Differences in neurometabolites and transcranial magnetic stimulation motor maps in children with attention-deficit/hyperactivity disorder.

BACKGROUND: Although much is known about cognitive dysfunction in attention-deficit/hyperactivity disorder (ADHD), few studies have examined the pathophysiology of disordered motor circuitry. We explored differences in neurometabolite levels and transcranial magnetic stimulation (TMS)-derived corticomotor representations among children with ADHD and typically developing children. METHODS: We used magnetic resonance spectroscopy (MRS) protocols to measure excitatory (glutamate + glutamine [Glx]) and inhibitory (γ-aminobutyric acid [GABA]) neurometabolite levels in the dominant primary motor cortex (M1) and the supplementary motor area (SMA) in children with ADHD and typically developing children. We used robotic neuronavigated TMS to measure corticospinal excitability and create corticomotor maps. RESULTS: We collected data from 26 medication-free children with ADHD (aged 7-16 years) and 25 typically developing children (11-16 years). Children with ADHD had lower M1 Glx (p = 0.044, d = 0.6); their mean resting motor threshold was lower (p = 0.029, d = 0.8); their map area was smaller (p = 0.044, d = 0.7); and their hotspot density was higher (p = 0.008, d = 0.9). M1 GABA levels were associated with motor map area (p = 0.036).Limitations: Some TMS data were lost because the threshold of some children exceeded 100% of the machine output. The relatively large MRS voxel required to obtain sufficient signal-to-noise ratio and reliably measure GABA levels encompassed tissue beyond the M1, making this measure less anatomically specific. CONCLUSION: The neurochemistry and neurophysiology of key nodes in the motor network may be altered in children with ADHD, and the differences appear to be related to each other. These findings suggest potentially novel neuropharmacological and neuromodulatory targets for ADHD.

Impact of COVID-19 on lifestyle habits and mental health symptoms in children with attention-deficit/hyperactivity disorder in Canada.

OBJECTIVES: The COVID-19 pandemic created an environment of restricted access to health and recreation services. Lifestyle habits including sleep, eating, exercise, and screen use were modified, potentially exacerbating adverse mental health outcomes. This study investigates the impact of COVID-19 on lifestyle habits and mental health symptoms in paediatric attention-deficit/hyperactivity disorder (ADHD) in Canada. METHODS: An online survey was distributed across Canada to caregivers of children with ADHD (children aged 5 to 18 years) assessing depression (PHQ-9), anxiety (GAD-7), ADHD (SNAP-IV), and lifestyle behaviours. Data were analyzed by gender (male/female) and age category (5 to 8, 9 to 12, and 13 to 18 years). Spearman's correlations between lifestyle habits and mental health outcomes were conducted. RESULTS: A total of 587 surveys were completed. Mean child age was 10.14 years (SD 3.06), including 166 females (28.3%). The PHQ-9 and GAD-7 indicated that 17.4% and 14.1% of children met criteria for moderately severe to severe depression and anxiety symptoms respectively. Children met SNAP-IV cut-off scores for inattention (73.7%), hyperactivity/impulsivity (66.8%), and oppositional defiant disorder (38.6%) behaviours. Caregivers reported changes in sleep (77.5%), eating (58.9%), exercise (83.7%), and screen use (92.9%) in their ADHD child, greatly impacting youth. Sleeping fewer hours/night, eating more processed foods, and watching TV/playing videogames >3.5 hours/day correlated with greater depression, anxiety and ADHD symptoms, and exercising <1 hour/day further correlated with depression symptoms (P<0.01). CONCLUSIONS: The COVID-19 pandemic has resulted in less healthy lifestyle habits and increased mental health symptoms in Canadian children with ADHD. Longitudinal studies to better understand the relationship between these factors are recommended.

Positive Child Personality Factors in Children with ADHD.

OBJECTIVE: Attention-Deficit/Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder. While previous studies have shown substantial impact of ADHD across multiple domains, relatively little attention has been devoted to studying positive personality factors in individuals with ADHD. To address this, the current study examined strength-based factors in children with ADHD in relation to their social skills. METHOD: Sixty-four children (aged 8-12 years) with ADHD completed questionnaires related to their social skills and strength-based factors (e.g., optimism, resilience, self-concept, and coping skills). RESULTS: Findings indicated significant differences between different levels of social skills in children with ADHD, with children with higher social skills reporting higher levels of resiliency, greater behavioral competence, and greater prosocial attitudes than those with lower social skills. CONCLUSIONS: The results highlight the importance of fostering strong social skills in children with ADHD, leading them to perceive themselves as competent and resilient.

Impact of stimulant medication on behaviour and executive functions in children with attention-deficit/hyperactivity disorder.

