The Effect of Mobile Neurofeedback Training in Children with Attention Deficit Hyperactivity Disorder: A Randomized Controlled Trial

Objective@#To examine the effect of mobile neurofeedback training on the clinical symptoms, attention abilities, and execution functions of children with attention deficit hyperactivity disorder (ADHD). @*Methods@#The participants were 74 children with ADHD aged 8−15 years who visited the Department of Child and Adolescent Psychiatry at Seoul National University Children’s Hospital. The participants were randomly assigned to the mobile neurofeedback (n = 35) or control (sham; n = 39) group. Neurofeedback training was administered using a mobile app (equipped with a headset with a 2-channel electroencephalogram [EEG] sensor) for 30 min/day, 3 days/week, for 3 months. Children with ADHD were individually administered various neuropsychological tests, including the continuous performance test, Children’s Color Trails Test-1 and 2, and Stroop Color and Word Tests. The effects of mobile neurofeedback were evaluated at baseline and at 3 and 6 months after treatment initiation. @*Results@#Following treatment, both mobile neurofeedback-only and sham-only groups showed significant improvements in attention and response inhibition. In the visual continuous performance test, omission errors decreased to the normal range in the mobile neurofeedback-only group after training, suggesting that mobile neurofeedback effectively reduced inattention in children with ADHD. In the advanced test of attention, auditory response times decreased in the mobile neurofeedback + medication group after training, but increased in the sham+medication group. Overall, there were no significant between-group differences in other performance outcomes. @*Conclusion@#Mobile neurofeedback may have potential as an additional therapeutic option alongside medication for children with ADHD.

Association of Pre- and Perinatal Risk Factors With Tourette Syndrome or Chronic Tic Disorders in a Korean School-Age Population

Objectives@#Tic disorders are highly heritable; however, growing evidence suggests that environmental factors play a significant role in their pathogenesis. Studies on these factors have been inconsistent, with conflicting results. Therefore, this study aimed to examine the associations of pre- and perinatal exposure to Tourette syndrome (TS) or chronic tic disorders (CTD) in Korean school-aged children. @*Methods@#This case-control study used data from a large prospective cohort study. The primary outcome was TS/CTD diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria and Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version-Korean Version. Demographic, pre-, and perinatal information was obtained from the maternal questionnaires. Data between the TS/CTD and control groups were compared using the chi-squared or Student’s t-test, as appropriate. Two-step logistic regression analyses were used to test the association between TS/CTD and pre- and perinatal risk factors. @*Results@#We included of 223 children (78 with TS/CTD and 145 controls). Significant differences in the demographic data between the two groups were observed. The male sex ratio, mean parental age, parental final education level, and family history of tics were included as confounders. In the final adjusted multivariable model, TS/CTD was significantly associated with antiemetic exposure during pregnancy (odds ratio [OR]=16.61, 95% confidence interval [CI] 1.49–185.22, p=0.02) and medically assisted reproduction (OR=7.89, 95% CI 2.28–27.28, p=0.01). @*Conclusion@#Antiemetic exposure and medically assisted reproduction are significantly associated with the risk of TS/CTD. These results should be replicated in future prospective and gene-by-environment studies.

Classifying Children with ADHD Based on Prefrontal Functional Near-infrared Spectroscopy Using Machine Learning

Objective@#Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children and adults characterized by cognitive and emotional self-control deficiencies. Previous functional near-infrared spectroscopy (fNIRS) studies found significant group differences between ADHD children and healthy controls during cognitive flexibility tasks in several brain regions. This study aims to apply a machine learning approach to identify medication-naive ADHD patients and healthy control (HC) groups using task-based fNIRS data. @*Methods@#fNIRS signals from 33 ADHD children and 39 HC during the Stroop task were analyzed. In addition, regularized linear discriminant analysis (RLDA) was used to identify ADHD individuals from healthy controls, and classification performance was evaluated. @*Results@#We found that participants can be correctly classified in RLDA leave-one-out cross validation, with a sensitivity of 0.67, specificity of 0.93, and accuracy of 0.82. @*Conclusion@#RLDA using only fNIRS data can effectively discriminate children with ADHD from HC. This study suggests the potential utility of the fNIRS signal as a diagnostic biomarker for ADHD children.

