Systemic therapy in children and adolescents with mental disorders: a systematic review and meta-analysis.

BACKGROUND: Systemic therapy (ST) is a psychotherapeutic intervention in complex human systems (both psychological and interpersonal). Cognitive behavioural therapy (CBT) is an established treatment for children and adolescents with mental disorders. As methodologically rigorous systematic reviews on ST in this population are lacking, we conducted a systematic review and meta-analysis to compare the benefit and harm of ST (and ST as an add-on to CBT) with CBT in children and adolescents with mental disorders. METHODS: We searched MEDLINE, Embase, PsycINFO and other sources for randomised controlled trials in 14 mental disorder classes for the above comparisons in respect of effects on patient-relevant outcomes (search date: 7/2022). Where possible, meta-analyses were performed and results were graded into 3 different evidence categories: "proof", "indication", or "hint" (or none of these categories). PRISMA standards were followed. RESULTS: Fifteen studies in 5 mental disorder classes with usable data were identified. 2079 patients (mean age: 10 to 19 years) were analysed. 12/15 studies and 29/30 outcomes showed a high risk of bias. In 2 classes, statistically significant and clinically relevant effects in favour of ST were found, supporting the conclusion of a hint of greater benefit of ST for mental and behavioural disorders due to psychoactive substance use and of ST as an add-on to CBT for obsessive-compulsive disorders. In 2 other classes (eating disorders; hyperkinetic disorders), there was no evidence of greater benefit or harm of ST. For affective disorders, a statistically significant effect to the disadvantage of ST was found for 1 outcome, supporting the conclusion of a hint of lesser benefit of ST. CONCLUSIONS: Our results show a hint of greater benefit of ST (or ST as an add-on to CBT) compared with CBT for 2 mental disorder classes in children and adolescents (mental and behavioural disorders due to psychoactive substance use, obsessive compulsive disorders). Given the importance of CBT as a control intervention, ST can therefore be considered a beneficial treatment option for children and adolescents with certain mental disorders. Limitations include an overall high risk of bias of studies and outcomes and a lack of data for several disorders.

["I Would Never have done it Without Coercion " - Experiences with Coercion and Compulsion in a Family Psychiatric and Psychotherapeutic Day Clinic]. / "Freiwillig hätt' ich's nicht gemacht " ­ Erfahrungen mit Zwangskontexten und erzwungenen Aufenthalten in einer familienpsychiatrischen und -psychotherapeutischen Tagesklinik.

"I Would Never have done it Without Coercion …" - Experiences with Coercion and Compulsion in a Family Psychiatric and Psychotherapeutic Day Clinic Coercion and compulsion have negative connotations, especially in psychiatric therapy. But in families, children are always also affected if parents do not want or are not able to make use of therapy. The avoidance of therapy can be a symptom of illness, e. g. separation anxiety. Perceived or real external coercion, e. g. from the youth welfare office or school, can be used to initially open up access to therapy and to allow parents to become capable of acting again. Coercion can initially reduce the ambivalence of the parents. The Family Therapeutic Centre (FaTZ) is a psychiatric and psychotherapeutic day clinic for parents and children. Family constellations are described in which initial coercion was a door-opener to therapy. During courses of treatment therapeutic alliances could be established, hope for positive change emerged, and the outcome was favourable. School avoidance of the child (e. g. due to separation anxiety) in combination with mentally ill parents is an exemplary constellation in which initial coercion can pave the way to therapy for families that otherwise wouldn't get access. Afterwards, voluntary cooperation should be intended, as the overriding objective is to reduce coercive measures to a minimum.

[Family Psychiatry - The Attachment-Focused, Systemic-Oriented, Integrative Concept of the Family Therapy Centre (FaTC), an Acute Multi-Family Day Clinic]. / Familienpsychiatrie ­ bindungsorientiert, systemisch ausgerichtet, integrativ im akut-tagesklinischen Mehrfamiliensetting: Das FaTZ-Konzept.

