Recognition memory for pictures in children with ADHD: an event-related potential study.

OBJECTIVE: Children with ADHD are reported to accompany by various degrees of recognition memory cognitive deficits. We aimed to investigate age-related changes of the amplitude in event-related potential recordings on recognition memory in Chinese children with ADHD and to provide theoretical basis of neuro-electrophysiology for the cognition development of children. METHOD: ERP and behavioral data of 6- to -10-year-old children with ADHD (n = 94) and typically developing controls (TD, n = 96) were collected while the children performed a classical visual study-test paradigm task. RESULTS: Children with ADHD have defects in pictures recognition and showed a significantly smaller P2 component than that of TD children. The development of P2 and P3 component were different between the two groups. Moreover, the TD children showed the frontal old/new effect (N2) taken as a correlate of familiarity at 6 years old, and a parietal old/new effect (P3) taken as a correlate of recollection at 9 years old, while children with ADHD showed a parietal old/new effect (P3) only at 6 years old. CONCLUSION: Our study provided the novel evidence that recognition memory follow different developmental trajectories at the age of 6-10 between TD and ADHD.

Degree centrality and voxel-mirrored homotopic connectivity in children with nocturnal enuresis: A functional MRI study.

AIM: To determine the characteristics of brain development in children with nocturnal enuresis, we investigated the intensity of functional connectivity both among the nodes in the brain network and between the two hemispheres of the brain. MATERIALS AND METHODS: Twenty-three children with nocturnal enuresis (NE) and an equal number of normal children were examined using resting-state functional magnetic resonance imaging (fMRI) scans. Data analysis was done via the degree centrality (DC) and voxel-mirrored homotopic connectivity (VMHC) approaches. Moreover, we compared the children's psychological status by utilizing the self-concept scale. RESULTS: In four areas of the brain, the the DC values of the NE group were obviously lower than that of the normal controls. These four areas were the posterior cerebellar lobe, anterior cingulate cortex (ACC), medial frontal gyrus, and superior left temporal gyrus (P < 0.05, after correction). We also found two brain areas where the VMHC values of the NE group were obviously lower than that of the normal controls. The two groups were the cerebellar lobe and the anterior cingulate cortex (ACC) [P < 0.05, after correction]. A psychological comparison between the children with NE and that in the normal group on the self-concept scale was also performed. The scores of the children with NE were lower than normal controls regarding behavior, appearance and property, anxiety, gregariousness, happiness, and satisfaction (P < 0.05). CONCLUSIONS: These findings provide evidence of the deficit of urination control in children with NE. Furthermore, through the methods of DC and VMHC, which are based on functional connectivity, it was also possible to explain why children with NE often have the concomitant symptoms of attention, control, and memory problems. The analysis of the self-concept scale suggests that children with NE lack self-confidence.

[Event-related potential and behavioral characteristics in children with attention deficit hyperactivity disorder of different school entrance ages: a comparative study].

OBJECTIVE: To evaluate the effects of school entrance age on cognition and behaviors in children with attention deficit hyperactivity disorder (ADHD) using mathematical event-related potential (ERP), behavioral test, and Conners Parent Symptom Questionnaire (PSQ). METHODS: Fifty-eight ADHD children aged 7-12 years were enrolled and classified into older age and younger age groups according to the school entrance age (n=29 each). The children in the older age group were admitted at an age of 6 years and 6 months to 6 years and 11 months, and those in the younger age group were admitted at an age of 6 years to 6 years and 5 months. The ERP with a mathematical task was used to detect the difference in brain electrical activity between the two groups, and the behavioral test results were compared. The children's parents were asked to complete the PSQ, and the scores on each subscale were compared. RESULTS: The ERP detection showed that the older age group had a significantly higher P2 amplitude for wrong answers than the younger age group (10.9±5.0 µv vs 8.5±3.6 µv; P<0.05). The younger age group had a significantly shorter time of response to wrong answers than the older age group (619±340 ms vs 870±418 ms; P<0.05). The scores on the subscales of learning problems and impulse-hyperactivity of PSQ were significantly higher in the younger age group than in the older age group (P<0.05). CONCLUSIONS: School entrance age can affect cognition and behaviors in children with ADHD, and the ADHD children with a younger school entrance age have an obvious defect in executive function, especially the function of error detection, which leads to the prominent problems in impulse-hyperactivity and learning.

