Mindfulness-based stress reduction for older adults: effects on executive function, frontal alpha asymmetry and immune function.

BACKGROUND/AIMS: Mindfulness-based stress reduction (MBSR) has enhanced cognition, positive emotion, and immunity in younger and middle-aged samples; its benefits are less well known for older persons. Here we report on a randomized controlled trial of MBSR for older adults and its effects on executive function, left frontal asymmetry of the EEG alpha band, and antibody response. METHODS: Older adults (n = 201) were randomized to MBSR or waiting list control. The outcome measures were: the Trail Making Test part B/A (Trails B/A) ratio, a measure of executive function; changes in left frontal alpha asymmetry, an indicator of positive emotions or approach motivation; depression, mindfulness, and perceived stress scores, and the immunoglobulin G response to a protein antigen, a measure of adaptive immunity. RESULTS: MBSR participants had a lower Trails B/A ratio immediately after intervention (p < 0.05); reduced shift to rightward frontal alpha activation after intervention (p = 0.03); higher baseline antibody levels after intervention (p < 0.01), but lower antibody responses 24 weeks after antigen challenge (p < 0.04), and improved mindfulness after intervention (p = 0.023) and at 21 weeks of follow-up (p = 0.006). CONCLUSIONS: MBSR produced small but significant changes in executive function, mindfulness, and sustained left frontal alpha asymmetry. The antibody findings at follow-up were unexpected. Further study of the effects of MBSR on immune function should assess changes in antibody responses in comparison to T-cell-mediated effector functions, which decline as a function of age.

Number processing in adolescents with prenatal alcohol exposure and ADHD: differences in the neurobehavioral phenotype.

BACKGROUND: Poor arithmetic performance is among the most sensitive outcomes associated with prenatal alcohol exposure and is also common in individuals with attention-deficit hyperactivity disorder (ADHD). We hypothesized that prenatal alcohol exposure would be associated with deficits in the most fundamental aspects of number processing, representation of quantity and distance, whereas ADHD would be associated with deficits in calculation, the form of number processing most dependent on attention and memory. METHODS: Two hundred and sixty-two inner-city, African American adolescents, who had been evaluated prospectively for prenatal alcohol exposure and ADHD, were assessed on a number-processing test comprised of 7 subtests. RESULTS: More heavily alcohol-exposed adolescents were 4 times more likely to meet diagnostic criteria for ADHD than those whose mothers abstained from alcohol use during pregnancy. Two dimensions of number processing were identified in a factor analysis-magnitude comparison and calculation. As hypothesized, prenatal alcohol exposure was more strongly related to the former and ADHD to the latter. Moreover, the relation of prenatal alcohol to calculation was fully mediated by magnitude comparison, whereas the relation of ADHD to calculation was mediated by IQ but not by magnitude comparison. CONCLUSION: These data confirm findings from previous studies identifying arithmetic as a particularly sensitive developmental endpoint for prenatal alcohol exposure. Whereas difficulties with arithmetic in ADHD are mediated by domain-general deficits in overall cognitive ability, fetal alcohol-related arithmetic difficulties are mediated primarily by a specific deficit in the core quantity system involving the ability to mentally represent and manipulate number. These data suggest that different interventions are likely to be effective for remediating arithmetic problems in children with prenatal alcohol exposure than in non-exposed children with ADHD.

An event-related potential study of response inhibition in ADHD with and without prenatal alcohol exposure.

BACKGROUND: The attention and cognitive problems seen in individuals with a history of prenatal alcohol exposure often resemble those associated with attention deficit hyperactivity disorder (ADHD), but few studies have directly assessed the unique influence of each on neurobehavioral outcomes. METHODS: We recorded event-related potentials (ERPs) during a Go/No-go response inhibition task in young adults with prospectively obtained histories of prenatal alcohol exposure and childhood ADHD. RESULTS: Regardless of prenatal alcohol exposure, participants with childhood ADHD were less accurate at inhibiting responses. However, only the ADHD group without prenatal alcohol exposure showed a markedly diminished P3 difference between No-go and Go, which may reflect a more effortful strategy related to inhibitory control at the neural processing level. CONCLUSION: This finding supports a growing body of evidence suggesting that the manifestation of idiopathic ADHD symptoms may stem from a neurophysiologic process that is different from the ADHD symptomatology associated with prenatal alcohol exposure. Individuals who have been prenatally exposed to alcohol and present with ADHD symptomatology may represent a unique endophenotype of the disorder, which may require different treatment approaches from those found to be effective with idiopathic ADHD.

