Effects of general anaesthesia in early childhood on local and global visual processing: a post hoc analysis of the APEX cohort study.

BACKGROUND: Preclinical studies suggest that early exposure to anaesthesia alters the visual system in mice and non-human primates. We investigated whether exposure to general anaesthesia leads to visual attention processing changes in children, which could potentially impact essential life skills, including learning. METHODS: This was a post hoc analysis of data from the APprentissages EXécutifs et cerveau chez les enfants d'âge scolaire (APEX) cohort study. A total of 24 healthy 9-10-yr-old children who were or were not exposed to general anaesthesia (for surgery) by a mean age of 3.8 (2.6) yr performed a visual attention task to evaluate ability to process either local details or general global visual information. Whether children were distracted by visual interference during global and local information processing was also assessed. RESULTS: Participants included in the analyses (n=12 participants exposed to general anaesthesia and n=12 controls) successfully completed (>90% of correct answers) the trial tasks. Children from both groups were equally distracted by visual interference. However, children who had been exposed to general anaesthesia were more attracted to global visual information than were control children (P=0.03). CONCLUSIONS: These findings suggest lasting effects of early-life exposure to general anaesthesia on visuospatial abilities. Further investigations of the mechanisms by which general anaesthesia could have delayed effects on how children perceive their visual environment are needed.

Consequences of General Anesthesia in Infancy on Behavior and Brain Structure.

BACKGROUND: One in 7 children will need general anesthesia (GA) before the age of 3. Brain toxicity of anesthetics is controversial. Our objective was to clarify whether exposure of GA to the developing brain could lead to lasting behavioral and structural brain changes. METHODS: A first study was performed in mice. The behaviors (fear conditioning, Y-maze, and actimetry) and brain anatomy (high-resolution magnetic resonance imaging) of 6- to 8-week-old Swiss mice exposed or not exposed to GA from 4 to 10 days old were evaluated. A second study was a complementary analysis from the preexisting APprentissages EXécutifs et cerveau chez les enfants d'âge scolaire (APEX) cohort to assess the replicability of our data in humans. The behaviors (behavior rating inventory of executive function, emotional control, and working memory score, Backward Digit Span, and Raven 36) and brain anatomy (high-resolution magnetic resonance imaging) were compared in 102 children 9 to 10 years of age exposed or not exposed to a single GA (surgery) during infancy. RESULTS: The animal study revealed chronic exacerbated fear behavior in the adult mice (95% confidence interval [CI], 4-80; P = .03) exposed to postnatal GA; this was associated with an 11% (95% CI, 7.5-14.5) reduction of the periaqueductal gray matter (P = .046). The study in humans suggested lower emotional control (95% CI, 0.33-9.10; P = .06) and a 6.1% (95% CI, 4.3-7.8) reduction in the posterior part of the right inferior frontal gyrus (P = .019) in the children who had been exposed to a single GA procedure. CONCLUSIONS: The preclinical and clinical findings of these independent studies suggest lasting effects of early life exposure to anesthetics on later emotional control behaviors and brain structures.

Differential effects of mindfulness meditation and cognitive training on cool and hot inhibitory control in children and adolescents.

Inhibitory control (IC) can occur either in a neutral context (cool) or in social contexts involving emotions (hot). Cool and hot IC have specific developmental trajectories; cool IC develops linearly from childhood to adulthood, whereas hot IC follows a quadratic trajectory. Some activities can improve the IC, such as cognitive training (CT) and mindfulness meditation (MM). The aim of our study was to compare the effects of 5 weeks of computerized MM versus CT on IC performance in 66 children (9-10 years old) and 63 adolescents (16-17 years old) by specifically analyzing cool and hot dimensions in the same participants and from a developmental perspective. We fit a linear mixed-effect model on the Stroop interference score with time (pretest vs. posttest) and type of conflict (cool vs. hot) as within-participant factors and intervention group (CT vs. MM) and age group (child vs. adolescent) as between-participant factors. The findings revealed that children but not adolescents benefitted from interventions. More specifically, CT improved cool IC but not hot IC, whereas MM practice improved hot IC but not cool IC. This study supports the benefits of MM at a young age. Theoretical issues linking MM programs to emotional competence grounded in hot IC skills are considered in academic settings.

