Does attentional focus modulate affective information processing in male violent offenders with psychopathic traits?

Antisocial and psychopathic individuals are characterized by a reduced responsivity to affective information. Yet, the role of attentional processes as possible modulator of these deficits is poorly understood. The current study investigated early and late processing of emotional stimuli in a sample of incarcerated offenders while manipulating the attentional focus. Twenty-seven male violent offenders with psychopathic traits and 27 healthy controls completed two experimental tasks while electroencephalography (EEG) data were collected. Task 1 assessed indirect processing of emotional or neutral distractors during a perceptual judgment task, while Task 2 measured direct processing of the emotional or neutral stimuli and required participants to rate the stimuli regarding valence and arousal. EEG data indicated no differences in early stage processing (early posterior negativity) between the experimental groups. However, we found significant group differences with regard to the late processing stage (late positive potential, LPP). Controls showed increased LPP amplitudes in Task 2 as compared to Task 1, indicating that task demands (i.e., attentional focus) had an effect on the processing of the emotional stimuli. In contrast, LPP amplitudes in the violent offender group were largely unaffected by task demands, suggesting specific late alterations in the neural processing of emotional stimuli. In sum, this study provides new evidence for a modulatory impact of attention on affective information processing in male violent offenders with psychopathic traits.

Cognitive and electrophysiological markers of adult full syndrome and subthreshold attention-deficit/hyperactivity disorder.

Attention-deficit/hyperactivity disorder (ADHD) has been often referred to as an executive function deficit disorder with a specific electrophysiological signature. Although previous research suggests that individuals with subthreshold symptoms also suffer from severe impairments in daily life, only few studies have investigated cognitive and neural alterations in this group. Here, we explored impairments in executive functions and their electrophysiological correlates in a sample of adults with full syndrome (N = 113) and subthreshold (N = 46) ADHD compared to controls (N = 42). Results suggest that adults with full syndrome ADHD exhibit more executive function deficits than controls, while there were no electrophysiological differences found between groups. Also, we observed only small differences in neuropsychological variables between subthreshold ADHD and controls and no evidence for altered neural activity in the resting state. While subthreshold ADHD was not associated with altered executive functions or abnormal electrophysiological activity, this group reported significant psychological impairments and comorbidity.

Interpretation of ambiguous facial affect in adults with attention-deficit/hyperactivity disorder.

In addition to impairments in cognitive functioning, attention-deficit/hyperactivity disorder (ADHD) is associated with deficits in interpersonal functioning as well which are assumed to stem from a distorted perception or interpretation of affective information. While previous research suggests that the decoding of negatively valenced facial stimuli is impaired, less is known about the potential interpretation biases in ADHD which are linked to other externalizing psychopathologies. The present study investigated interpretation biases in adults with ADHD (N = 65) and controls (N = 49) using ambiguous facial stimuli (angry/happy, angry/fearful, fearful/happy blends) with different proportions of each emotion. Participants indicated the dominant emotion and rated the perceived intensity of each image. While impaired processing of fearful expressions was evident in the ADHD group, the results of the current study do not provide support for an interpretation bias in adults with ADHD. These findings suggest that interpretation biases may be restricted to aggressive psychopathology and cannot be generalized to individuals with ADHD.

Processing of Dynamic Affective Information in Adults With ADHD.

OBJECTIVE: ADHD has been repeatedly linked to problems in social functioning. Although some theories assume that the emotion recognition deficits are explained by general attentional deficits, mounting evidence suggests that they may actually constitute a distinct impairment. However, it remains unclear whether the deficient processing affects specific emotional categories or may generalize to all basic emotions. The present study aims to investigate these questions by assessing the sensitivity to all six basic emotions in adults with ADHD. METHOD: The participants judged the emotion onset in animated morph clips displaying facial expressions that slowly changed from neutral to emotional. RESULTS: ADHD participants exhibited an impaired recognition of sad and fearful facial expressions. CONCLUSION: The present findings indicate that ADHD is possibly associated with a specific deficit in the recognition of facial emotions signaling negative social feedback.

