Efficacy of Neurofeedback Versus Pharmacological Support in Subjects with ADHD.

Behavioral training in neurofeedback has proven to be an essential complement to generalize the effects of pharmacological support in subjects who have attention deficit with hyperactivity disorder (ADHD). Therefore, this investigation attempts to analyze the efficacy of neurofeedback compared with pharmacological support and the combination of both. Participants were 131 students, classified into four groups: control (did not receive neurofeedback or pharmacological support), neurofeedback group, pharmacological support group, and combined group (neurofeedback + pharmacological support). Participants' executive control and cortical activation were assessed before and after treatment. Results indicate that the combined group obtained more benefits and that the neurofeedback group improved to a greater extent in executive control than the pharmacological support group. It is concluded that this kind of training may be an alternative to stimulate activation in subjects with ADHD.

The Impact of Children's and Parents' Perceptions of Parenting Styles on Attention, Hyperactivity, Anxiety, and Emotional Regulation.

Attention-deficit/hyperactivity disorder (ADHD) symptomatology can be studied by examining the associated neurobiological factors or by looking at the environmental factors involved, such as parenting styles. Negative parenting styles have been associated with ADHD symptoms in childhood and adolescence. The present study aimed to analyze the predictive power of two parenting style dimensions (warmth-communication and criticism-rejection) and three factors about rule-setting and compliance (inductive, strict, and indulgent styles) in the explanation of ADHD symptoms (attention and hyperactivity) and associated emotional factors (anxiety and emotional regulation) considering parents' and children's perspectives. The results indicate that from the parents' perspective, the criticism-rejection variable was the most important in explaining attention difficulties, anxiety and emotional regulation. From the children's perspective, the strict parenting style was the most important variable in explaining hyperactivity and emotional regulation. In addition, for children, warmth-communication was significant in predicting fewer emotional regulation difficulties. Our results highlight the importance of considering family dynamics when assessing ADHD in order to implement comprehensive interventions that consider parental training in positive parenting styles.

Neurodevelopmental disorders: An innovative perspective via the response to intervention model.

Neurodevelopmental disorders are a group of conditions classified together by the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders which include intellectual disability, communication disorders, autism spectrum disorder, attention-deficit/hyperactivity disorder, specific learning disorder (SLD), and motor disorders. SLD is present in many students, who exhibit significant difficulties in the acquisition of reading, written expression, and mathematics, mostly due to problems with executive functions (EF). The present study is a review of the current situation of neurodevelopmental disorders and SLD focusing on the benefits of the response to intervention model (RtI), which allows the combination of evaluation and intervention processes. It also addresses the key role of EF. The importance of adapting RtI to new possibilities such as the use of virtual reality is discussed and a theoretical framework for carrying that out is provided.

The Influence of State and Trait Anxiety on the Achievement of a Virtual Reality Continuous Performance Test in Children and Adolescents with ADHD Symptoms.

The three types of presentations of ADHD often co-occur with other disorders, anxiety being one of the most prevalent. For this reason and because there are few studies that have examined the influence of anxiety on attentional activities, this study aims to determine how internalizing difficulties (anxiety levels) can influence performance in a virtual reality continuous performance test. The study used a non-probabilistic clinical sample comprising 68 boys (66%) and 35 girls (34%) aged between 6 and 16 (M = 12.24; SD = 2.45) who had been referred to clinical services for the evaluation of ADHD symptoms. Once informed consent was given, the children were administered the STAI-C scale and a virtual reality continuous performance test by expert researchers. Hierarchical regression models showed that only state anxiety demonstrated significant explanatory power over attentional variables. These findings confirm how important it is for children to feel relaxed when they undergo psychological evaluation tests, as otherwise the individual's intervention design would be based on biased data. Similarly, the findings also suggested an effect of IQ in the interpretation of continuous performance scores.

A Case Study in Attention-Deficit/Hyperactivity Disorder: An Innovative Neurofeedback-Based Approach.