Inhibitory control and the understanding of buoyancy from childhood to adulthood.

Intuitive conceptions represent common obstacles to conceptual learning in science. A growing number of studies demonstrate that when learning occurs, these intuitive conceptions are not replaced by scientific conceptions but rather coexist with them and thus need to be inhibited to prevent systematic errors. However, to date no study has demonstrated that the increasing ability to mobilize a given scientific conception is rooted in the increasing ability to inhibit the intuitive conception that interferes with it. In the current study, we investigated whether the increasing ability from childhood to adulthood to solve a scientific problem regarding the buoyancy of marbles of different sizes and densities is rooted in the increasing ability to inhibit the "bigger objects sink more" intuitive conception. To do so, we designed a negative priming paradigm in which 11-year-old children, 17-year-old adolescents, and 24-year-old adults were asked to choose which of two marbles of various sizes and densities sinks more. Negative priming effects reported in children and adolescents suggest that, unlike adults, they must inhibit the "bigger objects sink more" intuitive conception to determine, for instance, that a small marble with high density (e.g., small lead marble) will sink more than a bigger marble with a lower density (e.g., big wooden marble). We also found that the amplitude of negative priming effects decreased with age, suggesting that the level of exposition to the scientific knowledge of buoyancy (increasing with age) may decrease the need to inhibit the "bigger objects sink more" intuitive conception.

The forest, the trees, and the leaves in preterm children: the impact of prematurity on a visual search task containing three-level hierarchical stimuli.

Very preterm (VPT; < 33 gestational weeks) children are at risk of developing visuospatial deficits, including local/global attention deficits. They are also more likely to develop poorer inhibitory control. Here, we investigated, using the same stimuli, the potential local/global attention and inhibitory control deficits of VPT children using three levels compound stimuli (global, intermediate, and local levels), more ecological than the ones used in a classic global/local task (Navon task). We compared the results from 22 VPT children to those of a control group of 21 children to investigate (1) how VPT children processed compound stimuli with three-level information and (2) how inhibitory control in a visual task differs between VPT and control children. The results revealed that VPT children had no difficulty processing information presented at the local level. By contrast, VPT children were impaired when considering the intermediate and global levels of processing in comparison to control children. Finally, a reduced efficiency in VPT children in inhibiting visual distractors was evidenced for the conditions with a larger number of distractors. These results are discussed in terms of neurodevelopmental disorders of both dorsal stream (global visual processing) and prefrontal regions (inhibitory control) in VPT children. Given the central role of visuospatial and inhibitory control in day-to-day situations, the present results provide important clues for pedagogical implications regarding the organization of visual information presented to VPT children.

Complex and subtle structural changes in prefrontal cortex induced by inhibitory control training from childhood to adolescence.

A number of training interventions have been designed to improve executive functions and inhibitory control (IC) across the lifespan. Surprisingly, no study has investigated the structural neuroplasticity induced by IC training from childhood to late adolescence, a developmental period characterized by IC efficiency improvement and protracted maturation of prefrontal cortex (PFC) subregions involved in IC. The aim of the present study was to investigate the behavioral and structural changes induced by a 5-week computerized and adaptive IC training in school-aged children (10-year-olds) and in adolescents (16-year-olds). Sixty-four children and 59 adolescents were randomly assigned to an IC (i.e. Color-Word Stroop and Stop-Signal tasks) or an active control (AC) (knowledge- and vocabulary-based tasks) training group. In the pre- and posttraining sessions, participants performed the Color-Word Stroop and Stop-signal tasks, and an anatomical resonance imaging (MRI) was acquired for each of them. Children's IC efficiency improved from the pre- to the posttraining session in boys but not in girls. In adolescents, IC efficiency did not improve after IC training. Similar to the neuroplastic mechanisms observed during brain maturation, we observed IC training-related changes in cortical thickness and cortical surface area in several PFC subregions (e.g. the pars opercularis, triangularis, and orbitalis of the inferior frontal gyri) that were age- and gender-specific. Because no correction for multiple comparisons was applied, the results of our study provide only preliminary evidence of the complex structural neuroplastic mechanisms at the root of behavioral changes in IC efficiency from pre- to posttraining in school-aged children and adolescents.

