Eye Tracking During a Continuous Performance Test: Utility for Assessing ADHD Patients.

OBJECTIVE: The use of continuous performance tests (CPTs) for assessing ADHD related cognitive impairment is ubiquitous. Novel psychophysiological measures may enhance the data that is derived from CPTs and thereby improve clinical decision-making regarding diagnosis and treatment. As part of the current study, we integrated an eye tracker with the MOXO-dCPT and assessed the utility of eye movement measures to differentiate ADHD patients and healthy controls. METHOD: Adult ADHD patients and gender/age-matched healthy controls performed the MOXO-dCPT while their eye movements were monitored (n = 33 per group). RESULTS: ADHD patients spent significantly more time gazing at irrelevant regions, both on the screen and outside of it, than healthy controls. The eye movement measures showed adequate ability to classify ADHD patients. Moreover, a scale that combined eye movement measures enhanced group prediction, compared to the sole use of conventional MOXO-dCPT indices. CONCLUSIONS: Integrating an eye tracker with CPTs is a feasible way of enhancing diagnostic precision and shows initial promise for clarifying the cognitive profile of ADHD patients. Pending replication, these findings point toward a promising path for the evolution of existing CPTs.

The Effect of Martial Arts Training on Cognitive and Psychological Functions in At-Risk Youths.

The current study assessed whether an extended program of martial arts training was a viable intervention for at-risk youths in improving cognitive and psychological functions. Adolescent boys attending specialized education facilities for at-risk youths took part in regular sport lessons or martial arts practice twice a week for 6 months. Hormonal reactivity was assessed during initial training, and measures of psychological (aggression, self-esteem) and cognitive (inhibition, flexibility, speed of processing, and attention) functions were assessed before and immediately following the intervention. Participants in the martial arts training demonstrated significant improvement in the domains of inhibition and shifting and speed of processing. Additionally, initial hormonal reactivity (oxytocin and cortisol) to the intervention predicted significant post-intervention change on several measures of cognitive and psychological functioning. Specifically, oxytocin reactivity predicted improvement in processing speed, as well as reduction of aggression, whereas cortisol reactivity predicted increases in self-esteem. This pioneering, ecologically valid study demonstrates the initial efficacy of this enjoyable, readily available, group intervention for at-risk boys and suggests potential mechanisms that may mediate the process of change.

Detection of Feigned ADHD Using the MOXO-d-CPT.

Objective: The objective of this study was to assess the MOXO-d-CPT utility in detecting feigned ADHD and establish cutoffs with adequate specificity and sensitivity. Method: The study had two phases. First, using a prospective design, healthy adults who simulated ADHD were compared with healthy controls and ADHD patients who performed the tasks to the best of their ability (n = 47 per group). Participants performed the MOXO-d-CPT and an established performance validity test (PVT). Second, the MOXO-d-CPT classification accuracy, employed in Phase 1, was retrospectively compared with archival data of 47 ADHD patients and age-matched healthy controls. Results: Simulators performed significantly worse on all MOXO-d-CPT indices than healthy controls and ADHD patients. Three MOXO-d-CPT indices (attention, hyperactivity, impulsivity) and a scale combining these indices showed adequate discriminative capacity. Conclusion: The MOXO-d-CPT showed promise for the detection of feigned ADHD and, pending replication, can be employed for this aim in clinical practice and ADHD research.

Attention-Deficit/Hyperactivity Disorder (ADHD): Integrating the MOXO-dCPT with an Eye Tracker Enhances Diagnostic Precision.

Clinical decision-making may be enhanced when combining psychophysiological sensors with computerized neuropsychological tests. The current study explored the utility of integrating an eye tracker with a commercially available continuous performance test (CPT), the MOXO-dCPT. As part of the study, the performance of adult attention-deficit/hyperactivity disorder (ADHD) patients and healthy controls (n = 43, n = 42, respectively) was compared in the integrated system. More specifically, the MOXO-dCPT has four stages, which differ in their combinations of ecological visual and auditory dynamic distractors. By exploring the participants' performance in each of the stages, we were able to show that: (a) ADHD patients spend significantly more time gazing at irrelevant areas of interest (AOIs) compared to healthy controls; (b) visual distractors are particularly effective in impacting ADHD patients' eye movements, suggesting their enhanced utility in diagnostic procedures; (c) combining gaze direction data and conventional CPT indices enhances group prediction, compared to the sole use of conventional indices. Overall, the findings indicate the utility of eye tracker-integrated CPTs and their enhanced diagnostic precision. They also suggest that the use of attention-grabbing visual distractors may be a promising path for the evolution of existing CPTs by shortening their duration and enhancing diagnostic precision.