Family Psychiatry - The Attachment-Focused, Systemic-Oriented, Integrative Concept of the Family Therapy Centre (FaTC), an Acute Multi-Family Day Clinic Up to three quarters of the children of mentally ill parents develop a mental disorder during their lifetime. The transmission occurs essentially through dysfunctional interaction and disturbed attachment. Parent-child interaction is characterized by a vicious circle of escalating symptoms in the child and increasing helplessness in the parents. For this family psychiatric approaches are helpful, which address the interaction in addition to the individual disorders. The Family Therapy Centre (FaTC) Neckargemünd offers family psychiatric, integrated therapy for parents and children in an acute day clinic multi-family setting. The basic therapeutic principles are attachment orientation, mentalisation and systemic perspective with a multi-family therapy approach. Typical family psychiatric case constellations are presented, for which the concept seems particularly helpful: (1) Early childhood regulatory disorders in interaction with mentally ill parents, (2) mother with PTSD and expansive-aggressive preschool child and (3) adolescents with separation anxiety and depressive-anxious mother. The previous experiences are reflected by a moderated focus group of the entire FaTC team. The FaTC concept was evaluated as very helpful. It was positively judged that the family system is visibly present on site (and not only virtually). The focus is on interaction, therefore causal therapy can be offered rather than symptomatic treatment. Limitations of the concept are therapy of severely aggressive adolescents or parents who do not want to participate. The concept of the FaTC is currently being scientifically evaluated.

Time course of facial emotion processing in women with borderline personality disorder: an ERP study.

BACKGROUND: Borderline personality disorder (BPD) is characterized by a negative perception of others. Previous studies have revealed deficits and biases in facial emotion recognition. This study investigates the behavioural and electrophysiological correlates underlying facial emotion processing in individuals with BPD. METHODS: The present study was conducted between July 2012 and May 2014. In an emotion classification task, unmedicated female patients with BPD as well as healthy women had to classify faces displaying blends of anger and happiness while the electroencephalogram was recorded. We analyzed visual event-related potentials (ERPs) reflecting early (P100), structural (N170) and categorical (P300) facial processing in addition to behavioural responses. RESULTS: We included 36 women with BPD and 29 controls in our analysis. Patients with BPD were more likely than controls to classify predominantly happy faces as angry. Independent of facial emotion, women with BPD showed enhanced early occipital P100 amplitudes. Additionally, temporo-occipital N170 amplitudes were reduced at right hemispherical electrode sites. Centroparietal P300 amplitudes were reduced particularly for predominantly happy faces and increased for highly angry faces in women with BPD, whereas in healthy volunteers this component was modulated by both angry and happy facial affect. LIMITATIONS: Our sample included only women, and no clinical control group was investigated. CONCLUSION: Our findings suggest reduced thresholds for facial anger and deficits in the discrimination of facial happiness in individuals with BPD. This biased perception is associated with alterations in very early visual as well as deficient structural and categorical processing of faces. The current data could help to explain the negative perception of others that may be related to the patients' impairments in interpersonal functioning.

Visual N80 latency as a marker of neuropsychological performance in schizophrenia: Evidence for bottom-up cognitive models.

OBJECTIVE: Cognitive deficits and visual impairment in the magnocellular (M) pathway, have been independently reported in schizophrenia. The current study examined the association between neuropsychological (NPS) performance and visual evoked potentials (VEPs: N80/P1 to M- and P(parvocellular)-biased visual stimuli) in schizophrenia and healthy controls. METHODS: NPS performance and VEPs were measured in n = 44 patients and n = 34 matched controls. Standardized NPS-scores were combined into Domains and a PCA (Principal Component Analysis) generated Composite. Group differences were assessed via (M)ANOVAs, association between NPS and VEP parameters via PCA, Pearson's coefficient and bootstrapping. Logistic regression was employed to assess classification power. RESULTS: Patients showed general cognitive impairment, whereas group differences for VEP-parameters were non-significant. In patients, N80 latency across conditions loaded onto one factor with cognitive composite, showed significant negative correlations of medium effect sizes with NPS performance for M/P mixed stimuli and classified low and high performance with 70% accuracy. CONCLUSION: The study provides no evidence for early visual pathway impairment but suggests a heightened association between early visual processing and cognitive performance in schizophrenia. SIGNIFICANCE: Our results lend support to bottom-up models of cognitive function in schizophrenia and implicate visual N80 latency as a potential biomarker of cognitive deficits in schizophrenia.