In research about attention-deficit/hyperactivity disorder (ADHD) there is growing interest in evaluating cortical activation and using neurofeedback in interventions. This paper presents a case study using monopolar electroencephalogram recording (brain mapping known as MiniQ) for subsequent use in an intervention with neurofeedback for a 10-year-old girl presenting predominantly inattentive ADHD. A total of 75 training sessions were performed, and brain wave activity was assessed before and after the intervention. The results indicated post-treatment benefits in the beta wave (related to a higher level of concentration) and in the theta/beta ratio, but not in the theta wave (related to higher levels of drowsiness and distraction). These instruments may be beneficial in the evaluation and treatment of ADHD.

[Empirically Supported Psychological Treatments for Children and Adolescents: State of the Art].

Empirically Supported Psychological Treatments for Children and Adolescents: State of the Art. BACKGROUND: The empirical evidence accumulated on the efficacy, effectiveness, and efficiency of psychotherapeutic treatments in children and adolescents calls for an update. The main goal of this paper objective was to carry out a selective review of empirically supported psychological treatments for a variety of common psychological disorders and problems in childhood and adolescence. METHOD: A review was carried out of the psychological treatments for different psychological disorders and problems in social-emotional or behavioral adjustment in the child-adolescent population according to the Spanish National Health System (Clinical Practice Guidelines) levels of evidence and degrees of recommendation. RESULTS: The findings suggest that psychological treatments have empirical support for addressing a wide range of psychological problems in these developmental stages. The degree of empirical support ranges from low to high depending on the phenomenon analyzed. The review suggests unequal progress in the different fields of intervention. CONCLUSIONS: From this update, psychologists will be able to make informed decisions when implementing those empirically supported treatments to address the problems that occur in childhood and adolescence.

Self-Concept and Inattention or Hyperactivity-Impulsivity Symptomatology: The Role of Anxiety.

Attention-deficit/hyperactivity disorder (ADHD) has been associated with low levels of self-concept (academic, emotional, social or physical), although this association can differ in the function of the inattention or hyperactivity-impulsivity symptomatology. Furthermore, the relation between ADHD and self-concept can be mediated or moderated by the levels of anxiety. This work is aimed to examine the differential effect of inattention symptomatology and hyperactivity-impulsivity symptomatology on academic, emotional, social and physical self-concept and the mediating or moderating role of anxiety in this relationship. A total of 167 students (70.7% boys and 29.3% girls) aged between 11 and 16 participated in this study. Students' ADHD symptomatology, self-concept in four areas (academic, emotional, social and physical self-concept) and trait anxiety were measured with the State-Trait Anxiety Inventory for Children. The results indicate that trait anxiety mediates the relationship between inattention and emotional, social and physical self-concept but does not moderate this relationship. Trait anxiety does not mediate or moderate the relationship between hyperactivity-impulsivity symptoms and self-concept. When inattention symptomatology increases, academic self-concept decreases directly, but students' emotional, social and physical self-concept decreases indirectly through trait anxiety.

Attention, inhibitory control and early mathematical skills in preschool students.

BACKGROUND: Early mathematical skills may be important indicators of school success. Executive Functions (EFs) such as attention and inhibitory control may be related to the development of early mathematical skills. METHOD: This study is aimed at understanding the relationship between two EFs (attention and inhibitory control) and low and high relational and numerical mathematical skills in preschool students (143 children between 4 and 6 years old). Participants completed the Early Numeracy Test Revised and a continuous performance test which assessed attention (omissions and response time [RT]) and inhibitory control (commissions and variability). RESULTS: Logistic Binomial Regression Analysis was carried out showing that in 4 to 6-year olds there are differences in omissions, RT and variability between the groups (low and high relational and numerical mathematical skills). However, once the effect of the age was controlled for, only RT predicted numerical mathematical skills. CONCLUSIONS: The results highlight the importance of attention in the numerical skills of preschool students, with a greater weight of response time which is better in students with higher numerical mathematics skills.