Effects of Adversities during Childhood on Anxiety Symptoms in Children and Adolescents: Comparison of Typically Developing Children and Attention-Deficit/ Hyperactivity Disorder Group

Objectives@#Childhood adversity is a risk factor for anxiety symptoms, but it affects anxiety symptoms in attention-deficit/hyperactivity disorder (ADHD). The current study aimed to examine the association between childhood adversity and anxiety symptoms in participants with and without ADHD. @*Methods@#Data were obtained from a school-based epidemiological study of 1017 randomly selected children and adolescents. The ADHD and non-ADHD groups were divided using the Diagnostic Interview Schedule for Children Predictive Scale (DPS). The DPS was also used to assess comorbidities such as anxiety and mood disorders. The childhood adversities were assessed using the Early Trauma Inventory Self Report-Short Form, and the anxiety symptoms were assessed using the Screen for Child Anxiety Related Disorders. Linear and logistic regression models were used to investigate the association between childhood adversity and anxiety in the ADHD and non-ADHD groups with adjustments for age and sex. @*Results@#This study found that the ADHD group did not show any significant association between anxiety symptoms and childhood adversities, whereas the non-ADHD group always showed a significant association. In a subgroup analysis of the non-ADHD group, the normal group without any psychiatric disorders assessed with DPS demonstrated a statistically significant association between childhood adversities and anxiety symptoms. These results were consistent with the association between childhood adversities and anxiety disorders assessed using DPS, as shown by logistic regression. @*Conclusion@#The association between anxiety symptoms and childhood adversities statistically disappears in ADHD; ADHD may mask or block the association. Further longitudinal research is necessary to investigate this relationship.

Effects of Adversities during Childhood on Anxiety Symptoms in Children and Adolescents: Comparison of Typically Developing Children and Attention-Deficit/ Hyperactivity Disorder Group

Objectives@#Childhood adversity is a risk factor for anxiety symptoms, but it affects anxiety symptoms in attention-deficit/hyperactivity disorder (ADHD). The current study aimed to examine the association between childhood adversity and anxiety symptoms in participants with and without ADHD. @*Methods@#Data were obtained from a school-based epidemiological study of 1017 randomly selected children and adolescents. The ADHD and non-ADHD groups were divided using the Diagnostic Interview Schedule for Children Predictive Scale (DPS). The DPS was also used to assess comorbidities such as anxiety and mood disorders. The childhood adversities were assessed using the Early Trauma Inventory Self Report-Short Form, and the anxiety symptoms were assessed using the Screen for Child Anxiety Related Disorders. Linear and logistic regression models were used to investigate the association between childhood adversity and anxiety in the ADHD and non-ADHD groups with adjustments for age and sex. @*Results@#This study found that the ADHD group did not show any significant association between anxiety symptoms and childhood adversities, whereas the non-ADHD group always showed a significant association. In a subgroup analysis of the non-ADHD group, the normal group without any psychiatric disorders assessed with DPS demonstrated a statistically significant association between childhood adversities and anxiety symptoms. These results were consistent with the association between childhood adversities and anxiety disorders assessed using DPS, as shown by logistic regression. @*Conclusion@#The association between anxiety symptoms and childhood adversities statistically disappears in ADHD; ADHD may mask or block the association. Further longitudinal research is necessary to investigate this relationship.

Association between BDNF and Antidepressant Effects of Exercise in Youth: A Preliminary Study

OBJECTIVES: The purpose of this study was to evaluate anti-depressive effects of exercise on child and adolescent and its association with brain derived neurotrophic factor (BDNF). METHODS: Twenty nine middle school boys (age 13.3±0.7) were divided into two groups, 15 boys for control group and 14 in the experimental group. The control group participated in a regular exercise program, 3 times a week for 15 weeks. During the same period, the experimental group participated in an aerobic exercise program specifically designed to enhance anti-depressive effect of exercise. Serum BDNF level and its performance of each group on the Beck Depression Index (BDI), Children's Depression Inventory (CDI), Screen for Child Anxiety Related Emotional Disorders (SCARED), Aggression Questionnaire (AK-Q), and Stroop task were compared before and after the exercise program. RESULTS: Scores of BDI, CDI, SCARED, and AK-Q were significantly lower in both groups after the exercise programs compared to those before the programs. The Stroop task performances were significantly improved after the programs. However, there were no significant differences between two exercise programs, except SCARED separation anxiety, AK-Q physical, and verbal aggression scores. Also, no association was found between serum BDNF level and anti-depressive effects of exercise. CONCLUSION: Our preliminary results suggest a possible effect of exercise on depression, anxiety, aggression, and cognition of child and adolescents.