Temporospatial components of brain ERPs as biomarkers for Alzheimer's disease.

INTRODUCTION: Developing biomarkers that distinguish individuals with Alzheimer's disease (AD) from those with normal cognition remains a crucial goal for improving the health of older adults. We investigated adding brain spatial information to temporal event-related potentials (ERPs) to increase AD identification accuracy over temporal ERPs alone. METHODS: With two-step principal components analysis, we applied multivariate analyses that incorporated temporal and spatial ERP information from a cognitive task. Discriminant analysis used temporospatial ERP scores to classify participants as belonging to either the AD or healthy control group. RESULTS: Temporospatial ERPs produced a cross-validated area under the curve of 0.84. Adding spatial information through a formal procedure significantly improves classification accuracy. DISCUSSION: A weighted combination of temporospatial ERP markers performs well in detecting AD. Because ERPs are noninvasive and inexpensive, they may be promising biomarkers for AD that can add functional information to other biomarker systems while providing the individual's probability of correct classification.

Error-related event-related potentials in children with attention-deficit hyperactivity disorder, oppositional defiant disorder, reading disorder, and math disorder.

We studied error-related negativity (ERN) and error positivity (Pe) during a discrimination task in 319 unmedicated children divided into subtypes of ADHD (Not-ADHD/inattentive/combined), learning disorder (Not-LD/reading/math/reading+math), and oppositional defiant disorder. Response-locked ERPs contained a frontocentral ERN and posterior Pe. Error-related negativity and positivity exhibited larger amplitude and later latency than corresponding waves for correct responses matched on reaction time. ADHD did not affect performance on the task. The ADHD/combined sample exceeded controls in ERN amplitude, perhaps reflecting patients' adaptive monitoring efforts. Compared with controls, subjects with reading disorder and reading+math disorder performed worse on the task and had marginally more negative correct-related negativities. In contrast, Pe/Pc was smaller in children with reading+math disorder than among subjects with reading disorder and Not-LD participants; this nonspecific finding is not attributable to error processing. The results reflect anomalies in error processing in these disorders but further research is needed to address inconsistencies in the literature.

Effects of methylphenidate on subtypes of attention-deficit/hyperactivity disorder.

OBJECTIVE: To compare the effects of methylphenidate on attention-deficit/hyperactivity disorder (ADHD) subtypes. METHOD: Nineteen ADHD/inattentive (ADHD/I) and 22 ADHD/combined (ADHD/C) 6- to 12-year-old children entered a 6-week, double-blind trial of placebo and methylphenidate in divided doses (0.94 +/- 0.02 mg/kg/day = 33.06 +/- 1.40 mg/day). ADHD children received a restricted arithmetic task without medication before the trial and after their noon dose on the last day of each phase. Thirty-four unmedicated controls were tested at comparable time points. Parents and teachers rated ADHD children before and after each phase of the trial; parents rated controls before the study. RESULTS: Controls had marginally better arithmetic performance than children with ADHD/C who outperformed ADHD/I children. Unmedicated children with ADHD exceeded controls in task-incompatible behaviors during restricted arithmetic. Under methylphenidate, both ADHD subtypes reached control levels of arithmetic performance and task-incompatible behavior. Before the trial, parents rated children with both ADHD subtypes higher than controls on inattention, hyperactivity, and oppositionality/aggression and parents and teachers rated ADHD/C children higher than ADHD/I children on hyperactivity and oppositionality/aggression but not inattention. Methylphenidate lowered parent and teacher ratings of inattention and hyperactivity for those with both ADHD subtypes, but ratings of children with ADHD/C decreased more in hyperactivity and aggression. CONCLUSIONS: Methylphenidate ameliorated task-incompatible behavior, arithmetic performance, and inattention comparably in both ADHD subtypes, whereas medication reduced hyperactivity and aggression largely in children with ADHD/C.