Predicting Mathematics Achievement in Secondary Education: The Role of Cognitive, Motivational, and Emotional Variables.

Academic achievement in general, and in mathematics in particular, is positively associated not only with cognitive abilities, but also with emotional and motivational skills. The objective of this study was to analyze the prediction strength of cognitive, motivational, and emotional variables in mathematics achievement throughout high school, considering students' gender and age. A large sample of 2,365 Spanish students from the 4 years of high school (12-16 years old) participated in the study. Students provided information about their intellectual skills, perceived competence in mathematics, perceived utility of mathematics, intrinsic interest in learning, mathematics anxiety, and their causal attributions (for failure and for success), and of their achievement in mathematics. Data showed differences according to gender and the school grade level. The motivational and affective variables did not seem to play an important role in this relationship as predicted in the current study. The results of this study are discussed in light of previous research.

Is a Virtual Reality Test Able to Predict Current and Retrospective ADHD Symptoms in Adulthood and Adolescence?

Despite the persistence of attention deficit hyperactivity disorder (ADHD) into adulthood and adolescence, there are few objective, reliable instruments (based on patient performance) that have been shown to be able to predict current and retrospective ADHD symptoms. The present study aimed to explore whether a validated VR test called Nesplora Aquarium is able to predict ADHD symptoms in adults and adolescents, based on both current and retrospective self-reports. A non-clinical sample of 156 adults and adolescents (70 women and 86 men) between 16 and 54 years of age (M = 21.23, SD = 8.04) took part in the study. Virtual reality (VR) variables such as the number of correct answers, omission and commission errors, among others, were used to predict current and retrospective self-reported symptoms of ADHD using multiple regression models. Correct answers and omission errors in the VR test significantly predicted both current and retrospective ADHD symptoms. However, only the number of perseveration errors and gender were able to significantly predict retrospective ADHD symptoms. These findings suggest that inattention problems tend to remain after adolescence, while perseveration errors (which have been related to impulsive behavior) and gender differences tend to diminish.

Mathematics Competence Level: The Contribution of Non-symbolic and Spatial Magnitude Comparison Skills.

Magnitude comparison skills have been related to mathematics competence, although results in this area vary. The current study aimed to describe the performance of 75 children (aged 4-5 years) in two comparison tasks; and examine the strength of the relationship between each of the two tasks and mathematics competence level (MCL). Participants were assessed with the Early Numeracy Test which provides a global MCL score. Magnitude comparison skills were assessed with two tasks: a non-symbolic number comparison task and a spatial comparison task. Results of the Pearson correlation analysis showed a relationship between the two tasks with better performance in the spatial comparison task. Regression analysis with the stepwise method showed that only the non-symbolic number comparison task had a significant value in the prediction of the MCL pointing to the need to take these kinds of tasks into account in the first years of school.

Influence of initial mathematical competencies on the effectiveness of a classroom-based intervention.

BACKGROUND: Students commonly struggle with mathematics and mathematical problem-solving. Therefore, it is necessary to design and implement interventions aimed at improving these essential components of learning. Furthermore, the outcomes of these interventions can vary significantly and appear to be a function of a student's initial competencies in mathematics. AIM: This study attempts to analyse the influence of initial levels of mathematics competency with respect to the benefits of a specific intervention known as the Integrated Dynamic Representation (IDR). SAMPLE: Participants were 288 students (aged 6-8 years) who were divided according to their levels of mathematics competency (low-medium-high). METHODS: Students were assigned to the two primary intervention groups, experimental group (EG; students who received the IDR intervention) and control group (CG; students who followed the traditional instructional methods). All participants completed the Test of Early Mathematics Abilities (TEMA-3) both before and after the intervention. RESULTS AND CONCLUSIONS: Although all the three competency levels of the EG improved, the progression was different for each level. Results showed that students with low competency level improved substantially more than the students with medium and/or high baseline competency level.