Evidence for the role of inhibition in numerical comparison: A negative priming study in 7- to 8-year-olds and adults.

Adapting a numerical comparison task to a negative priming paradigm, we aimed to provide new evidence that inhibitory control processes are involved in numerical comparison. We observed negative priming effects in both 7- to 8-year-olds (n = 47, Mage = 7.92 years) and adults (n = 33, Mage = 27.86 years), confirming that inhibition of irrelevant dimensions of magnitude is needed in numerical estimation at both ages. In addition, the amplitude of the negative priming effect was larger in children, in line with recent accounts suggesting that numerical development is rooted in part in the improvement of inhibitory control abilities. Our findings have educational implications for the investigation of the predictive values of numerical intuitions and executive functions for math achievement.

Inhibition of the whole number bias in decimal number comparison: A developmental negative priming study.

A major source of errors in decimal magnitude comparison tasks is the inappropriate application of whole number rules. Specifically, when comparing the magnitude of decimal numbers and the smallest number has the greatest number of digits after the decimal point (e.g., 0.9 vs. 0.476), using a property of whole numbers such as "the greater the number of digits, the greater its magnitude" may lead to erroneous answers. By using a negative priming paradigm, the current study aimed to determine whether the ability of seventh graders and adults to compare decimals where the smallest number has the greatest number of digits after the decimal point was partly rooted in the ability to inhibit the "the greater the number of digits, the greater its magnitude" misconception. We found that after participants needed to compare decimal numbers in which the smallest number has the greatest number of digits after the decimal point (e.g., 0.9 vs. 0.476), they were less efficient at comparing decimal numbers in which the largest number has the greatest number of digits after the decimal point (e.g., 0.826 vs. 0.3) than they were after comparing decimal numbers with the same number of digits after the decimal point (e.g., 0.981 vs. 0.444). The negative priming effects reported in seventh graders and adults suggest that inhibitory control is needed at all ages to avoid errors when comparing decimals where the smallest number has the greatest number of digits after the decimal point.

Adolescents' inhibitory control: keep it cool or lose control.

Inhibitory control (i.e., the ability to resist automatisms, temptations, distractions, or interference and to adapt to conflicting situations) is a determinant of cognitive and socio-emotional development. In light of the discrepancies of previous findings on the development of inhibitory control in affectively charged contexts, two important issues need to be addressed. We need to determine (a) whether cool inhibitory control (in affectively neutral contexts) and hot inhibitory control (in affectively charged contexts) follow the same developmental pattern and (b) the degree of specificity of these two types of inhibitory control at different ages. Thus, in the present study, we investigated the developmental patterns of cool and hot inhibitory control and the degree of specificity of these abilities in children, adolescents and adults. Typically developing children, adolescents, and adults performed two Stroop-like tasks: an affectively neutral one (Cool Stroop task) and an affectively charged one (Hot Stroop task). In the Cool Stroop task, the participants were asked to identify the ink color of the words independent of color that the words named; in the Hot Stroop task, the participants were asked to identify the emotional expression of a face independent of the emotion named by a simultaneously displayed written word. We found that cool inhibitory control abilities develop linearly with age, whereas hot inhibitory control abilities follow a quadratic developmental pattern, with adolescents displaying worse hot inhibitory control abilities than children and adults. In addition, cool and hot inhibitory control abilities were correlated in children but not in adolescents and adults. The present study suggests (a) that cool and hot inhibitory control abilities develop differently from childhood to adulthood - i.e., that cool inhibition follows a linear developmental pattern and hot inhibition follows an adolescent-specific pattern - and (b) that they become progressively more domain-specific with age.