[Correlation between event-related potential and behavioral problems in early school-age children with attention deficit hyperactivity disorder].

OBJECTIVE: To investigate the cognitive characteristics in early school-age children with attention deficit hyperactivity disorder (ADHD) using event-related potential (ERP) and Achenbach Child Behavior Checklist (CBCL), as well as the correlation between ERP and behavioral problems. METHODS: A total of 22 children aged 6-7 years with ADHD and 19 healthy children matched by age were enrolled. Continue Performance Test-AX (CPT-AX) was performed for ERP test. The amplitude and latency of N2 and P3 of Go and Nogo were compared. The CBCL was completed by the parents, and the correlation between behavioral factors and ERP was analyzed. RESULTS: The ADHD group had a significantly higher number of ERP omissions than the normal control group (10±8 vs 5±4; P<0.05), while the reaction time and number of commission errors showed no significant differences between the two groups (P>0.05). The ADHD group showed a significantly lower Go-N2 amplitude than the normal control group (-8±5 µV vs -10±4 µV; P<0.05). In the ADHD group, the detection rates of hyperactivity, attack, and discipline violation were 27%, 27% and 9% respectively. The scores on attack and discipline violation subscales were negatively correlated with the Go-N2 amplitude of ERP (r=-0.43 and -0.48 respectively; P<0.05), while the score on hyperactivity subscale was positively correlated with the latency of Go-P3 (r=0.50, P<0.05). CONCLUSIONS: The early school-age children with ADHD show the tendency to the impairment of attention/executive function, but the inhibition function defect has not been noted. In early school-age children with ADHD, the behavioral problems such as hyperactivity, attack, and discipline violation are associated with ERP.

[Intensity of functional connection between bilateral hemispheres of children with attention-deficit hyperactivity disorder by functional magnetic resonance imaging].

OBJECTIVE: To explore the neural mechanisms of attention-deficit hyperactivity disorder (ADHD) through analyzing the intensity of functional connection between bilateral hemispheres of children with ADHD by resting-state functional magnetic resonance imaging (rs-fMRI). METHODS: The approach of voxel-mirrored homotopic connectivity (VMHC) was employed to analyze 31 school-age and 31 ADHD children by rs-fMRI scans. RESULTS: Positively activated brain regions were visualized when comparing ADHD and normal children, suggesting that ADHD children's VMHC scores were higher in bilateral frontal lobe (t = 5.81), bilateral occipital lobe (t = 5.82) and bilateral cerebellar posterior lobe (t = 6.17). Statistically significant differences existed between two groups (FDR correction, Q<0.01). CONCLUSIONS: The increased intensity of functional connection between bilateral prefrontal lobes in children with ADHD reflects attention disorder and leads to a decline of working memory . The strengthening of bilateral occipital lobes slows down memory process. And the increased intensity of cerebellar connections may damage neural circuits and aggravate ADHD symptoms.

[Mathematical cognitive function in children with attention deficit hyperactivity disorder: a behavior and event-related potential study].