Perception of facial expressions of emotion in migraine.

Both lower-level perceptual changes and especially higher-level cognitive alterations in individuals with migraine are poorly understood. Here, we behaviorally and electrophysiologically investigated the perception of emotional facial expressions in migraine. Young female individuals with migraine and healthy controls watching neutral faces gradually shifting to either happy, fearful, or angry expressions were asked to classify the facial expressions as quickly and accurately as possible by pressing a corresponding button, and to keep looking at the face until the last frame disappeared. Migraine individuals, compared to healthy controls, had a reduced habituation in the N170 time interval towards a gradually emerging emotional expression. The early P1, the early posterior negativity (EPN), and the late positive potential (LPP) amplitudes were not statistically different between groups and among expressions. The mean reaction time for recognizing an expression did not differ between groups and it was not at a cost of more incorrect responses. Interestingly, the amplitude of the early posterior negativity correlated negatively with the time interval since the last attack. It is concluded that young female individuals with migraine, compared to healthy controls, do not show a biased emotional facial processing toward positive or negative expressions.

The association of self-injurious behaviour and suicide attempts with recurrent idiopathic pain in adolescents: evidence from a population-based study.

BACKGROUND: While several population-based studies report that pain is independently associated with higher rates of self-destructive behaviour (suicidal ideation, suicide attempts, and self-injurious behaviour) in adults, studies in adolescents are rare and limited to specific chronic pain conditions. The aim of this study was to investigate the link between self-reported idiopathic pain and the prevalence and frequency of self-injury (SI) and suicide attempts in adolescents. METHODS: Data from a cross-sectional, school-based sample was derived to assess SI, suicide attempts, recurrent pain symptoms and various areas of emotional and behavioural problems via a self-report booklet including the Youth Self-Report (YSR). Adolescents were assigned to two groups (presence of pain vs. no pain) for analysis. Data from 5,504 students of 116 schools in a region of South Western Germany was available. A series of unadjusted and adjusted multinomial logistic regression models were performed to address the association of pain, SI, and suicide attempts. RESULTS: 929 (16.88%) respondents reported recurrent pain in one of three areas of pain symptoms assessed (general pain, headache, and abdominal pain). Adolescents who reported pain also reported greater psychopathological distress on all sub-scales of the YSR. The presence of pain was significantly associated with an increased risk ratio (RR) for SI (1-3 incidences in the past year: RR: 2.96; >3 incidences: RR: 6.04) and suicide attempts (one attempt: RR: 3.63; multiple attempts: RR: 5.4) in unadjusted analysis. Similarly, increased RR was observed when adjusting for sociodemographic variables. While controlling for psychopathology attenuated this association, it remained significant (RRs: 1.4-1.8). Sub-sequent sensitivity analysis revealed different RR by location and frequency of pain symptoms. CONCLUSIONS: Adolescents with recurrent idiopathic pain are more likely to report previous incidents of SI and suicide attempts. This association is likely mediated by the presence of psychopathological distress as consequence of recurrent idiopathic pain. However, the observed variance in dependent variables is only partially explained by emotional and behavioural problems. Clinicians should be aware of these associations and interview adolescents with recurrent symptoms of pain for the presence of self-harm, past suicide attempts and current suicidal thoughts. Future studies addressing the neurobiology underpinnings of an increased likelihood for self-injurious behaviour and suicide attempts in adolescents with recurrent idiopathic pain are necessary.

Pattern-reversal visual-evoked potentials in children with migraine and other primary headache: evidence for maturation disorder?