Oxygen: The Rate-Limiting Factor for Episodic Memory Performance, Even in Healthy Young Individuals.

Cognition is a crucial element of human functionality. Like any other physical capability, cognition is both enabled and limited by tissue biology. The aim of this study was to investigate whether oxygen is a rate-limiting factor for any of the main cognitive domains in healthy young individuals. Fifty-six subjects were randomly assigned to either increased oxygen supply using hyperbaric oxygen (two atmospheres of 100% oxygen) or to a "sham" treatment (a simulation of increased pressure in a chamber with normal air). While in the chamber, participants went through a battery of tests evaluating the major cognitive domains including information processing speed, episodic memory, working memory, cognitive flexibility, and attention. The results demonstrated that from all evaluated cognitive domains, a statistically significant improvement was found in the episodic memory of the hyper-oxygenized group. The hyper-oxygenized group demonstrated a better learning curve and a higher resilience to interference. To conclude, oxygen delivery is a rate-limiting factor for memory function even in healthy young individuals under normal conditions. Understanding the biological limitations of our cognitive functions is important for future development of interventional tools that can be used in daily clinical practice.

Hormonal reactivity during martial arts practice among high-risk youths.

Martial arts have become a popular afterschool activity for youths across the globe. Accumulating data suggest that these activities may confer substantial cognitive and psychological benefits, and recent efforts have been made to introduce martial arts training into educational and rehabilitation settings. However, few studies have examined the potential mechanisms that may underlie these benefits. The current study evaluated the reactivity of two hormones, oxytocin (OT) and cortisol (CT), thought to be respectively involved in regulating mammalian social behaviors and responsivity to stress, to a session of intensive martial arts training in samples of at high-risk and low-risk (in regular educational establishments) youths. OT and CT were measured at baseline, during peak training, and following a cool down period. Analyses revealed that high-risk youths had lower OT but similar CT baseline levels, compared to low-risk youths, prior to the martial arts session. A significant group by time interaction indicated that whereas the OT levels among low-risk youths returned to baseline levels following training, OT levels among high-risk youths remained elevated. Finally, unlike low-risk youths for whom CT levels continued to increase throughout the training session, high-risk youths showed no significant CT reactivity. This study suggests that some of the beneficial effects of martial arts may be related to hormonal processes, especially increases in OT levels, and highlights the differing effects that training may have in different populations.

Paying attention to speech: The role of working memory capacity and professional experience.

Managing attention in multispeaker environments is a challenging feat that is critical for human performance. However, why some people are better than others in allocating attention appropriately remains highly unknown. Here, we investigated the contribution of two factors-working memory capacity (WMC) and professional experience-to performance on two different types of attention task: selective attention to one speaker and distributed attention among multiple concurrent speakers. We compared performance across three groups: individuals with low (n = 20) and high (n = 25) WMC, and aircraft pilots (n = 24), whose profession poses extremely high demands for both selective and distributed attention to speech. Results suggests that selective attention is highly effective, with good performance maintained under increasingly adverse conditions, whereas performance decreases substantially with the requirement to distribute attention among a larger number of speakers. Importantly, both types of attention benefit from higher WMC, suggesting reliance on some common capacity-limited resources. However, only selective attention was further improved in the pilots, pointing to its flexible and trainable nature, whereas distributed attention seems to suffer from more fixed and severe processing bottlenecks.

Who becomes addicted and to what? psychosocial predictors of substance and behavioral addictive disorders.

