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.

[Intellectual styles and academic achievement: a developmental perspective]. / Estilos intelectuales y rendimiento académico: una perspectiva evolutiva.

The aim of the present study is to provide additional information to highlight some aspects concerning the relationship between thinking styles and academic achievement. In order to understand the extent to which thinking styles predict academic achievement, 1466 students, between 12 and 16 years old, from first to fourth grades of Compulsory Secondary Education (Spanish ESO) took part in the research. A parsimonious model of covariances was assumed in each of the four samples corresponding to the four different grades of Secondary School as well as in the total sample. Data show that thinking styles significantly explain part of the variance of academic achievement, although only about 10%.

Impact of Family and Friends on Antisocial Adolescent Behavior: The Mediating Role of Impulsivity and Empathy.

Adolescence is an especially risky phase for the appearance of antisocial behaviors. Antisocial behavior produces significant individual and social harms, so it is important to provide keys for prevention and treatment. To do that, it is essential to identify the main predictors. The objective of this study is to analyze the effect of family (affection and communication, behavioral control) and friends (antisocial friendships) on adolescent antisocial behavior, as well as the mediating role of adolescent impulsivity and empathy on these relationships. Previously validated questionnaires measuring parental affection and communication, and behavioral control, as well as adolescent impulsivity, empathy, antisocial friendships, and antisocial behavior were applied to 3199 adolescents in Asturias (Spain), aged between 11 and 18 (M = 14.03; SD = 1.39). Descriptive, correlational, and structural equation analysis were performed. Antisocial friendships were a risk factor for antisocial behavior in adolescence, with a moderate effect size. The effect is mostly direct, although it is also indirect through the positive relationship with adolescent impulsivity and low empathy. The two analyzed parenting style dimensions (affection and communication, and behavioral control) demonstrate a protective effect, albeit small, on adolescent antisocial behavior. There is a direct protective effect, but it is mostly indirect through the negative relationship with antisocial friendships and low adolescent empathy. Parental behavioral control can be a risk factor for antisocial behavior, through the positive relationship with adolescent impulsivity. This study helps to clarify the causal mechanisms of antisocial behavior in adolescence, as a basis for its prevention and treatment.

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.

The Effect of Parental Control on Cyber-Victimization in Adolescence: The Mediating Role of Impulsivity and High-Risk Behaviors.

The aim of this work is to analyze the relationship between parental control and cyber-victimization in adolescence, considering the possible mediating effect of impulsivity, and high-risk internet behavior. To that end we analyzed the responses of 3360 adolescents aged between 11 and 18 (M = 14.02; SD = 1.40), from Asturias (Spain), to four previously validated questionnaires in order to measure the level of parental control over the use of the internet (restriction and supervision), along with high-risk internet behaviors, impulsivity, and cyber-victimization in the adolescents. The results show that parental control tends to have a protective effect on the likelihood of the children being victims of cyber-aggression, with impulsivity, and high-risk internet behaviors as mediating variables. More specifically, parental restriction and supervision are positively related to each other; both forms of parental control are negatively related with the adolescent's engaging in high-risk internet behaviors; supervision is negatively related with impulsivity; impulsivity is positively related with high-risk internet behaviors; and both impulsivity and high-risk internet behaviors are positively related to being a victim of cyber-aggression. The practical implications of these results are discussed.

[Computerized hypertextual strategy and personal construction of meaning]. / Estrategia hipertextual computerizada y construcción personal de significados.

The aim of this study is to provide information about the effects of strategic training in the area of social sciences (1) on the real level, as well as perceived competence in terms of the students' skills to select, organise and produce information; and (2) on their attitude and motivation towards working in this area of the curriculum. 107 students took part in this study, 57 of whom were the control group and 50 the experimental one. They were all enrolled in the third year of secondary school (9th year). The teachers and students who took part in this experience followed an on-line course to manage the <> strategy for approximately three months. Subsequently, the teacher introduced the tool in class, applying it both from a conceptual and a procedural point of view. The results show that the strategic training implemented in this study greatly improved written understanding procedures (both literal and inferential), increased perceived competence to manage internal information (selection, organization, and elaboration), and generated positive changes in terms of students' attitude and motivation towards working in the area of social sciences.

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.

Analysis of cognitive and attentional profiles in children with and without ADHD using an innovative virtual reality tool.

In previous studies, children with Attention-Deficit Hyperactivity Disorder (ADHD) have been found to have more difficulties with processing speed, working memory, and attentional tasks. The present study aimed to compare the cognitive variables (working memory and processing speed) and the attentional profiles of a sample of students with and without ADHD, using scales from the WISC-IV, and the virtual reality-based attentional test known as 'Aula Nesplora'; and determine the extent to which the aforementioned variables may predict student group membership. A total of 88 students took part in this study (66 males and 22 females), aged from 6 to 16 years (M = 10.20; SD = 2.79). The sample was divided into two groups: an ADHD group (n = 50) and a Control group (n = 38). Students in the ADHD group obtained lower scores in working memory and in processing speed, as well as demonstrating poorer performance in Aula Nesplora than did their peers. Working memory, and the number of omissions, were both shown to be reliable predictors of group membership. This study revealed the importance of obtaining data from attentional variables differentiated by modality when considering cognitive variables, in order to better characterize the difficulties experienced by individuals diagnosed with ADHD.

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.

Naming speed as a predictive diagnostic measure in reading and attentional problems.

This study aimed to describe and compare naming speed abilities in children diagnosed with either Reading Learning Difficulties (RLD) or Attention Deficit/Hyperactivity Disorder (ADHD), or comorbidity for both (ADHD+RLD). To examine the explanatory power of naming speed and ADHD symptomatology in predicting group associations (while controlling for gender and age), the "Rapid Automatized Naming and Rapid Alternating Stimulus Tests" (RAN/RAS) were utilized. A sample of 101 children (age range = 5-16 years) was divided into four groups: RLD (n = 14), ADHD (n = 28), comorbid (n = 19), and control (n = 40). There were statistically significant differences in RAN/RAS results among the diagnostic groups. Moreover, discriminant analysis revealed that naming speed tasks significantly predicted reading and attentional problems, especially at earlier ages. These results demonstrate the potential usefulness of RAN/RAS in the diagnosis of reading and attentional problems, particularly if the children are aged from 5 to 9.

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.