Recently, evidence for a disturbed maturation of cerebral information processing in migraine came from studies investigating the auditory-evoked contingent negative variation and the auditory-evoked potential from childhood to adulthood. This study is to clarify whether age-dependent development is altered also for the processing of visual stimuli in migraine. Components of pattern-reversal visual-evoked potentials at four different spatial frequencies (which can preferentially activate the magno- and the parvocellular visual system) were compared between children aged 6 and 18 years with primary headache (N = 123; 67 migraine without aura, MO; 32 migraine with aura, MA; 24 tension-type headache, TH) in the headache-free interval and healthy controls (N = 82). Children were divided into two age groups: 6-11 years (pre- and early puberty) and 12-18 years (late and post-puberty). Age-dependent development was normal for N80 and P100 latency in children with primary headache, but altered for N135 latency as indicated by a significant interaction among the factors diagnosis, spatial frequency and age group (P < 0.01). In headache-free controls, N135 latency reduction between pre- and post-puberty age was most pronounced at high spatial frequency. The main 'decline' of N135 latency with increasing age was shifted to lower spatial frequencies in the headache subgroups. The results give evidence that maturation of visual processing is partly disturbed in migraineurs.

Motor processing after movement execution as revealed by evoked and induced activity.

Event-related synchronization (ERS) in the beta frequency band following movement execution has shown that motor processing is not completed yet when a movement ends. It is known that induced and evoked activities reflect different aspects of cortical processing which may result in different time courses. In the current study, we analyzed topography of postimperative negative variation (PINV) in 39 healthy right-handed adolescents in an acoustic forewarned reaction time (contingent negative variation, CNV) task using a 64-electrode high-density sensor array. We dissociated different PINV components in their time course from postmovement beta ERS in order to provide fundamental knowledge about evoked and induced EEG components after movement execution as a basis for further analysis of postmovement processing. A postmovement negativity occurred from about 500 to 1200 ms after the imperative stimulus (peaking about 600 ms after a right-hand button press) at central electrodes, contralateral to the response movement side. Current source density (CSD) analysis confirmed the current sinks over motor areas [contralateral primary motor/premotor and supplementary/cingulate motor area]. The described DC component (motor PINV, mPINV) differed in time course and localization from later "classical" PINV (cPINV) which is thought to reflect contingency reappraisal. mPINV could also be distinguished topographically from a mere delayed CNV resolution. When mPINV and ERS at the same left central electrode were compared, both parameters showed different time courses. Left central mPINV rather paralleled ERS at midcentral electrodes. Therefore, we suggest that the topography of mPINV provides first hints towards an involvement of contralateral primary motor cortex in postmovement processing beyond a mere idling state as reflected by later beta ERS. mPINV could be a useful tool to investigate the role of primary motor cortex in motor-learning processes. The combined analysis of induced and evoked activities seems to be able to elucidate different aspects of cortical connectivity and motor processes following movement.

Specific task anticipation versus unspecific orienting reaction during early contingent negative variation.

OBJECTIVE: To investigate whether a warning stimulus in a forewarned reaction time task elicits only an unspecific orienting reaction or task specific motor cortex activity. METHODS: We examined the time-course of alpha event-related desynchronization (ERD) as an indicator for primary motor cortex activation in an auditory contingent negative variation (CNV) paradigm with an interstimulus interval of 3 s in healthy subjects between 6 and 18 years using a 64 channel high-density sensor array. RESULTS: We replicated a wide frontal distribution for the initial CNV component (iCNV), while only during late CNV (lCNV) a centro-parietal negativity resembling the 'Bereitschaftspotential' occurred. However, an early alpha-ERD over the central area contralateral to the side of the response movement followed the imperative stimulus already during the iCNV-interval. This early alpha-ERD was highly significantly lateralised and was even more prominent during iCNV than during lCNV indicating an activation of the contralateral sensorimotor cortex already during iCNV. CONCLUSIONS: We conclude that early task specific preparatory motor processes (which might reflect the retrieval of a motor program from memory) were elicited by the warning stimulus. These preparatory processes clearly exceeded an unspecific orienting reaction as early alpha-ERD was influenced by the side of the anticipated movement.

Object recognition deficit in early- and adult-onset schizophrenia regardless of age at disease onset.