Methylphenidate improves aspects of executive function in African American children with ADHD.

OBJECTIVE: The undertreatment of ethnic minority children with ADHD prompted a study on the effects of methylphenidate (MPH) on the executive functions of African American children with ADHD. METHOD: Nineteen African American children with ADHD are tested on the Tower of Hanoi (TOH) and the Paired Associates Learning Task (PAL) in a double-blind crossover acute challenge of MPH and placebo. RESULTS: Under MPH, TOH rule breaks decrease, especially in the second testing session, and TOH planning time increases, particularly for incorrect solutions; PAL recall in the final learning trial improves with MPH. CONCLUSION: Similar to previous findings with predominantly majority samples of patients with ADHD, MPH enhances planning, precision, and persistence in African American children with ADHD.

ERP C250 shows the elderly (cognitively normal, Alzheimer's disease) store more stimuli in short-term memory than Young Adults do.

OBJECTIVE: To determine how aging and dementia affect the brain's initial storing of task-relevant and irrelevant information in short-term memory. METHODS: We used brain Event-Related Potentials (ERPs) to measure short-term memory storage (ERP component C250) in 36 Young Adults, 36 Normal Elderly, and 36 early-stage AD subjects. Participants performed the Number-Letter task, a cognitive paradigm requiring memory storage of a first relevant stimulus to compare it with a second stimulus. RESULTS: In Young Adults, C250 was more positive for the first task-relevant stimulus compared to all other stimuli. C250 in Normal Elderly and AD subjects was roughly the same to relevant and irrelevant stimuli in Intratrial Parts 1-3 but not 4. The AD group had lower C250 to relevant stimuli in part 1. CONCLUSIONS: Both normal aging and dementia cause less differentiation of relevant from irrelevant information in initial storage. There was a large aging effect involving differences in the pattern of C250 responses of the Young Adult versus the Normal Elderly/AD groups. Also, a potential dementia effect was obtained. SIGNIFICANCE: C250 is a candidate tool for measuring short-term memory performance on a biological level, as well as a potential marker for memory changes due to normal aging and dementia.

Performance and private speech of children with attention-deficit/hyperactivity disorder while taking the Tower of Hanoi test: effects of depth of search, diagnostic subtype, and methylphenidate.

We administered the Tower of Hanoi to demographically comparable samples of control participants (n = 34) and children with the Combined (n = 22) and Inattentive subtypes (n = 19) of Attention-Deficit/Hyperactivity Disorder (ADHD). Controls excelled over children with the Inattentive subtype, who outperformed patients with the Combined subtype. These results replicated findings of greater executive deficits in the Combined than in the Inattentive type of ADHD. Double-blind administration of methylphenidate improved task performance only for patients with the Inattentive subtype. In a drug-free Baseline session, children with both subtypes of ADHD made more private verbalizations than controls, particularly when failing puzzles. In later sessions, regardless of drug condition, the inattentive sample exhibited a smaller increase in self-regulatory utterances under failure. In contrast, the combined sample decreased self-regulatory verbalizations under failure only under methylphenidate. The results support some differences between the two subtypes of ADHD in executive functioning and in their response to stimulant therapy.

Predicting Outcome of Community-Based Early Intensive Behavioral Intervention for Children with Autism.

We examined predictors of outcome (IQ, adaptive behavior, and ASD severity) after 12 and 24 months of early intensive behavioral intervention (EIBI) in 71, 20-59 months old children with autism spectrum disorder (ASD) who were enrolled in publicly-funded, community-based agencies. Predictors included social engagement (combining variables loading onto a single factor: social approach, joint attention, and imitation) and sensorimotor rituals. Younger age and higher IQ at intake predicted favorable outcomes at both 12 and 24 months. Adjusting for age, IQ, baseline predictor scores, EIBI hours, treatment site, and sensorimotor rituals, social engagement predicted superior later IQ and adaptive behavior. In contrast, sensorimotor rituals did not predict outcome. Although limited by the absence of a control group, the study indicates social engagement predicts some EIBI outcomes.

