Neurophysiological and behavioral correlates of alertness impairment and compensatory processes in ADHD evidenced by the Attention Network Test.

In Attention Deficit Hyperactivity disorder (ADHD), fMRI studies show asymmetric alterations: widespread hypoactivation in anterior cortical areas and hyperactivation in some posterior regions, and the latter is considered to be related to compensatory processes. In Posner's attentional networks, an important role is attributed to functional interhemispheric asymmetries. The psychophysiological Attention Network Test (ANT), which measures the efficiency of the alerting, orienting, and executive networks, seems particularly informative for ADHD. Potentials related to ANT stimuli (ANT-RPs) have revealed reduced cognitive potential P3 in ADHD. However, there are no studies associated with asymmetry of ANT-RPs. In the present study, conducted with 20 typically developing boys and 19 boys with ADHD, aged 11-13 years, the efficiency of the three Posner's networks regarding performance and amplitude asymmetries in ANT-RPs was evaluated according to the arithmetic difference of these parameters between different cue and target presentation conditions. The results were correlated to Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) scores. Regarding accuracy and intraindividual variation in reaction time, ADHD subjects showed lower efficiency of executive and alerting network, and this effect was correlated with DSM. Regarding alerting network, ANT-RPs in ADHD did not have the right-side amplitude prevalence in the temporal regions, which was observed in controls. In all ANT conditions, significantly higher asymmetries were observed in ADHD than in controls in the occipital regions 40-200 ms after target onset. Their amplitude in ADHD subjects was inversely proportional to DSM scores of inattentiveness and directly proportional to accuracy and efficiency of the executive network. The results suggest impaired alerting and executive networks in ADHD and compensatory occipital mechanisms.

Estimating biological accuracy of DSM for attention deficit/hyperactivity disorder based on multivariate analysis for small samples.

OBJECTIVE: To estimate whether the "Diagnostic and Statistical Manual of Mental Disorders" (DSM) is biologically accurate for the diagnosis of Attention Deficit/ Hyperactivity Disorder (ADHD) using a biological-based classifier built by a special method of multivariate analysis of a large dataset of a small sample (much more variables than subjects), holding neurophysiological, behavioral, and psychological variables. METHODS: Twenty typically developing boys and 19 boys diagnosed with ADHD, aged 10-13 years, were examined using the Attentional Network Test (ANT) with recordings of event-related potentials (ERPs). From 774 variables, a reduced number of latent variables (LVs) were extracted with a clustering of variables method (CLV), for further reclassification of subjects using the k-means method. This approach allowed a multivariate analysis to be applied to a significantly larger number of variables than the number of cases. RESULTS: From datasets including ERPs from the mid-frontal, mid-parietal, right frontal, and central scalp areas, we found 82% of agreement between DSM and biological-based classifications. The kappa index between DSM and behavioral/psychological/neurophysiological data was 0.75, which is regarded as a "substantial level of agreement". DISCUSSION: The CLV is a useful method for multivariate analysis of datasets with much less subjects than variables. In this study, a correlation is found between the biological-based classifier and the DSM outputs for the classification of subjects as either ADHD or not. This result suggests that DSM clinically describes a biological condition, supporting its validity for ADHD diagnostics.

Visuospatial information processing load and the ratio between parietal cue and target P3 amplitudes in the Attentional Network Test.

In ERP studies of cognitive processes during attentional tasks, the cue signals containing information about the target can increase the amplitude of the parietal cue P3 in relation to the 'neutral' temporal cue, and reduce the subsequent target P3 when this information is valid, i.e. corresponds to the target's attributes. The present study compared the cue-to-target P3 ratios in neutral and visuospatial cueing, in order to estimate the contribution of valid visuospatial information from the cue to target stages of the task performance, in terms of cognitive load. The P3 characteristics were also correlated with the results of individuals' performance of the visuospatial tasks, in order to estimate the relationship of the observed ERP with spatial reasoning. In 20 typically developing boys, aged 10-13 years (11.3±0.86), the intelligence quotient (I.Q.) was estimated by the Block Design and Vocabulary subtests from the WISC-III. The subjects performed the Attentional Network Test (ANT) accompanied by EEG recording. The cued two-choice task had three equiprobable cue conditions: No cue, with no information about the target; Neutral (temporal) cue, with an asterisk in the center of the visual field, predicting the target onset; and Spatial cues, with an asterisk in the upper or lower hemifield, predicting the onset and corresponding location of the target. The ERPs were estimated for the mid-frontal (Fz) and mid-parietal (Pz) scalp derivations. In the Pz, the Neutral cue P3 had a lower amplitude than the Spatial cue P3; whereas for the target ERPs, the P3 of the Neutral cue condition was larger than that of the Spatial cue condition. However, the sums of the magnitudes of the cue and target P3 were equal in the spatial and neutral cueing, probably indicating that in both cases the equivalent information processing load is included in either the cue or the target reaction, respectively. Meantime, in the Fz, the analog ERP components for both the cue and target stimuli did not depend on the cue condition. The results show that, in the parietal site, the spatial cue P3 reflects the processing of visuospatial information regarding the target position. This contributes to the subsequent "decision-making", thus reducing the information processing load on the target response, which is probably reflected in the lower P3. This finding is consistent with the positive correlation of parietal cue P3 with the individual's ability to perform spatial tasks as scored by the Block Design subtest.