Perceptual closure is the ability of the brain to recognize a complete object based on fragmentary information and has been known to be impaired in schizophrenia. Here, the neural integrity of perceptual closure in schizophrenia with different disease onsets was evaluated by examining the generation of event-related potential (ERP) components (P100, N180, and N(cl)). ERPs were recorded from 40 patients (19 early-onset schizophrenia, "EOS" and 21 adult-onset schizophrenia, "AOS") and 40 age-matched healthy volunteers. Brain electric source analysis (BESA) was applied to localize the cerebral generators underlying perceptual closure. Patients showed an impaired generation of N(cl) and P100 components. P100 and N(cl) amplitudes were significantly reduced in both AOS and EOS (P<0.01). Moreover, N180 and N(cl) amplitudes were significantly increased with age in controls and patients (P<0.01). In the case of the N(cl), there was also a significant interaction (P<0.001) between age and group, indicating a greater age-dependent N(cl) increase in controls compared to patients. Visual information processing during perceptual closure is impaired in schizophrenia, regardless of age at disease onset. The combined influence of age and group on the amplitude of the N(cl) might support the idea of neurodevelopmental deficits in schizophrenia.

Specific music therapy techniques in the treatment of primary headache disorders in adolescents: a randomized attention-placebo-controlled trial.

UNLABELLED: Migraine and tension-type headache have a high prevalence in children and adolescents. In addition to common pharmacologic and nonpharmacologic interventions, music therapy has been shown to be efficient in the prophylaxis of pediatric migraine. This study aimed to assess the efficacy of specific music therapy techniques in the treatment of adolescents with primary headache (tension-type headache and migraine). A prospective, randomized, attention-placebo-controlled parallel group trial was conducted. Following an 8-week baseline, patients were randomized to either music therapy (n = 40) or a rhythm pedagogic program (n = 38) designed as an "attention placebo" over 6 sessions within 8 weeks. Reduction of both headache frequency and intensity after treatment (8-week postline) as well as 6 months after treatment were taken as the efficacy variables. Treatments were delivered in equal dose and frequency by the same group of therapists. Data analysis of subjects completing the protocol showed that neither treatment was superior to the other at any point of measurement (posttreatment and follow-up). Intention-to-treat analysis revealed no impact of drop-out on these results. Both groups showed a moderate mean reduction of headache frequency posttreatment of about 20%, but only small numbers of responders (50% frequency reduction). Follow-up data showed no significant deteriorations or improvements. PERSPECTIVE: This article presents a randomized placebo-controlled trial on music therapy in the treatment of adolescents with frequent primary headache. Music therapy is not superior to an attention placebo within this study. These results draw attention to the need of providing adequate controls within therapeutic trials in the treatment of pain.

Development of brain synchronisation within school-age--individual analysis of resting (α) coherence in a longitudinal data set.

OBJECTIVE: Given evidence that synchronisation of neuronal activity may be a correlate of cognition, we examined EEG coherence as function of age and inter-electrode distance in healthy children and adolescents in order to elucidate basic information for a better understanding of developmental disorders associated with deficits in cognitive functions. METHODS: Based on a 64-channel eyes closed resting EEG we combined local and global coherence measures in order to reduce volume conduction and reference effects. We used a two point longitudinal design in order to analyze intraindividual change during school-age (n=40; 6-18 years). Coherence was analyzed within individually adjusted frequency bands and around iPF (= individual alpha peak frequency). RESULTS: Both local and global resting coherence was largest in the alpha range and particularly around iPF. Local synchronisation was larger in the left compared with the right hemisphere. Controlling for increases in iPF, synchronisation increased with age, with global changes being most pronounced in the alpha range. Moreover age-related changes suggest an earlier development in girls. CONCLUSIONS: Our data provides evidence that both local and global functional integration increases during normal development within school-age. SIGNIFICANCE: This general pattern - combined with more specific effects of sex and frequency - may help to specify deviations in developmental disorders.

Maturation of P300 amplitude and short-term learning as reflected by P300 habituation between trial blocks in children.