BACKGROUND: Children with attention-deficit/hyperactivity disorder (ADHD) often exhibit behaviour challenges and deficits in executive functions (EF). Psychostimulant medications [e.g., methylphenidate (MPH)] are commonly prescribed for children with ADHD and are considered effective in 70% of the cases. Furthermore, only a handful of studies have investigated the long-term impact of MPH medication on EF and behaviour. AIM: To evaluate behaviour and EF challenges in children with ADHD who were involved in an MPH treatment trial across three-time points. METHODS: Thirty-seven children with ADHD completed a stimulant medication trial to study the short- and long-term impact of medication. Children with ADHD completed three neuropsychological assessments [Continuous Performance Test (CPT)-II, Digit Span Backwards and Spatial Span Backwards]. Parents of children with ADHD completed behaviour rating scales [Behaviour Rating Inventory of Executive Functioning (BRIEF) and Behaviour Assessment System for Children-Second Edition (BASC-2)]. Participants were evaluated at: (1) Baseline (no medication); and (2) Best-dose (BD; following four-week MPH treatment). Additionally, 18 participants returned for a long-term naturalistic follow up (FU; up to two years following BD). RESULTS: Repeated measure analyses of variance found significant effects of time on two subscales of BRIEF and four subscales of BASC-2. Neuropsychological assessments showed some improvement, but not on all tasks following the medication trial. These improvements did not sustain at FU, with increases in EF and behaviour challenges, and a decline in performance on the CPT-II task being observed. CONCLUSION: Parents of children with ADHD reported improvements in EF and behaviours during the MPH trial but were not sustained at FU. Combining screening tools and neuropsychological assessments may be useful for monitoring medication responses.

Right Superior Frontal Gyrus Cortical Thickness in Pediatric ADHD.

OBJECTIVE: We investigated the right Superior Frontal Gyrus (right-SFG) and Anterior Cingulate Cortex (ACC) in children with ADHD and their clinical relevance with Executive Function (EF) and ADHD symptom severity. METHODS: About 26 children with ADHD and 24 typically developing children (TDC; 7‒16 years) underwent Magnetic Resonance Imaging (MRI) and completed an EF assessment battery. RESULTS: Significantly thinner right-SFG in the ADHD group was found compared to the TDC group (t (48) = 2.81, p = .007, Cohen's d = 0.84). Linear regression models showed that 12.5% of inattention, 13.6% of hyperactivity, and 9.0% of EF variance was accounted for by the right-SFG thickness. CONCLUSIONS: Differences in the right-SFG thickness were found in our ADHD group and were associated with parent ratings of inattentive and hyperactive symptoms as well with EF ratings. These results replicate previous findings of thinner right-SFG and are consistent with the delayed cortical maturation theory of ADHD.

Neurochemical Correlates of Executive Function in Children with Attention-Deficit/Hyperactivity Disorder.

OBJECTIVES: Attention-Deficit/Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder with no known biomarkers. The objectives of this study were 1) to investigate spectroscopic biomarkers in the right prefrontal cortex (R-PFC) and left striatum; 2) to evaluate Executive Function (EF) performance; and, 3) to examine the clinical relevance of glutamate in EF tasks. METHODS: A total of 21 children with ADHD (M = 10.41 years, SD = 1.41) and 15 controls without ADHD (M = 9.90 years, SD = 1.54 years) were enrolled. Short echo proton magnetic resonance spectroscopy (1H-MRS; TE = 30ms) was used to study the changes in the R-PFC and left striatum. Both groups completed an EF assessment battery, including working memory, inhibition, cognitive flexibility and verbal fluency tasks. RESULTS: In the R-PFC, independent t-tests found decreased concentration of glutamate (p = 0.009), NAA (p = 0.029) and choline (p = 0.016) in ADHD participants compared to controls. No significant differences were seen in the left striatum. Multivariate analysis of variance did not indicate overall EF challenges in the ADHD sample (p < .05). Positive correlations with glutamate concentration and EF performance in the control group were observed, however, no such correlations were reported in the ADHD group. CONCLUSIONS: The results indicated a subgroup of children with ADHD who presented with hypo-glutamatergic signalling in the R-PFC. Additionally, findings suggested a decoupling effect of glutamate in EF related tasks in children with ADHD compared to controls. Thus, glutamate concentration may be a possible ADHD biomarker and novel treatments target.