Stop in the name of lies: The cost of blocking the truth to deceive.

Most researchers assume that deception involves a conflict between a predominant truth response and a deliberate deceptive response. Such a view is consistent with dual process theories that state that high-order cognition operates through fast-automatic processes that may conflict with slow-deliberate ones. In the present study, we tested whether one must inhibit the truth to deceive in light of inconsistent findings in the literature. One hundred and eighty-nine participants were tested across two Negative Priming paradigms that rest on the logic that the activation of a fast-automatic process will be hampered on a given display if it is inhibited on the previous display. Our findings suggest that truthful responses are predominant in healthy adults, which is why inhibitory control is required to activate a deliberate deceptive mode. We argue that the findings from deception studies could be best accounted for by dual process theories.

Children inhibit global information when the forest is dense and local information when the forest is sparse.

Visual environments are composed of global shapes and local details that compete for attentional resources. In adults, the global level is processed more rapidly than the local level, and global information must be inhibited in order to process local information when the local information and global information are in conflict. Compared with adults, children present less of a bias toward global visual information and appear to be more sensitive to the density of local elements that constitute the global level. The current study aimed, for the first time, to investigate the key role of inhibition during global/local processing in children. By including two different conditions of global saliency during a negative priming procedure, the results showed that when the global level was salient (dense hierarchical figures), 7-year-old children and adults needed to inhibit the global level to process the local information. However, when the global level was less salient (sparse hierarchical figures), only children needed to inhibit the local level to process the global information. These results confirm a weaker global bias and the greater impact of saliency in children than in adults. Moreover, the results indicate that, regardless of age, inhibition of the most salient hierarchical level is systematically required to select the less salient but more relevant level. These findings have important implications for future research in this area.

Predominance of lateral over vertical mirror errors in reading: A case for neuronal recycling and inhibition.

We investigated whether lateral mirror errors could be more prevalent than vertical mirror errors (e.g., p/q vs. p/b confusions) because mirror generalization is harder to inhibit for the discrimination of a reversible letter and its lateral than its vertical mirror-image counterpart. Expert adult readers performed a negative priming task in which they determined on the prime whether two letters and on the probe whether two objects facing opposite directions were identical. We found in both experiments longer response times for objects facing opposite lateral orientations preceded by a reversible letter and its lateral mirror-image counterpart (e.g., p/q) than preceded by perceptually matched non-reversible letters (e.g., g/j). No negative priming effect was observed when objects that were vertical (Experiment 1 & 2) or lateral (Experiment 2) mirror images of each other were preceded by a letter and its vertical mirror-image counterpart (e.g. p/b). Finally, we observed longer response times for objects that were lateral mirror images of each other after lateral than after vertical reversible letters. These results suggest that lateral mirror errors are more prevalent than vertical ones because mirror generalization might be stronger and thus more difficult to inhibit in the context of the former than the latter.

Is inhibitory control involved in discriminating pseudowords that contain the reversible letters b and d?

Children tend to confuse reversible letters such as b and d when they start learning to read. According to some authors, mirror errors are a consequence of the mirror generalization (MG) process that allows one to recognize objects independently of their left-right orientation. Although MG is advantageous for the visual recognition of objects, it is detrimental for the visual recognition of reversible letters. Previous studies comparing novice and expert readers demonstrated that MG must be inhibited to discriminate reversible single letters. In this study, we investigated whether MG must also be inhibited by novice readers to discriminate between two pseudowords containing reversible letters. Readable pseudowords, rather than words, were used to mimic early non-automatic stages of reading when reading is achieved by decoding words through grapheme-phoneme pairing and combination. We designed a negative priming paradigm in which school-aged children (10-year-olds) were asked to judge whether two pseudowords were identical on the prime and whether two animals were identical on the probe. Children required more time to determine that two animals were mirror images of each other when preceded by pseudowords containing the reversible letter b or d than when preceded by different pseudowords containing the control letter f or t (Experiment 1) or by different pseudowords that differed only by the target letter f or k (Experiment 2). These results suggest that MG must be inhibited to discriminate between pseudowords containing reversible letters, generalizing the findings regarding single letters to a context more representative of the early stages of reading.