Distraction by salient stimuli in adults with attention-deficit/hyperactivity disorder: Evidence for the role of task difficulty in bottom-up and top-down processing.

The cognitive mechanisms of increased distractibility in attention-deficit/hyperactivity disorder (ADHD) are poorly understood. The current study investigated the influence of two major modulating factors (emotional saliency, task difficulty) on behavioral and electrophysiological parameters underlying distractibility in ADHD. In addition, the attentional focus (indirect and direct processing of distractors) was examined. Thirty-six adults with ADHD and 37 healthy controls completed two experimental tasks while electroencephalography (EEG) data was collected. Task 1 assessed indirect processing of emotional or neutral distractors during a perceptual judgment task with varying task difficulty. Task 2 measured direct processing of the emotional or neutral stimuli and required participants to rate the stimuli regarding valence and arousal. Results showed that adults with ADHD exhibited generally higher behavioral distractibility than healthy controls. Furthermore, the ADHD group exhibited an enhanced bottom-up processing [increased early posterior negativity (EPN) amplitudes] of distractors in trials with high task difficulty as well as enhanced top-down processing [increased late positive potential (LPP) amplitudes] in trials with low task difficulty. However, no group differences were evident in the neural processing of emotional content or between attentional focus conditions. These findings support the notion that distractibility in ADHD results from impairments to both top-down as well as bottom-up processes and underscore the importance of task difficulty as a modulating factor.

Neurofeedback, sham neurofeedback, and cognitive-behavioural group therapy in adults with attention-deficit hyperactivity disorder: a triple-blind, randomised, controlled trial.

BACKGROUND: Many studies suggest that electroencephalographic (EEG) neurofeedback might be beneficial in the treatment of attention-deficit hyperactivity disorder (ADHD). However, numbers of well controlled studies are low and neurofeedback techniques are regarded as highly controversial. The present trial examined the efficacy (compared with sham neurofeedback) and efficiency (compared with meta-cognitive therapy) of a standard EEG neurofeedback protocol in adults with ADHD. METHODS: We did a concurrent, triple-blind, randomised, controlled trial using authorised deception in adults with ADHD from one centre (University of Tübingen) in Tübingen, Germany. Participants were eligible if they fulfilled the DSM-IV-TR criteria for ADHD, were aged between 18 years and 60 years, and had no or stable use of medication for at least 2 months with no intention to change. We excluded participants who had comorbid schizophrenia or schizoaffective disorder, bipolar disorder, borderline personality disorder, epilepsy, or traumatic brain injury; substance abuse or dependence; or current or planned other psychological treatment. Those eligible were randomly assigned to three groups: a neurofeedback group which received 30 verum θ-to-ß neurofeedback sessions over 15 weeks, a sham neurofeedback group which received 15 sham followed by 15 verum θ-to-ß neurofeedback sessions over 15 weeks, or a meta-cognitive group therapy group which received 12 sessions over 12 weeks. Participants were assigned equally to one of the three interventions through a computerised minimisation randomisation procedure stratified by sex, age, and baseline symptom severity of ADHD. Participants were masked as to whether they were receiving neurofeedback or sham neurofeedback, but those receiving meta-cognitive therapy were aware of their treatment. Clinical assessors (ie, those assessing outcomes) and research staff who did the neurofeedback training were masked to participants' randomisation status only for neurofeedback and sham neurofeedback. The primary outcome was symptom score on the Conners' adult ADHD rating scale, assessed before treatment, at midtreatment (after 8 weeks), after treatment (after 16 weeks), and 6 months later. All individuals with at least one observation after randomisation were included in the analyses. This trial is registered with ClinicalTrials.gov, number NCT01883765. FINDINGS: Between Feb 1, 2013, and Dec 1, 2015, 761 people were assessed for eligibility. 656 (86%) were excluded and 118 (15%) were eligible for participation in this study. Eligible participants were randomly assigned to neurofeedback (38 [32%]), sham neurofeedback (39 [33%]), or meta-cognitive therapy (41 [35%]). 37 (97%) individuals for neurofeedback, 38 (97%) for sham neurofeedback, and 38 (93%) for meta-cognitive therapy were included in analyses. Self-reported ADHD symptoms decreased substantially for all treatment groups (B=-2·58 [95% CI -3·48 to -1·68]; p<0·0001) between pretreatment and the end of 6 month follow-up, independent of treatment condition (neurofeedback vs sham neurofeedback B=-0·89 [95% CI -2·14 to 0·37], p=0·168; neurofeedback vs meta-cognitive therapy -0·30 [-1·55 to 0·95], p=0·639). No treatment-related or trial-related serious adverse events were reported. INTERPRETATION: Our findings suggest that neurofeedback training is not superior to a sham condition or group psychotherapy. All three treatments were equivalently effective in reducing ADHD symptoms. This first randomised, sham-controlled trial did not show any specific effects of neurofeedback on ADHD symptoms in adults. FUNDING: German Research Foundation.