OBJECTIFS: Le trouble de déficit de l'attention avec hyperactivité (TDAH) est un trouble neurodéveloppemental prévalent sans biomarqueurs connus. Les objectifs de la présente étude étaient 1) de rechercher les biomarqueurs spectroscopiques du cortex préfrontal droit (CPF-D) et du striatum gauche; 2) d'évaluer le rendement de la fonction exécutive (FE); et 3) d'examiner la pertinence clinique du glutamate dans les tâches de la FE. MÉTHODES: Au total, 21 enfants souffrant du TDAH (M = 10,41 ans, ET = 1,41) et 15 témoins sans TDAH (M = 9,90 ans, ET = 1,54 an) ont été inscrits. La spectroscopie par résonance magnétique protonique à bref temps d'écho (1H-SRM; TE = 30 ms) a servi à étudier les changements dans le CPF-D et le striatum gauche. Les deux groupes ont passé une batterie de tests d'évaluation de la FE, dont les tâches de la mémoire de travail, l'inhibition, la flexibilité cognitive et la fluidité verbale. RÉSULTATS: Dans le CPF-D, les t-tests indépendants ont constaté une concentration réduite de glutamate (p = 0,009), de NAA (p = 0,029) et de choline (p = 0,016) chez les participants du TDAH comparés aux témoins. Aucune différence significative n'a été observée dans le striatum gauche. Des analyses multivariées de la variance n'ont pas indiqué de problèmes généraux pour la FE dans l'échantillon TDAH (p < 0,05). Des corrélations positives avec la concentration de glutamate et le rendement de la FE dans le groupe témoin ont été observées, toutefois, ces corrélations n'ont pas été observées dans le groupe du TDAH. CONCLUSIONS: Les résultats indiquaient un sous-groupe d'enfants souffrant du TDAH qui présentait un signal hypo-glutamatergique dans le CPF-D. En outre, les résultats suggéraient un effet de découplage du glutamate dans les tâches liées à la FE chez les enfants souffrant du TDAH comparés aux témoins. Ainsi, la concentration de glutamate peut être un biomarqueur du TDAH et une nouvelle cible de traitement.

Group engagement in persons with dementia: The concept and its measurement.

Although a few papers documented benefits of group therapeutic activities for individuals with dementia, there is a dearth of studies that have investigated the effects of group activities on persons with dementia. This paper introduces a theoretical framework of studying group therapeutic recreational activity, the Comprehensive Process Model of Group Engagement, and an assessment tool, the Group Observational Measurement of Engagement (GOME). We also report the psychometric properties of this assessment. One hundred and four persons with dementia took part in ten different group activities, with each activity conducted twice at random order so that 20 activities were observed for each group of participants. Following each group activity, research and therapeutic recreation staff members used the GOME assessment to independently rate participants on individual-level measures of attendance duration and engagement, and group level measures (e.g., positive and negative interactions among group members). Reliability and validity analyses comparing observer ratings for each group activity on the individual-level measures of attendance and engagement showed good psychometric properties. Different measures collected on a group level differed with respect to their psychometric quality. We present a theoretical framework to understand group engagement and present measures that could be used in future research and practice.

The Ultimate Outlier: Transitional Care for Persons with Dementia and BPSD.

BACKGROUND: Transitional care units aim to assist caregivers who cannot manage the care for persons with dementia who manifest behavioral and psychological symptoms of dementia (BPSD). However, there is a dearth of research on such care units. OBJECTIVE: The current study reviewed one specialized transitional unit to better understand the characteristics of the persons with dementia and behavioral symptoms entering such unit. The study also looked at the change in terms of (a) BPSD, (b) use of psychotropic medications and (c) function of the patients in this unit. METHOD: A retrospective chart review of 73 residents of a transitional care unit was conducted. Background and outcome information were collected on electronic data entry sheets. RESULTS: Patients had an average age of 75.0 years, 74.0% were men. Mean Cognitive Performance Scale score was 4.7. Comparing admission to discharge, there was a significant decrease in BPSD, and a significant increase in number of central nervous system medications. There were no significant changes in cognition or ability to perform activities of daily living. CONCLUSION: Patient characteristics differed from those of other long term care settings. This unique population requires further study to optimize the outcomes.

Friend or foe? Age moderates time-course specific responsiveness to trustworthiness cues.

OBJECTIVES: There is growing evidence of a greater focus on positive relative to negative information in older adulthood. Up to date, the age-related positivity effect in affective processing has been only investigated with respect to explicit emotional cues. Thus, the purpose of this study was to investigate whether similar age-related differences would be observed in reference to subtler cues, such as emotionally suggestive structural facial characteristics. METHOD: We used a gaze following paradigm and investigated the temporal dynamics of responding to facial trustworthiness cues in younger and older adults. RESULTS: Both age groups provided similar trustworthiness evaluations. Nonetheless, under responding conditions that allowed for volitional modulatory influences (600 ms), older (but not younger) adults with superior cognitive resources showed more gaze following in response to trustworthy than to untrustworthy looking faces. CONCLUSIONS: This study provided initial evidence that the age-related positivity effect in affective processing extends to subtle emotional cues, generally interpreted as being reflective of socially relevant personality traits. Implications for aging theories of motivated cognition and developmental changes in reliance on superficial affective cues are discussed.