OBJECTIVE: To explore the mathematics cognitive function of children with attention deficit hyperactivity disorder and explore neural mechanisms with event-related potential(ERP) and behaviors. METHODS: Behavior data and ERP elicited by performing mental calculation tasks were recorded in 27 children with ADHD and 29 normal controls from July to October 2012 at Third Affiliated Hospital of Soochow University.The differences of behaviors and N2 component of ERP were compared and analyzed. RESULTS: The reaction time of the children with ADHD were longer than the control group in addition, subtraction and multiplication ((949 ± 144) vs (829 ± 166) ms, (981 ± 129) vs (856 ± 170) ms, (944 ± 136) vs (825 ± 172) ms, all P < 0.05). While the correct rate were less than normal control in all three arithmetic operations (0.80% (0.72%, 0.88%) vs 0.90% (0.85%,0.96%), 0.78% (0.64%,0.85%) vs 0.90% (0.84%,0.93%), 0.86% (0.74%,0.92%) vs 0.93%(0.90%,0.98%), all P < 0.05). N2 component could be elicited by all subjects in forehead. The amplitude of N2 of children with ADHD were significantly lower than control group in all three arithmetic operations at left frontal (F3: (-3.5 ± 5.2) vs (-6.7 ± 3.5)µV, (-3.8 ± 4.0) vs (-7.4 ± 4.5)µV, -5.8 (-7.6,1.6) vs -6.4(-10.3, -4.9) µV, all P < 0.05) and Fz ((-4.3 ± 6.4) vs ( -7.4 ± 4.2) µV, (-5.0 ± 5.4) vs (-7.9 ± 4.6)µV, -5.2(-9.7, -0.6) vs -7.9 (-10.5, -5.1)µV, all P < 0.05), the latency of ADHD group were prolonger than controls in subtraction operations at right and left frontal ((328 ± 36) vs (307 ± 27)ms, 325 (307,354)vs 309 (280, 330)ms) and frontal electrodes ((331 ± 35) vs (311 ± 30) ms, all P < 0.05). In addition and multiplication operations, there was no significant difference in latency (all P > 0.05). CONCLUSIONS: The children with ADHD have weak capacities of inhibition irrelevant information and paying attention to control. Their deficits in mental arithmetics may be due to the difficulties of selecting the best strategy during cognitive tasks.

Prevalence of hematologic complications on extracorporeal membranous oxygenation in critically ill pediatric patients: A systematic review and meta-analysis.

OBJECTIVES: Despite advances in Extracorporeal Membranous Oxygenation (ECMO) equipment, hematologic complications remain significant in critically ill children. The aim of this study is to summarize prevalence of hematologic complications for children and neonates. METHODS: MEDLINE, PubMed and Scopus databases were searched focusing on the period from January 01, 2017 to October 01, 2022. The population included critically ill children and neonates with hematologic complications. The review included all aspects of related complications including hemorrhage, thrombosis, and hemolysis. We performed random effects meta-analyses. The primary outcome measure was overall hematologic complications. Secondary outcomes are changes in the prevalence of hemorrhagic complications. Risk of bias of included studies was assessed using the Joanna Briggs Institute checklist. RESULTS: The systematic search identified 37 studies totaling 10,659 critically ill pediatric patients receiving ECMO. The pooled prevalence of hemorrhagic complications, thrombotic complications and hemolysis among pediatric patients requiring ECMO was 43.7 % (95 % CI: 28.6 % to 58.9 %, P < 0.001), 27.6 % (95 % CI: 20.4 % to 34.8 %, P < 0.001), 34.3 % (95 % CI: 22.9 % to 45.7 %, P < 0.001). The prevalence of hemorrhagic complications was represented in descending order: surgical site (21.6 %, 95 % CI: 10.3 % to 32.9 %); cannulation site (20.6 %, 95 % CI: 11.8 % to 29.3 %); intracranial (12.2 %, 95 % CI: 9.5 % to 15.0 %); pulmonary (7.7 %, 95 % CI: 5.9 % to 9.6 %); gastrointestinal (6.0 %, 3.7 % to 8.4 %). For the assessment of thrombotic complications, thrombosis in cannulation site had a higher prevalence (28.5 %, 95 % CI: 22.1 % to 34.9 %), followed by DIC (13.5 %, 95 % CI: 8.7 % to 18.3 %) and intracranial thrombosis (4.5 %, 95 % CI: 1.4 % to 7.6 %). Predictors of increased prevalence of hemorrhagic complications included age (P = 0.017) and VV-ECMO support mode (P = 0.029). CONCLUSIONS: Among critically ill pediatric patients, there was a series of hematologic complications can occur during ECMO support. Physicians should pay special attention to the management and establish appropriate treatment programs to reduce the occurrence of hematologic complications.