A multitude of psychological and social factors likely contribute to the development and maintenance of addictive disorders. As different people develop different addictions, it is important to understand whether psychosocial factors are related differently to different types of addictive disorders. In this study, we examined the unique interaction of personality traits, family environment, and life events in predicting substance (drugs, alcohol) and behavioral (gambling, sex) addictive disorders, among 207 participants suffering from an addictive disorder and 79 controls. Results identified several psychosocial factors, including impulsivity and reported negative life events, that predicted all types of addictive disorders. There was also a unique prediction model for each addiction. Drug and alcohol use disorders were predicted by lower agreeableness and less intellectual-cultural family orientation, with alcohol use disorder further predicted by lower extraversion and higher family organization. Gambling disorder was predicted by a family with lower intellectual-cultural orientation and higher organization and control, whereas compulsive sexual behavior was predicted by lower extraversion and agreeableness and higher neuroticism, and by higher family control. These findings suggest that the complex interplay among psychosocial factors is manifested differently across addictive disorders and may thus have important implications for research, prevention, and intervention.

Efficacy of Psychological Intervention for Children with Concurrent Posttraumatic Stress Disorder and Mild Traumatic Brain Injury.

Posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) are common conditions following motor vehicle accidents (MVAs). Mild TBI and PTSD not only share similar features but may also coexist and interact. Nonetheless, research on psychotherapeutic interventions for PTSD in patients with a history of mTBI, particularly regarding pediatric populations, is limited. The present study compared the efficacy of the prolonged exposure treatment protocol for children and adolescents (PE-A) with PTSD and mTBI (n = 16) versus PTSD alone (n = 21); treatment commenced at least 3 months following an MVA. Emotional status and cognitive functioning were assessed pre- and postintervention using questionnaires and standardized neuropsychological tests. Participants from both groups benefitted from the intervention, as reflected in their emotional status via increased ratings of well-being and decreased ratings of PTSD, anxiety, depression, and postconcussive symptoms, η2 = .21-.50. Ratings of cognitive function also improved for cognitive flexibility, η2 = .30; executive function in everyday life, η2 = .27; and attention and inhibition, η2 = .16. Parental PTSD was the strongest predictor of improvement after intervention, sr2 = .35. Thus, it appears that PE-A is an effective intervention for children with MVA-related PTSD regardless of its comorbidity with mTBI.

Perception of Caregiving During Childhood is Related to Later Executive Functions and Antisocial Behavior in At-Risk Boys.

Executive functions are considered essential for effective navigation in the social world. Parental responsiveness is a critical ingredient for normative social development and, as such, may be connected with the development of executive functions. Disruption of this development may, in turn, lead to maladaptive and antisocial behaviors. The purpose of this study was to evaluate the nature of the connections among perceived patterns of caregiving experienced in childhood, executive functions, and antisocial behaviors in at-risk adolescents. Seventy-one adolescent boys were recruited from two high-schools for adolescents who were not deemed suitable for regular schooling due to behavioral and emotional issues. Executive functions were tested using a computer-administered neuropsychological battery (CANTAB), and maternal parenting experiences and antisocial behaviors were assessed using retrospective and current questionnaires. Structural equation modeling (SEM) approach was employed to examine whether executive functions mediated the relationship between children's perceived patterns of maternal care and subsequent development of antisocial behaviors. Although maternal care had a significant direct effect on executive function (standardized coefficient = .49, p = .03) and antisocial behavior (standardized coefficient = .53, p = .05), SEM demonstrated no mediating relationships among these variables. Instead, maternal care predicted unique variance in both executive functions (standardized coefficient = .61, p = .02) and antisocial behavior (standardized coefficient = .51, p = .05). This study suggests a link between the experience of childhood caregiving and adolescent executive functions and delinquency and highlights the importance of early parenting interventions to aid executive function development. Such early interventions could potentially enhance long-term pro-social behavior.

Testing the magnocellular-pathway advantage in facial expressions processing for consistency over time.

The ability to identify facial expressions rapidly and accurately is central to human evolution. Previous studies have demonstrated that this ability relies to a large extent on the magnocellular, rather than parvocellular, visual pathway, which is biased toward processing low spatial frequencies. Despite the generally consistent finding, no study to date has investigated the reliability of this effect over time. In the present study, 40 participants completed a facial emotion identification task (fearful, happy, or neutral faces) using facial images presented at three different spatial frequencies (low, high, or broad spatial frequency), at two time points separated by one year. Bayesian statistics revealed an advantage for the magnocellular pathway in processing facial expressions; however, no effect for time was found. Furthermore, participants' RT patterns of results were highly stable over time. Our replication, together with the consistency of our measurements within subjects, underscores the robustness of this effect. This capacity, therefore, may be considered in a trait-like manner, suggesting that individuals may possess various ability levels for processing facial expressions that can be captured in behavioral measurements.