Although numerous studies concerning P300 have been reported in adults, few have focused on the normal development of children, particularly in relation to habituation. The aim of this study was to investigate maturation of the P300 component and its habituation (short-term automatic learning) in a sample of healthy children and adolescents. Four models of maturation of the P300 (linear, quadratic or two different linear regressions for the pre-pubertal and pubertal age groups as well as age-inverse) were applied and compared, in order to find the most adequate model according to the Bayesian Information Criterion. A visual oddball paradigm was presented to 81 healthy children and adolescents aged 6-18 years. Three blocks, each with 200 trials were recorded to assess between-block habituation. The data was best fitted to (a) an age-inverse relation between P300 latency and age, and (b) a linear relationship between P300 amplitude and age. An age-dependent effect of habituation was detected in the P300 amplitude, where a considerable amplitude decline was found in the younger children and no significant change for adolescents. Our results support the hypothesis that younger children show stronger habituation effects because they activate a larger neuronal pool from which unnecessary neurons can be excluded during short-term learning. In contrast, in adolescents, these neurons may have already been eliminated as a consequence of pruning, thus reducing habituation effects. Future studies are required to test this hypothesis because our data do not permit alternative explanations to be discarded.

Individual analysis of EEG background-activity within school age: impact of age and sex within a longitudinal data set.

OBJECTIVES: Quantitative EEG can monitor changes in brain function during development and may help to understand developmental disorders. However, current EEG-databases are primarily based on standardized frequency bands which disregard age-related changes in alpha peak frequency (PF) and therefore complicate the interpretation of spectral estimates in the theta and alpha range. METHODS: We used a two point longitudinal design in order to analyze intraindividual changes in 40 healthy children and adolescents with age (T1: 6-18 years; interval approximately 4 years). Using a 64-channel eyes closed resting EEG we calculated absolute/relative power in individualized frequency bands (IFB: delta, theta, alpha1/2 and beta) based on PF. RESULTS: PF increased with age, with changes being larger for children than adolescents. Controlling for changes in PF, changes in absolute/relative alpha1/2 power and in absolute beta power were minor. Relative beta power, however, increased while absolute/relative delta and theta power decreased massively. Sex-differences in PF did not reach significance. However, boys exhibited larger changes during adolescence than girls for all absolute power measures except alpha. CONCLUSION: Normal EEG development during school-age is mainly based on an absolute decrease of slow frequency activity and increases of PF which may be interpreted in terms of a reorganization of the EEG towards a higher frequency oscillatory scale rather than a maturation of the theta-alpha1/2 band power sequence. Age-related changes differed between boys and girls suggesting a different developmental timing for the sexes. In future studies a combined analysis of PF and IFB may help to specify deviations in developmental disorders.

Butterbur root extract and music therapy in the prevention of childhood migraine: an explorative study.

BACKGROUND: Migraine is very common in school-aged children, but despite a number of pharmacological and non-pharmacological options for prophylaxis, randomized controlled evidence in children is small. Evidence-based prophylactic drugs may have considerable side effects. OBJECTIVE: This study was to assess efficacy of a butterbur root extract (Petadolex) and music therapy in primary school children with migraine. DESIGN: Prospective, randomized, partly double-blind, placebo-controlled, parallel-group trial. METHODS: Following a 8-week baseline patients were randomized and received either butterbur root extract (n=19), music therapy (n=20) or placebo (n=19) over 12 weeks. All participants received additionally headache education ("treatment as usual") from the baseline onwards. Reduction of headache frequency after treatment (8-week post-treatment) as well as 6 months later (8-week follow-up) was the efficacy variable. RESULTS: Data analysis of subjects completing the respective study phase showed that during post-treatment, only music therapy was superior to placebo (p=0.005), whereas in the follow-up period both music therapy and butterbur root extract were superior to placebo (p=0.018 and p=0.044, respectively). All groups showed a substantial reduction of attack frequency already during baseline. CONCLUSION: Butterbur root extract and music therapy might be superior to placebo and may represent promising treatment approaches in the prophylaxis of paediatric migraine.

Stereotyped topography of different elevated contingent negative variation components in children with migraine without aura points towards a subcortical dysfunction.