Brain network study of attentional cognitive impairment in children with bronchial asthma.

Bronchial asthma often causes cognitive impairment, especially attentional deficit, which has a serious impact on children's learning. This study aims to provide objective indicators for the evaluation of attention in asthma children. Thirty-one asthmatic and typically developing children (TDC) were tested by resting-state functional magnetic resonance imaging (rs-fMRI). Brain network-based methods of degree centricity and voxel-mirrored homotopic connectivity (VMHC) methods were used in the study. Compared with the TDC group, asthmatic children had lower DC values in the right superior frontal gyrus (after FDR correction, P < 0.05). Meanwhile, VMHC values of bilateral superior frontal gyrus and bilateral superior parietal lobule in asthmatic children were lower than those in TDC group (after FDR correction, P < 0.05). There was significant correlation between the correct percentage of CPT and DC value in right superior frontal gyrus, VMHC value in right superior frontal gyrus, and right superior parietal lobule. In this study, impaired superior frontal gyrus and parietal lobe function are associated with attentional deficit in asthmatic children, and these brain regions are key brain regions in attention-related networks.

The study of functional connectivity of attention cognitive impairment in children with nocturnal enuresis.

We aimed to explore the brain functional connectivity mechanism of attention cognitive impairment in children with nocturnal enuresis (NE). Children with NE often show attention cognitive deficit, but its brain mechanism remains unclear. Most previous studies have only focused on a single brain region, without involving the association among brain regions. In this study, 26 NE and 26 normal children were selected. Functional magnetic resonance imaging (fMRI) and integrated visual and auditory continuous performance test (IVA-CPT) were performed. The 12 key brain regions of the dorsal attention network (DAN), default mode network (DMN) and ventral attention network (VAN) were selected as areas of interest, and 66 groups of functional connectivity (FC) were analysed among these 12 brain regions. The correlation between FC and IVA-CPT in the two groups was analysed. The FC values showed that the groups with significant differences between NE and normal children were lFEF-aMPFC, rFEF-lIFG, rFEF-rIPS and lAG-VFC (P < 0.05), and the FC value of lAG-VFC was positively correlated with the Full-Scale Attention Quotient (FAQ). Our results showed that attention deficit in children with NE was associated with all three networks and was relative to the FC among the three attention networks. DAN was the brain network most related to attention cognition in children with NE, and most of the brain regions with abnormal connectivity in NE were related to the prefrontal lobe. The lAG was also an important brain region in attention impairment in NE.

How aerobic exercise improves executive function in ADHD children: A resting-state fMRI study.

The aim of the study is to explore the functional magnetic resonance imaging (fMRI) characteristics of the improvement in executive function by aerobic exercise in children with attention deficit hyperactivity disorder (ADHD). Seventeen children with ADHD were selected for 8 weeks of rope skipping aerobic training, and fMRI findings and executive function were examined before and after training. Regional homogeneity (ReHo) and degree centrality (DC) indexes were used in fMRI analysis, whereas the flanker task was used to test executive function. A paired t test was used to compare the fMRI indexes and response time of executive function before and after training. After aerobic exercise, the brain regions in which the ReHo value of ADHD children significantly increased included the left middle frontal gyrus and the right superior frontal gyrus; the brain region in which the DC value increased was the right posterior cingulate cortex. The flanker task response time decreased significantly (P < 0.05, after correction) after aerobic exercise. The study findings support the hypothesis that aerobic exercise can improve the executive function of ADHD children, and the brain mechanism involved is mainly related to the enhancement of spontaneous prefrontal lobe activity.

The brain mechanism of awakening dysfunction in children with primary nocturnal enuresis based on PVT-NAc neural pathway: a resting-state fMRI study.