Computerized Cognitive Training for Older Adults at Higher Dementia Risk due to Diabetes: Findings From a Randomized Controlled Trial.

BACKGROUND: To evaluate the effects of adaptive and tailored computerized cognitive training on cognition and disease self-management in older adults with diabetes. METHODS: This was a single-blind trial. Eighty-four community-dwelling older adults with diabetes were randomized into a tailored and adaptive computerized cognitive training or a generic, non-tailored or adaptive computerized cognitive training condition. Both groups trained for 8 weeks on the commercially available CogniFit program and were supported by a range of behavior change techniques. Participants in each condition were further randomized into a global or cognition-specific self-efficacy intervention, or to a no self-efficacy condition. The primary outcome was global cognition immediately following the intervention. Secondary outcomes included diabetes self-management, meta-memory, mood, and self-efficacy. Assessments were conducted at baseline, immediately after the training, and at a 6-month follow-up. RESULTS: Adherence and retention were lower in the generic computerized cognitive training condition, but the self-efficacy intervention was not associated with adherence. Moderate improvements in performance on a global cognitive composite at the posttreatment assessments were observed in both cognitive training conditions, with further small improvement observed at the 6-month follow-up. Results for diabetes self-management showed a modest improvement on self-rated diabetes care for both intervention conditions following the treatment, which was maintained at the 6-month follow-up. CONCLUSIONS: Our findings suggest that older adults at higher dementia risk due to diabetes can show improvements in both cognition and disease self-management following home-based multidomain computerized cognitive training. These findings also suggest that adaptive difficulty and individual task tailoring may not be critical components of such interventions. TRIAL REGISTRATION: NCT02709629.

Non-pharmacological interventions for cognitive difficulties in ADHD: A systematic review and meta-analysis.

Attention deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in children and is associated with significant risk of educational failure, interpersonal problems, mental illness, and delinquency. Despite a number of comparative and comprehensive reviews on the effects of ADHD treatments on ADHD core symptoms, evidence synthesizing the effects of ADHD interventions on cognitive difficulties is limited. In this meta-analysis, the neuropsychological effects of non-pharmacological interventions for ADHD were examined across studies published between 1980 and 2017. Data were extracted from studies that used objective cognitive measures (either computerized or pencil-and-paper), and multiple meta-analyses were conducted to compare the effectiveness across these interventions. Publication bias was assessed, as well as quality of the evidence, using Cochrane risk of bias tool for randomized control trials studies. Our final meta-analysis included 18 studies with interventions that were categorized into four categories: neurofeedback, cognitive-behavioral therapy, cognitive training, and physical exercises. Physical exercises demonstrated the highest average effect size (Morris d = 0.93). A further evaluation of cognitive functions yielded 49 effect sizes for the five categories, including attention, inhibition, flexibility, and working memory. Analyses demonstrated a homogenous, medium to large, effect size of improvement across interventions, with inhibition demonstrating the largest average effect size (Morris d = 0.685). This study highlights the positive effect of psychological interventions on ADHD cognitive symptomology and supports the inclusion of non-pharmacological interventions in conjunction with the commonly used pharmacological treatments.

Martial arts increase oxytocin production.

Numerous studies have demonstrated that oxytocin (OT), a peptide hormone, plays an important role in regulating mammalian social behaviors, linking it to social affiliation in parent-infant attachment, romantic and filial relationships, and other prosocial behaviors, such as trust and cooperation. Not surprisingly, research efforts have been made to increase endogenous levels of OT. In the present study, we investigated whether traditional martial arts training, which integrates the natural benefits of physical exercise with dyadic prosocial interaction, would result in OT response. To this end, 68 beginner and advanced participants were recruited from several schools practicing Jujitsu ("soft art"), a form of traditional martial arts originating in Japan. Salivary OT levels were assessed at baseline, immediately following high-intensity training, and following a cool-down period. Analyses revealed a significant increase in OT immediately after a high-intensity training, returning to baseline levels following a cool-down period. Additionally, although no significant difference between beginner and advanced martial artists was found, a significantly higher increase in salivary OT followed ground grappling, as compared to "punch-kick" sparring, indicating an added benefit of close contact tactile interaction. These results suggest that the reportedly socially beneficial effects of traditional martial arts may be in part mediated by OT release and underscore the potentially therapeutic applications of these methods for disorders involving social dysfunction, such as autism, conduct problems, or schizophrenia.

