negative likelihood ratio 0.06-0.24, and accuracy 94.6%-83.4%. The areas under the ROC curve were 0.985 (95% Confidence Intervals (CI) 0.967-0.995) and 0.904 (95% CI: 0.870-0.932) respectively. The intraclass correlation coefficient was 0.79 (0.74-0.83). CONCLUSION: The PCL is a simple instrument, which is both valid and reliable, for the screening of dementia in population samples of individuals with low educational level. This instrument could be useful in primary health care.