Differential Efficacy of Neurofeedback in Children with ADHD Presentations.

Training in neurofeedback (NF) reduces the symptomatology associated with attention deficit with hyperactivity disorder (ADHD). However, ADHD differs in terms of the type of presentation, i.e., inattentive (ADHD-I), impulsive/hyperactive (ADHD-HI), or combined (ADHD-C). This study examines the efficacy of NF in ADHD presentations. Participants were 64 students (8⁻12 years old). Cortical activation, executive control, and observed symptomatology by parents were assessed. Results indicated that ADHD-C and ADHD-HI demonstrated greater improvements than ADHD-I. It was concluded that this kind of training produces an improvement and that it is necessary to explore it further in terms of the protocol used.

Efficacy of a Continuous Performance Test Based on Virtual Reality in the Diagnosis of ADHD and Its Clinical Presentations.

OBJECTIVE: To analyze the diagnostic effectiveness of the AULA Nesplora test to discriminate the different ADHD presentations: impulsive/hyperactive (I/H), inattentive, and combined. METHOD: A total of 117 students (76.9% male and 23.1% female) between 5 and 16 years of age ( M = 11.18 years, SD = 3.10 years) participated, and were divided into three groups with ADHD according to their presentation, and a control group. RESULTS: Each of the test conditions allowed the discrimination between the I/H and combined presentations with respect to the control group, and between the I/H and inattentive presentations. However, differences among ADHD presentations were only evident when the results were separately analyzed for the visual and auditory modalities. CONCLUSION: This study showed that the indicators offered by the AULA Nesplora test (omissions, commissions, response times, and motor activity) make it possible to establish a differential diagnosis of ADHD presentations when analyzed under different contextual conditions.

Comparison between two continuous performance tests for identifying ADHD: Traditional vs. virtual reality.

Background/Objective: Continuous Performance Tests (CPTs) have demonstrated validity when differentiating children with ADHD from healthy controls. However, these CPTs have limitations such as low ecological validity. New CPTs based on the use of Virtual Reality (VR) have appeared as supposedly improved methods for assessing ADHD. This study aims to compare the discriminant value of attentional variables produced by a VR CPT (Aula Nesplora) with that of variables from a traditional CPT (Test of Variables of Attention; TOVA) for identifying ADHD. Method: A total of 338 children aged between 6 and 16 years old (M = 10.84, SD = 3.01) participated in the study: 31.95% correspond to the inattentive presentation, 15.38% to the impulsive-hyperactive presentation, 22.78% to the combined presentation, and the remaining 29.88% correspond to children without ADHD. Results: Results indicated that Aula Nesplora predicts ADHD presentations better than TOVA. It also differentiates better between ADHD and non-ADHD students. Conclusions: These findings show the potential advantages of using virtual reality in ADHD assessment, as it facilitates the diagnosis of ADHD and the differentiation of its presentations in a realistic environment.

Antecedentes/objetivos: Los tests de ejecución continua (Continuous Perfomance Test; CPT) han mostrado utilidad en la diferenciación de los niños con TDAH de los controles. Sin embargo, este tipo de tarea no está exenta de limitaciones como su baja validez ecológica. Para la mejora de la evaluación del Trastorno por Déficit de Atención con Hiperactividad (TDAH) surgen en los últimos años los CPTs en realidad virtual. Este estudio tiene como objetivo comparar el valor discriminativo de las variables proporcionadas por un CPT basado en la realidad virtual (Aula Nesplora) con respecto a aquellas recogidas por un CPT tradicional (Test de variables de atención; TOVA) para identificar las distintas presentaciones de TDAH. Método: Participaron un total de 338 estudiantes de entre 6 y 16 años (M = 10,84; DT = 3,01): 31,95% correspondientes a la presentación inatenta, 15,38% presentación hiperactiva-impulsiva, 22,78% presentación combinada y 29,88% controles. Resultados: Los resultados indicaron que el Aula Nesplora predice mejor que el TOVA las presentaciones de TDAH, así como a los estudiantes sin TDAH. Conclusiones: Se discuten las ventajas del uso de la realidad virtual en evaluación del TDAH, ya que facilitan el diagnóstico del trastorno y la diferenciación de sus presentaciones.