Negative and positive life events and their relation to substance and behavioral addictions.

BACKGROUND: Research has shown that negative life events (LEs) may be connected to the development and maintenance of addictions. However, few studies have examined the potential relationship between positive events and addictive disorders, and even fewer studies evaluated the subjective perception of LEs that may underlie these relationships. Importantly, addictive disorders include both substance-related and behavioral addictions, but the relative relationship of each type of addiction with LEs remains unclear. METHODS: The present study compared 212 participants suffering from an addiction (drugs, alcohol, gambling, and sex) and 79 controls on self-report measures of negative and positive LEs. RESULTS: Compared with controls, individuals with an addiction reported experiencing a larger number of both negative and positive LEs and also tended to be more influenced by negative LEs. Findings also demonstrated differential patterns across addiction types, such that participants with compulsive sexual behavior (CSB) reported experiencing less negative events than those with drug use disorders (DUD) and were less influenced by these events than participants with alcohol use disorder (AUD). Finally, analyses within each group further revealed differences in the way each group experienced negative compared to positive events. Controls and participants with CSB reported experiencing a similar number of positive and negative events, whereas participants with DUD, AUD, and gambling disorder reported more negative events in their lives. CONCLUSIONS: These findings suggest a unique profile among different types of addictions, which should be taken into account when planning personalized prevention and intervention approaches.

Qualitative review and quantitative effect size meta-analyses in brain regions identified by cue-reactivity addiction studies.

OBJECTIVE: Various brain regions have been identified as involved in addictions, yet inconsistencies remain regarding the primary regions that may underlie addictive behaviors. To address this, we conducted a meta-analysis investigating cue-reactivity functional MRI studies for different addictions. METHOD: We explored 8 different addiction-related brain regions in 27 studies (29 samples) using homogeneity tests of effect sizes. RESULTS: An initial qualitative review failed to identify consistent activations in any brain region. We subsequently explored possible moderators related to either the addiction, participants, or study design, and found addiction type to be a relevant moderator, suggesting that different addictions may not necessarily involve the same brain regions. Successive quantitative analyses found that internet gaming addiction and heroin dependence modulated neural activation in the right dorsolateral prefrontal cortex and heroin dependence further in the right orbitofrontal cortex. Our analyses also demonstrated the expected mean effect sizes in each region when conducting cue-reactivity experiments on addictions. CONCLUSIONS: It appears that distinct addiction types may manifest differently in the brain and may moderate cue reactivity to a greater extent than previously suggested factors. This study underscores the need for additional research comparing the neural mechanisms underlying different addiction types. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Evidence for a differential visual M300 brain response in gamblers.

OBJECTIVE: Gambling disorder is the first behavioral addiction recognized in the DSM-5. This marks the growing realization that both behavioral and substance-related addictions are manifestations of an 'addicted brain', displaying similar altered neurophysiological mechanisms. A decreased electrophysiological visual P300 is considered a hallmark effect of substance-related addictions, but has not yet been shown in behavioral addictions. METHODS: Magnetoencephalographic recordings of 15 gamblers and 17 controls were taken as they performed a cue-reactivity paradigm in which they passively viewed addiction- and non-addiction-related cues. RESULTS: The main finding of the study is a reduction in the magnetic counterpart of P300 (M300) for gamblers beyond cue condition over frontal regions. Additionally, we found a significant group by cue-type interaction. Gamblers exhibited heightened sensitivity to addiction-related cues in regions corresponding to the frontoparietal attentional network, whereas controls exhibited an opposite effect localized to the right insula. CONCLUSIONS: The results suggest that a reduced P300 characterizes addictions in general, not just substance-related addictions, thus providing important neurophysiological support for the inclusion of behavioral addictions in the DSM-5 and in the incentive-sensitization theory. SIGNIFICANCE: The study offers important insights into neural mechanisms underlying behavioral addictions, and may assist in developing better prevention and intervention strategies.