Taking a Third-Person Perspective Requires Inhibitory Control: Evidence From a Developmental Negative Priming Study.

To determine whether the growing ability to take a third-person perspective (3PP) is explained in part by the growing ability to inhibit a first-person perspective (1PP), 10-year-old children (n = 49) and 22-year-old adults (n = 52) performed a negative priming adaptation of the own body transformation task. Both children and adults were less efficient in adopting a 1PP after they adopted a 3PP-with a smaller amplitude of the negative priming effect with older age-and adults' and children's performances in the own body transformation task were predicted in part by their Stroop interference scores. These results suggest that the growing efficiency to adopt a 3PP is rooted in part in the growing efficiency to inhibit the 1PP.

Inhibition of the mirror generalization process in reading in school-aged children.

A striking error in reading is the early and sometimes persistent confusion of mirror letters such as b and d. These mirror errors are likely a result of the mirror generalization process that allows one to identify a visual stimulus regardless of its presentation side. A previous study demonstrated that preventing mirror errors in reading requires the inhibition of the mirror generalization process in expert adult readers (Borst et al., 2015). Using the same experimental paradigm, the current study aimed at replicating this result in school-aged children. Three age groups-1st, 3rd, and 5th graders-performed a negative priming study in which they were asked to determine on the primes whether two letters were identical and on the probes whether two animals facing opposite directions were identical. All three groups of children required more time to discriminate two letters that were lateral mirror images of one another (e.g., b/d) than two letters that were not (e.g., f/t). Crucially, children required more time to determine that two animals facing opposite directions were identical when preceded by two letters that were lateral mirror images of one another (b/d) than when preceded by letters that were not mirror images of one another (f/t). Importantly, the amplitude of the negative priming effect did not vary with age. Our results suggest that overcoming mirror errors in reading, regardless of the reading proficiency of school-aged children, is rooted in the ability to inhibit the mirror generalization process.

Inhibitory Control as a Core Process of Creative Problem Solving and Idea Generation from Childhood to Adulthood.

Developmental cognitive neuroscience studies tend to show that the prefrontal brain regions (known to be involved in inhibitory control) are activated during the generation of creative ideas. In the present article, we discuss how a dual-process model of creativity-much like the ones proposed to account for decision making and reasoning-could broaden our understanding of the processes involved in creative ideas generation. When generating creative ideas, children, adolescents, and adults tend to follow "the path of least resistance" and propose solutions that are built on the most common and accessible knowledge within a specific domain, leading to fixation effect. In line with recent theory of typical cognitive development, we argue that the ability to resist the spontaneous activation of design heuristics, to privilege other types of reasoning, might be critical to generate creative ideas at all ages. In the present review, we demonstrate that inhibitory control at all ages can actually support creativity. Indeed, the ability to think of something truly new and original requires first inhibiting spontaneous solutions that come to mind quickly and unconsciously and then exploring new ideas using a generative type of reasoning.

Inhibition of misleading heuristics as a core mechanism for typical cognitive development: evidence from behavioural and brain-imaging studies.