Using Brain Activation (nir-HEG/Q-EEG) and Execution Measures (CPTs) in a ADHD Assessment Protocol.

Attention Deficit Hyperactivity Disorder (ADHD) is a problem that impacts academic performance and has serious consequences that result in difficulties in scholastic, social and familial contexts. One of the most common problems in the identification of this disorder relates to the apparent over diagnosis of the disorder due to the absence of global protocols for assessment. The research group of School Learning, Difficulties and Academic Performance (ADIR) from the University of Oviedo, has developed a complete protocol that suggests the existence of certain patterns of cortical activation and executive control for identifying ADHD more objectively. This protocol takes into consideration some of the hypothetical determinants of ADHD, including the relationship between activation of selected areas of the brain, and differences in performance on various aspects of executive functioning such as omissions, commissions or response times, using innovative tools of Continuous Performance Testing (based on Virtual Reality CPT and Traditional CPT) and brain activation measures (two different tools, based on Hemoencephalography- nirHEG; and Quantified Electroencephalography --Q-EEG, respectively). This model of assessment aims to provide an effective assessment of ADHD symptomatology in order to design an accurate intervention and make appropriate recommendations for parents and teachers.

Improvement of Self-regulated Learning in Mathematics through a Hypermedia Application: Differences based on Academic Performance and Previous Knowledge.

Self-regulation on behalf of the student is crucial in learning Mathematics through hypermedia applications and is an even greater challenge in these IT environments. Two aims are formulated. First, to analyze the effectiveness of a hypermedia tool in improving perceived knowledge of self-regulatory strategies and the perceived usage of the planning, executing and assessment strategy on behalf of students with low, medium and high levels of academic performance. Second, to analyze the effectiveness of the hypermedia tool in improving perceived usage of the strategy for planning, monitoring and evaluating on behalf of students with a perceived knowledge (low, medium and high). Participants were 624 students (aged 10-13), classified into a treatment group (TG; 391) and a comparative group (CG; 233). They completed a questionnaire on perceived knowledge (Perceived Knowledge of Self-Regulatory Strategies) and another one on perceived usage of the strategy for planning, performing and evaluating (Inventory of Self-regulatory Learning Processes). Univariate covariance analyses (ANCOVAs) and Student-t tests were used. ANCOVA results were not statistically significant. However, the linear contrast indicated a significant improvement in perceived knowledge of strategies among the TG with low, medium and high academic performance (p ≤ .001). Results are discussed in the light of past and future research.

Information sources used by high school students in the college degree choice.

INTRODUCTION: Searching for information is a necessary step for young people to decide what to study and prevent school drop-out. The aim of this study is to identify the main sources of information used by students in choosing a university career and to assess the degree of usefulness of these sources. METHOD: A new measuring instrument to assess the use and usefulness of the information sources used in choosing university studies was developed. 2,005 high school students aged 17 to 24 (M = 17.56, SD = .77) participated in the study, representing 44.95 % of the total of school centers of the Principality of Asturias (Spain). RESULTS: The new instrument has adequate psychometric properties and shows that the information from parents and web pages by universities are the most used and most useful information sources for pre-university students. CONCLUSIONS: Obtaining this type of information is very important, as it encourages investing in those activities or resources that are important for pre-university students.

Attention Deficit/Hyperactivity Disorder (ADHD) Diagnosis: An Activation-Executive Model.