Single transcranial direct current stimulation in schizophrenia: Randomized, cross-over study of neurocognition, social cognition, ERPs, and side effects.

Over the last decades, the treatment of schizophrenia has shifted fundamentally from a focus on symptom reduction to a focus on recovery and improving aspects of functioning. In this study, we examined the effect of transcranial direct current stimulation (tDCS) on social cognitive and nonsocial neurocognitive functions, as well as on electroencephalogram (EEG) measures, in individuals with schizophrenia. Thirty-seven individuals with schizophrenia were administered one of three different tDCS conditions (cathodal, anodal, and sham) per visit over the course of three visits, with approximately one week between each visit. Order of conditions was randomized and counterbalanced across subjects. For the active conditions, the electrode was placed over the left dorsolateral prefrontal cortex with the reference electrode over right supraorbital cortex. Current intensity was 2 mA and was maintained for two 20-minute sessions, with a one hour break between the sessions. Assessments were conducted immediately following each session, in a counterbalanced order of administration. No systematic effects were found across the social and nonsocial cognitive domains, and no significant effects were detected on event-related potentials (ERPs). The very small effect sizes, further validated by post-hoc power analyses (large Critical Ns), demonstrated that these findings were not due to lack of statistical power. Except for mild local discomfort, no significant side effects were reported. Findings demonstrate the safety and ease of administration of this procedure, but suggest that a single dose of tDCS over these areas does not yield a therapeutic effect on cognition in schizophrenia. TRIAL REGISTRATION: ClinicalTrials.gov NCT02539797.

Personality profiles of substance and behavioral addictions.

Substance-related and behavioral addictions are extremely prevalent and represent a major public health concern. In the ongoing attempt to understand the addictive personality, contradictory results have arisen from studies that have explored personality traits in different addiction populations. The diversity across addiction types suggests that some of these inconsistencies stem from distinct personalities underlying each addiction. The present study compares the personality profiles of several addictions, representing both substance (drugs and alcohol) and behavioral (gambling and sex) subtypes. 216 addicted individuals and 78 controls completed personality and sociodemographic questionnaires. Notable personality distinctions were found among different types of addiction. Whereas impulsivity and neuroticism were higher across all addiction populations, as compared to controls, people with alcohol use disorders also scored significantly lower on the traits of extraversion, agreeableness, and openness to experience. People with drug use disorders and those with compulsive sexual behavior were surprisingly similar, scoring lowest on the traits of agreeableness and conscientiousness. Finally, people with gambling disorder demonstrated a personality profile similar to that of the control group. Of note, personality profiles were also related to several demographic characteristics, including socioeconomic status and religiosity. Our findings support a potential role for personality in distinguishing among different types of addiction. This study suggests that different addictions may, to some extent, stem from distinct processes that are involved in personality development. These findings may provide a useful framework for understanding why different people develop different addictions.

Gender Differences in Neurocognitive Performance Among Children With Posttraumatic Stress Disorder and Mild Traumatic Brain Injury.

Posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) are frequent sequelae after motor vehicle accidents (MVAs). These two pathologies often have overlapping neurocognitive deficits across several domains, such as attention, memory, and executive functions. The present study was an effort to examine the contribution of gender to these overlapping symptoms. To this end, psychodiagnostic and neuropsychological data were collected on 61 children and adolescents 3 months following MVA. All participants were diagnosed with PTSD, and about half (n = 33) also received a diagnosis of mTBI. Analyses of variance revealed significant interactions between gender and mTBI (ηp2=.15), such that girls with mTBIs preformed significantly worse than noninjured girls on measures of executive functions (Cohen's d = 3.88) and sustained attention (Cohen's d = 3.24). Boys, on the other hand, did not differ significantly on any of those measures, irrespective of TBI injury status. Similarly, comparisons to the normative population revealed that, whereas boys showed impaired neurocognitive performances regardless of TBI status, impaired performances in girls were limited to those cases in which the girls were comorbid for PTSD and mTBI. It appears then that whereas PTSD alone might explain boys' reduced neurocognitive performance, among girls the comorbidity of PTSD and mTBI is required to account for performance deficits.