Frontal brain asymmetry in adult attention-deficit/hyperactivity disorder (ADHD): extending the motivational dysfunction hypothesis.

OBJECTIVE: Attention-deficit/hyperactivity disorder (ADHD) involves motivational dysfunction, characterized by excessive behavioral approach tendencies. Frontal brain asymmetry in the alpha band (8-13 Hz) in resting-state electroencephalogram (EEG) represents a neural correlate of global motivational tendencies, and abnormal asymmetry, indicating elevated approach motivation, was observed in pediatric and adult patients. To date, the relation between ADHD symptoms, depression and alpha asymmetry, its temporal metric properties and putative gender-specificity remain to be explored. METHODS: Adult ADHD patients (n=52) participated in two resting-state EEG recordings, two weeks apart. Asymmetry measures were aggregated across recordings to increase trait specificity. Putative region-specific associations between asymmetry, ADHD symptoms and depression, its gender-specificity and test-retest reliability were examined. RESULTS: ADHD symptoms were associated with approach-related asymmetry (stronger relative right-frontal alpha power). Approach-related asymmetry was pronounced in females, and also associated with depression. The latter association was mediated by ADHD symptoms. Test-retest reliability was sufficient. CONCLUSIONS: The association between reliably assessable alpha asymmetry and ADHD symptoms supports the motivational dysfunction hypothesis. ADHD symptoms mediating an atypical association between asymmetry and depression may be attributed to depression arising secondary to ADHD. Gender-specific findings require replication. SIGNIFICANCE: Frontal alpha asymmetry may represent a new reliable marker of ADHD symptoms.

Temporal estimation of threatening stimuli in social anxiety disorder: investigation of the effects of state anxiety and fearfulness.

BACKGROUND AND OBJECTIVES: Prior studies suggest that particularly negative emotional events tend to be experienced as temporally dilated. Perceptual characteristics of the threat cue (averted or directed angry face), state as well as individual anxiety levels have been shown to contribute to the temporal distortions, but the interplay between these factors is not well understood. The present study investigated the relative contributions of these factors in a first study using clinical sample with social anxiety disorder (SAD) and healthy controls (HC). METHODS: Participants performed a temporal bisection task (TBT) before and after a stress provocation phase, which served to induce state anxiety. During the TBT task, angry and neutral faces with averted vs. direct gaze were presented for the length of 600, 800, 1000, 1200, 1400, 1600 ms, and judged regarding their similarity to the standard durations. RESULTS: A temporal overestimation effect for angry vs. neutral facial expressions was evident in both the HC and the SAD groups. An effect of experimentally induced state anxiety was evident solely in the SAD group, reflected in an overall increased temporal overestimation of angry vs. neutral expressions following the mood manipulation. LIMITATIONS: The clinical sample may represent a high-functioning group, as the study was conducted on college students. Replication in more heterogeneous SAD samples is needed in order to draw further conclusions. CONCLUSIONS: These results may be relevant for the understanding of the etiology and maintenance of SAD and potentially for the development of novel intervention methods.