Primary nocturnal enuresis (PNE) affects children's physical and mental health with a high rate. However, its neural mechanism is still unclear. Studies have found that the paraventricular thalamus (PVT) is among the key brain regions implicated with awakening regulation and its control of the transition between sleep and wakening is dependent on signaling through the PVT-nucleus accumbens (NAc) pathway. So this study analyzed the function of brain regions and their connectivity of PVT and NAc. A total of twenty-six PNE and typically developing (TD) children were involved in the study and the methods of amplitude of low frequency fluctuation (ALFF), degree centrality (DC) and functional connectivity (FC) based on resting-state functional magnetic resonance imaging (rs-fMRI) were used to analyze the brain functions. Results showed that there was no statistical significant difference in ALFF and DC between PNE and TD children in bilateral PVT and NAc. And there was statistical significant difference of the comparison of the FC of left PVT (lPVT) and left NAc (lNAc) between PNE and TD children. Meanwhile, there was negative correlation between awakening score and the FC of rPVT and lNAc, and no obvious correlation between awakening score and the FC of lPVT and lNAc in PNE children. Meanwhile, there was both negative correlation between awakening score and the FC of lPVT, rPTV and lNAc in TD children. Therefore, the FC between rPVT and lNAc was more reliable in assessing the degree of awakening ability in PNE children. This finding could help establish the evaluation index of PNE.

The Cognitive Characteristics of PNE Children with Different Genders: A Resting-State fMRI Study.

OBJECTIVES: To study the brain mechanism and behavioral performance of cognitive functional differences between children with primary nocturnal enuresis (PNE) of different genders by resting-state functional magnetic resonance imaging (rs-fMRI) and attention behavior research. METHODS: All the children participating the test were 5-11 years old including 32 PNE children (15 boys and 17 girls) and 35 normal children (16 boys and 19 girls). They respectively went through MRI scan and the data were analyzed by the method of amplitude of low frequency fluctuation (ALFF). Then continuous performance test (CPT) was done and the correct number and reaction time were recorded. The between-group variance was analyzed by two sample t-test. RESULTS: 1. fMRI: There were no obviously different brain regions of ALFF between normal boys and girls. The brain regions which had obvious differences of ALFF between PNE boys and girls were right middle frontal gyrus, left inferior parietal lobule and right posterior cerbellar lobe. And the group of PNE boys were higher than PNE girls on all the three regions (P < 0.05). 2. CPT: The reaction time of PNE and normal boys was both lower than those of girls, but there were no obvious differences on the correct number. CONCLUSION: This study found that girls with PNE performed more obvious damages on attention, executive function and working memory than boys which might be related to the fact that girls were more likely to suffer from confidence impairment due to enuresis leading to cognitive dysfunctions. The method of ALFF based on resting-state fMRI provided a new approach for studying the cognitive characteristics of PNE children.

Amplitude of low-frequency fluctuation of resting-state fMRI in primary nocturnal enuresis and attention deficit hyperactivity disorder.

Children with attention deficit hyperactivity disorder (ADHD) and nocturnal enuresis (NE) have similar symptoms, for example, inattention and dysfunction of working memory. We investigate disorder-specific abnormal activity by using the simple resting-state functional magnetic resonance imaging (RS-fMRI) metric amplitude of low-frequency fluctuation (ALFF). About 18 ADHD, NE, and typically developing children were examined by RS-fMRI and the child behavior checklist (CBCL) test. One-way ANOVA were used to compare the ALFF values of the three groups and post hoc was done. We conducted Pearson correlation analysis on the results of the three groups' scales with ALFF values at the discrepant brain areas after then. Significant group effect was found in the bilateral medial prefrontal cortex (MPFC), left inferior temporal gyrus (ITG), left middle temporal gyrus (MTG), cerebellum anterior lobe (CAL), and left inferior parietal lobule (IPL). There was no shared abnormal region for ADHD and NE. Specially, ADHD showed increased ALFF in the bilateral MPFC, left ITG, and CAL and showed decreased ALFF in the left MTG. The children with NE showed increased ALFF in the left IPL. This study reveals the brain mechanism of cognitive changes on ADHD and NE, which provides neuroimaging basis for behavioral differences among different diseases.