Effects of event probability and sequence on children with attention-deficit/hyperactivity, reading, and math disorder.

BACKGROUND: We investigated the impact of stimulus probability and sequence on performance and event-related potentials of 310 children classified into 12 combinations of attention-deficit/hyperactivity disorder (Not-attention-deficit/hyperactivity disorder, Inattentive and Combined subtypes) with presence/absence of reading disorder and math disorder. METHODS: Subjects pressed buttons to displays of the letters O and X, which were presented with probabilities of either .17/.83 or .50/.50. Greater response selection was required in the .17/.83 condition. RESULTS: Stimulus probability had comparable effects on all diagnostic groups. The extent of mismatch between a stimulus and preceding events elicited less systematic increases in errors, P3b latency, and P3b amplitude among both attention-deficit/hyperactivity disorder subtypes than controls. Mismatch with preceding trials more greatly reduced math disorder and reading disorder + math disorder children's speed in the Rare task and accuracy in both conditions. Math disorder and reading disorder + math disorder subjects also registered less the effects of alternations of the infrequent O on N2 amplitude and on P3b latency. CONCLUSIONS: Math disorder and reading disorder + math disorder youngsters' lower sensitivity to sequence irregularity in their event-related potentials along with greater disruption of performance suggest working memory deficits that adversely affected response selection. Comorbidity of attention-deficit/hyperactivity disorder and reading disorder did not affect the results.

Cognitive Brain Event-Related Potentials and Emotion Processing in Maltreated Children.

Cognitive event-related potentials (ERPs) were recorded from 23 maltreated and 21 nonmaltreated children. Children were presented with slides of Ekman photographs of asingle model posing an angry (25%), a happy (25%), or a neutral (50%) facial expression. In 1 of 2 counterbalanced target conditions, children were asked to press a button in response to the angry face; in the other target condition, they responded to the happy face. Both samples, as expected, exhibited the largest amplitude of the P300 component of the ERP to target stimuli and the smallest amplitude to nontargets. For nonmaltreated children, the average amplitude of P300 across slides was comparable for the 2 target conditions. In contrast, maltreated children displaed larger P300 ampltude to stimuli when they were directed to attend to angry, as opposd children displayed larger p300 amplitude to stimuli whe they were directed to attend to angry, as opposed to happy, targets. These reaults suggest different cognitive processing for positive versus negative affective expressions by children with histories of atypical emotiaonal exotional experiences.

Acoustic startle in maltreated children.

We investigated the eyeblink component of acoustic startle reactions in maltreated children. Previous research indicates that acoustic startle is enhanced in adult males with posttraumatic stress disorders (PTSD) whereas findings on women with PTSD have been inconsistent. In accord with the only previous report for children with PTSD, we found that maltreated boys, particularly those who had been physically abused, responded to increases in startle probe loudness with smaller increments in amplitude of startle eyeblink and smaller reductions in blink latency than did comparison boys. Results for girls were inconsistent: younger maltreated girls had smaller startle amplitude and slower onset latency than controls, whereas older maltreated girls exhibited the opposite pattern.

Effects of subtype of attention-deficit/hyperactivity disorder in adults on lateralized readiness potentials during a go/no-go choice reaction time task.

We studied 40 young adults with attention-deficit/hyperactivity disorder (ADHD; 18 predominantly inattentive type, 22 combined type) and 38 demographically comparable controls in a go/no-go choice reaction time task with 2 levels of difficulty. The ADHD/combined group was less accurate and had more variable reactions than controls. The ADHD/inattentive sample was slower than controls and had smaller early lateralized readiness potentials (LRPs). Compared with controls, both subtypes had (a) smaller early LRPs for no-go stimuli and (b) relatively earlier LRP onsets for difficult no-go events. The ADHD/combined sample also had smaller late LRP waves than controls. The results suggest that adults with ADHD, particularly those with the combined subtype, exhibit weaker central preparation to respond to both stimuli requiring a motor response and those prompting response inhibition.