Attention deficit with, or without, hyperactivity and impulsivity (ADHD) is categorized as neuro-developmental disorder. ADHD is a common disorder in childhood and one of the most frequent conditions affecting school ages. This disorder is characterized by a persistent behavioral pattern associated with inattention, over-activity (or hyperactivity), and difficulty in controlling impulses. Current research suggests the existence of certain patterns of cortical activation and executive control, which could more objectively identify ADHD. Through the use of a risk and resilience model, this research aimed to analyze the interaction between brain activation variables (nirHEG and Q-EEG) and executive variables (Continuous performance test -CPT-) in subjects with ADHD. The study involved 499 children, 175 females (35.1%) and 324 males (64.91%); aged from 6 to 16 years (M = 11.22, SD = 1.43). Two hundred and fifty six of the children had been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and 243 were without ADHD. For the analysis of this objective, a causal model was designed to include the following different measures of task-execution: CPT TOVA (omissions, commissions, response time, variability, D prime and the ADHD Index); electrical activity (using Q-EEG); and blood-flow oxygenation activity (using nirHEG). The causal model was tested by means of structural equation modeling (SEM). The model that had been constructed was based upon three general assumptions: (1) There are different causal models for children with ADHD and those without ADHD; (2) The activation measures influence students' executive performance; and (3) There are measurable structural differences between the ADHD and control group models (executive and activation). In general, the results showed that: (a) activation measures influence executive patterns differently, (b) the relationship between activation variables (nirHEG and Q-EEG) depends on the brain zone being studied, (c) both groups showed important differences in variables correlation, with a good fit in each model (with and without ADHD). Lastly, the results were analyzed with a view to the diagnosis procedure. Therefore, we discuss the implications for future research.

State, trait anxiety and selective attention differences in Attention Deficit Hyperactivity Disorder (ADHD) subtypes.

One of the disorders that most affects school performance is Attention Deficit Hyperactivity Disorder (ADHD). The criteria established by DSM distinguish three subtypes: inattentive, hyperactive-impulsive and combined. However, the expression of this disorder can be altered by its association with other disorders such as anxiety. The main goals of this study were to determine whether different patterns of attention (selective and concentration) and anxiety (state and trait anxiety) emerge from ADHD subtypes, and analyze how anxiety predicts the performance of students with ADHD in a selective attention task. The sample was made up of 220 children (6-12 years) divided into four groups: control group (n = 56), inattentive subtype (n = 54), hyperactive-impulsive subtype (n = 53), and combined subtype (n = 57). The results indicated that the groups differed significantly in the attention variables, and in state and trait anxiety. Multiple group comparisons revealed that the combined subtype exhibited higher trait anxiety, whereas the inattentive subtype showed more state anxiety. Additionally, trait anxiety predicted the students' performance in the concentration variable of the attention task. These results suggest a novel path of significant interest concerning objective and reliable diagnostic assessment of ADHD.

Uno de los trastornos que más afecta al rendimiento escolar es el Trastorno por Déficit de Atención con Hiperactividad (TDAH). El criterio establecido por el DSM diferencia tres subtipos: inatento, hiperactivo-impulsivo y combinado. Sin embargo, el perfil de este trastorno podría verse alterado por la asociación con otros como la ansiedad. El objetivo de esta investigación es determinar si hay diferentes patrones de atención (selectiva y sostenida) y ansiedad (estado y rasgo) en los tres subtipos de TDAH. Además, el objetivo es analizar cómo la ansiedad predice el rendimiento de los estudiantes con TDAH en una tarea de atención selectiva. La muestra estaba formada por 220 estudiantes (6-12 años): 56 en el grupo control, 54 con TDAH-Inatento, 53 con TDAH-Hiperactivo impulsivo y 56 con el subtipo combinado. Los resultados obtenidos mostraron que los cuatro grupos resultaban significativamente diferentes en las variables atencionales y en los niveles de ansiedad estado y rasgo. Al mismo tiempo, la ansiedad rasgo predijo el rendimiento en la variable de concentración analizada. Los resultados revelan un nuevo patrón de gran interés de cara a la evaluación diagnóstica objetiva y fiable en el TDAH.