Increased negativity during contingent negative variation (CNV) is thought to reflect abnormal neural activation in adult migraineurs' attention related processing. Findings in childhood and adolescence have yielded less clear results. This study characterizes the age-dependent development of CNV topography in migraine during childhood in order to elucidate the origin and cerebral generators of described CNV elevations. A large sample of children with primary headache (migraine with/without aura, tension type headache) and healthy controls aged 6-18 years was examined in a CNV paradigm using 64-channel high resolution DC-EEG. Patients were tested for diagnose-related topographic group differences of initial CNV (iCNV), late CNV (lCNV) and postimperative negative variation (PINV). All three CNV components of 6-11-year-old migraineurs without aura showed elevated negativity over the supplementary motor area (SMA) and around the vertex. Migraine children lacked age-dependent development of late CNV around Cz as previously reported. However, they showed a normal development of late CNV over pre-/primary motor cortex (MI). There was no marked elevation of iCNV amplitude over frontal areas (orienting reaction) nor specific amplitude elevations over "motor" or "sensory" areas during sustained attention (late CNV). Additional "pre-mature" activation e.g., in the locus coeruleus (leading to diffuse cortical activation summing up to a maximum over the vertex) or the basal ganglia (interacting with SMA) explained the rather stereotyped CNV elevation around the vertex better than a specific implication of the cortical systems responsible for orienting, motor preparation or sensory attention.

Frontal lobe involvement in the processing of meaningful auditory stimuli develops during childhood and adolescence.

Auditory event-related N1b reflects attention-related processing in bilateral temporal auditory cortex. Frontal contributions indicating an orienting reaction have been suggested. We analyzed the maturation of frontal contributions to the auditory event-related potential following the warning stimulus in a contingent negative variation (CNV) task by high-resolution current source density mapping and spatio-temporal source analysis in 80 healthy subjects and 121 primary headache patients (migraine with/without aura, tension type headache) from 6 to 18 years; as increased orienting responses and disturbed maturation have been described in migraineurs. A selective local increase of N1b with age occurred at mid-frontocentral leads. This increase could not be explained sufficiently by overlapping bilateral temporal sources but pointed towards additional frontal activation over the supplementary motor area (SMA) in adolescents which was absent in children. A second frontal N1 component peaked about 50 ms later, showed an earlier maturation and has been suggested to reflect early response selection processes in the anterior cingulate. Primary headache patients showed the same component structure and developmental trajectory as healthy subjects without significant influences of differential diagnosis. We conclude that: (1) Brain maturation crucially influences N1b. (2) Two frontal lobe N1 components can be dissociated in their maturational trajectory. (3) Early SMA activation could be elicited by rare auditory stimuli from about 12 years on, allowing fast sensory-motor coupling without previous categorical stimulus classification. (4) Primary headache patients did not differ in their maturation of frontal or temporal contributions to N1b when elicited by moderately loud short tone bursts.

Cortical motor areas are activated early in a characteristic sequence during post-movement processing.

During motor learning in goal-directed reactions, a specific movement has to be associated with feedback about the movement's success. Such feedback often follows when the movement is already over. We investigated the time-course of post-movement cortical motor processing by high-resolution analysis of lateralized post-movement potentials in forewarned and simple reaction time tasks. In both paradigms we could separate a post-movement component (motor postimperative negative variation-mPINV) peaking about 500 ms after the button press (confirmed by electromyogram and accelerometer). mPINV could not be sufficiently explained by motor cortex activity related to EMG output and/or by sensory feedback. mPINV was enhanced by long intertrial intervals and its lateralization changed with response movement side. Its scalp potential distribution resembled (pre-)motor cortex activity during preceding movement stages and differed from the frontal motor potential peak (proprioceptive and somatosensory reafferent feedback); suggesting post-movement activation of pre-/primary motor cortex. Dipole source analysis yielded a single radial source near premotor cortex which explained lateralized mPINV almost completely. mPINV was present in simple reaction time tasks, indicating that mPINV is an independent component and does not represent delayed resolution of pre-movement negativity. An equivalent of "classical" PINV (cPINV) occurred later over prefrontal and anterior temporal sites in simple and forewarned reaction time tasks. Our results suggest that high-resolution analysis of lateralized movement-related potentials allows to image post-movement motor cortex activity and might provide insights into basic mechanisms of motor learning: A characteristic sequence might involve motor cortex activation (mPINV) before "higher order associative areas" come into play (cPINV).