Cognitive development is generally conceived as incremental with knowledge of increasing complexity acquired throughout childhood and adolescence. However, several studies have now demonstrated not only that infants possess complex cognitive abilities but also that older children, adolescents, and adults tend to make systematic errors even in simple logical reasoning tasks. Therefore, one of the main issues for any theory of typical cognitive development is to provide an explanation of why at some age and in some contexts children, adolescents, and adults do not express a knowledge or cognitive principle that they already acquired when they were younger. In this review, we present convergent behavioural and neurocognitive evidence that cognitive development is more similar to a non-linear dynamic system than to a linear, stage-like system. In this theoretical framework, errors can emerge in problems similar to the ones infants or young children were succeeding when older children, adolescents, and adults rely on a misleading heuristic rather than on the correct logical algorithm to solve such problems. And the core mechanism for overcoming these errors is inhibitory control (i.e. the ability to inhibit the misleading heuristics). Therefore, typical cognitive development relies not only on the ability to acquire knowledge of incremental complexity but also to inhibit previously acquired knowledge.

The shape of the ACC contributes to cognitive control efficiency in preschoolers.

Cognitive success at school and later in life is supported by executive functions including cognitive control (CC). The pFC plays a major role in CC, particularly the dorsal part of ACC or midcingulate cortex. Genes, environment (including school curricula), and neuroplasticity affect CC. However, no study to date has investigated whether ACC sulcal pattern, a stable brain feature primarily determined in utero, influences CC efficiency in the early stages of cognitive and neural development. Using anatomical MRI and three-dimensional reconstruction of cortical folds, we investigated the effect that ACC sulcal pattern may have on the Stroop score, a classical behavioral index of CC efficiency, in 5-year-old preschoolers. We found higher CC efficiency, that is, lower Stroop interference scores for both RTs and error rates, in children with asymmetrical ACC sulcal pattern (i.e., different pattern in each hemisphere) compared with children with symmetrical pattern (i.e., same pattern in both hemispheres). Critically, ACC sulcal pattern had no effect on performance in the forward and backward digit span tasks suggesting that ACC sulcal pattern contributes to the executive ability to resolve conflicts but not to the ability to maintain and manipulate information in working memory. This finding provides the first evidence that preschoolers' CC efficiency is likely associated with ACC sulcal pattern, thereby suggesting that the brain shape could result in early constraints on human executive ability.

The impact of alexithymia on pathological gamblers' decision making: a preliminary study of gamblers recruited in "sportsbook" casinos.

OBJECTIVE: We investigated whether alexithymia is at the root of the decision-making deficit classically reported in pathological gamblers. BACKGROUND: Alexithymia has been shown to be a recurrent personality trait of pathological gamblers and to impair the decision-making abilities of nonpathological gamblers, but no previous studies have investigated whether alexithymia significantly affects pathological gamblers' decision making. Although investigations of pathological gamblers typically have studied those seeking treatment, most pathological gamblers do not seek treatment. Thus, to study people representative of the general population of pathological gamblers, we conducted our study in "sportsbook" casinos with a small sample of gamblers who were not seeking treatment. METHODS: We recruited gamblers in sportsbooks and classified them based on their scores on the South Oaks Gambling Screen and the Toronto Alexithymia Scale: 3 groups of pathological gamblers (6 alexithymic, 8 possibly alexithymic, and 6 nonalexithymic) and 8 healthy controls. All of the participants completed an adaptation of the Iowa Gambling Task. RESULTS: The alexithymic group chose less advantageously on the task than the other groups. The severity of the deficit in decision-making abilities was related to the severity of alexithymia, even when we controlled for the effects of anxiety and depression. CONCLUSIONS: Our findings provide preliminary evidence that alexithymia might be a critical personality trait underlying pathological gamblers' decision-making deficits.

Sparing of spatial mental imagery in patients with hippocampal lesions.

In four experiments, we explored the capacity for spatial mental imagery in patients with hippocampal lesions, using tasks that minimized the role of learning and memory. On all four tasks, patients with hippocampal lesions performed as well as controls. Nonetheless, in separate tests, the patients were impaired at remembering the materials that had been used to assess mental imagery. The findings suggest that the hippocampus is not needed for constructing many forms of spatial imagery but is needed for the formation of long-term memory. In future studies of the neural organization of spatial mental imagery, it will be important to separate the contribution of spatial processing from the contribution of learning and memory.