Degree centrality of key brain regions of attention networks in children with primary nocturnal enuresis: A resting-state functional magnetic resonance imaging study.

Primary nocturnal enuresis (PNE) is always associated with attention impairment, some of which even could develop to attention deficit hyperactivity disorder. The mechanism of attention impairment is not clear, especially lacking of objective indicators of neuroimaging. The aim of this study is to explore the possible functional imaging mechanism of impaired attention in PNE children. A total of 26 PNE children and 26 age-matched normal controls were recruited. Resting-state functional magnetic resonance imaging (rs-fMRI) was performed on these children. Degree centrality (DC) of key brain regions of DAN (lFEF, rFEF, lIFG, rIFG, lIPS, rIPS), VAN (TPJ, VFC) and DMN (PCC, aMPFC, lAG, rAG) were calculated and compared between PNE and normal children. And the correlations between DC values and attention behavioral results were measured. Compared with normal controls, PNE children exhibited lower DC value in the right frontal eye field (rFEF), left inferior parietal sulcus (lIPS), right inferior parietal sulcus (rIPS), temporal parietal junction (TPJ) and left angular gyrus (lAG). The correct number of continuous performance test (CPT) in the PNE group was significantly lower than the normal controls and there was no significant difference in the reaction time between the two groups. The correlation between DC values and attention behavioral results in PNE showed that the DC values of PCC and lAG were negatively correlated with the correct number. This work indicates that the damage of the key brain regions of DAN, VAN and DMN might be the possible functional imaging mechanism of impaired attention in children with PNE.

Functional network connectivity changes in children with attention-deficit hyperactivity disorder: A resting-state fMRI study.

The study aimed to investigate the pathologic mechanism of functional brain regions in attention-deficit hyperactivity disorder (ADHD) patients through making comparisons of normal and ADHD children from the perspective of the network nodes of brain network and the intensity of functional connection between bilateral of hemispheres by resting-state functional magnetic resonance imaging (fMRI). Thirty-five ADHD and forty-two children were examined by resting-state functional magnetic resonance imaging (fMRI) scans. Data analysis was done via the degree centrality (DC) and voxel-mirrored homotopic connectivity (VMHC) approaches. Compared with healthy subjects, the ADHD group exhibited significantly decreased DC values in the right posterior cingulate gyrus, left medial superior frontal gyrus, right inferior parietal gyrus, right middle frontal gyrus, left superior frontal gyrus and right superior frontal gyrus. Children with ADHD also exhibited some areas with increased DC values compared with healthy children. These regions included the cerebellar anterior lobe, right middle occipital cortex, left middle cingulate gyrus and right middle cingulate gyrus. VMHC analysis all revealed positive activation in a range of brain regions when comparing ADHD and normal children, suggesting that the VMHC scores of children with ADHD were higher in the bilateral superior frontal lobe, bilateral middle occipital lobe, and bilateral cerebellar anterior lobes. This work provides a new approach for examining the neural mechanisms underlying ADHD, demonstrating that the DC and VMHC methods enabled more comprehensive analysis that can be cross-checked.

Altered patterns of resting-state functional connectivity between the caudate and other brain regions in medication-naïve children with attention deficit hyperactivity disorder.

BACKGROUND: Structural and functional alterations occur in the caudate of patients with attention-deficit/hyperactivity disorder (ADHD). Here we aimed to investigate the functional connectivity between the dorsal caudate and other brain regions in ADHD children. METHODS: Resting-state functional connectivity from 30 ADHD and 33 age- and gender-matched "normal" children were measured by functional Magnetic Resonance Imaging. RESULTS: Positive connectivity with dorsal caudate was observed in the prefrontal areas, cingulate cortex and temporal lobe. Negative functional connectivity was observed in the precuneus, occipital cortices and cerebellum. The connectivity of left dorsal caudate to left inferior frontal gyrus was correlated with severity of ADHD. CONCLUSIONS: Connectivity of dorsal caudate with several brain regions was identified in ADHD children.