What future research should bring to help resolving the debate about the efficacy of EEG-neurofeedback in children with ADHD

In recent years a rising amount of randomized controlled trials, reviews, and meta-analyses relating to the efficacy of electroencephalographic-neurofeedback (EEG-NF) in children with attention-deficit/hyperactivity disorder (ADHD) have been published. Although clinical reports and open treatment studies suggest EEG-NF to be effective, double blind placebo-controlled studies as well as a rigorous meta-analysis failed to find support for the efficacy of EEG-NF. Since absence of evidence does not equate with evidence of absence, we will outline how future research might overcome the present methodological limitations. To provide conclusive evidence for the presence or absence of the efficacy of EEG-NF in the treatment of ADHD, there is a need to set up a well-designed study that ensures optimal implementation and embedding of the training, and possibly incorporates different forms of neurofeedback

Effects of maternal and paternal smoking on attentional control in children with and without ADHD

Maternal smoking during pregnancy is a risk factor for attention-deficit/hyperactivity disorder (ADHD), but data on its adverse effects on cognitive functioning are sparse and inconsistent. Since the effect of maternal smoking during pregnancy may be due to correlated genetic risk factors rather than being a pure environmental effect, we examined the effect of prenatal exposure to smoking on attentional control, taking into account the effects of both maternal and paternal smoking, and examined whether these effects were genetically mediated by parental genotypes. We further examined whether the effect of prenatal exposure to smoking on attentional control interacted with genotypes of the child. Participants were 79 children with ADHD, ascertained for the International Multi-centre ADHD Gene project (IMAGE), and 105 normal controls. Attentional control was assessed by a visual continuous performance task. Three genetic risk factors for ADHD (DRD4 7-repeat allele of the exon 3 variable number of tandem repeats (VNTR), DAT1 10/10 genotype of the VNTR located in the 3′ untranslated region, and the DAT1 6/6 genotype of the intron 8 VNTR) were included in the analyses. Paternal smoking had a negative effect on attentional control in children with ADHD and this effect appeared to be mediated by genetic risk factors. The prenatal smoking effect did not interact with genotypes of the child. Maternal smoking had no main effect on attentional control, which may be due to lower smoking rates. This study suggests that the effects of paternal smoking on attentional control in children with ADHD should be considered a proxy for ADHD and/or smoking risk genes. Future studies should examine if the results can be generalized to other cognitive domains

Response time variability and response inhibition predict affective problems in adolescent girls, not in boys: the TRAILS study

The present study examines the relationship between neurocognitive functioning and affective problems through adolescence, in a cross-sectional and longitudinal perspective. Baseline response speed, response speed variability, response inhibition, attentional flexibility and working memory were assessed in a cohort of 2,179 adolescents (age 10–12 years) from the TRacking Adolescents’ Individual Lives Survey (TRAILS). Affective problems were measured with the DSM-oriented Affective Problems scale of the Youth Self Report at wave 1 (baseline assessment), wave 2 (after 2.5 years) and wave 3 (after 5 years). Cross-sectionally, baseline response speed, response time variability, response inhibition and working memory were associated with baseline affective problems in girls, but not in boys. Longitudinally, enhanced response time variability predicted affective problems after 2.5 and 5 years in girls, but not in boys. Decreased response inhibition predicted affective problems after 5 years follow-up in girls, and again not in boys. The results are discussed in light of recent insights in gender differences in adolescence and state–trait issues in depression

Cognitive endophenotypes of ADHD

Attention Deficit Hyperactivity Disorder is an impairing childhood-onset neuropsychiatric disorder, highly influenced by (multi)genetic factors. The precise genetic constellation of ADHD is still unknown. Since it is increasingly recognized that the traditional nosological categories described in the DSM-IV and ICD-10 are suboptimal when it comes to describing who is affected and carrying susceptibility genes and who is not, emphasis should be on the description of endophenotypes. Endophenotypes are latent traits that carry genetic loading and which are related indirectly to the classic behavioral symptoms as defined in DSM-IV or ICD-10. The main aim of this thesis was to uncover candidate cognitive endophenotypes of ADHD. The chapters 2 and 3 focused respectively on response inhibition and fine motor functioning as candidate endophenotypes of ADHD. These aspects of executive functioning were examined in a family-genetic study design with 25 carefully phenotyped ADHD probands with a family history of ADHD, their non-affected siblings (n = 25), and 48 normal controls (age ranged from 6 to 17 years in all groups). The non-affected siblings were compared with the ADHD probands and with the controls on response inhibition (chapter 2), and fine motor functioning (chapter 3). It was hypothesized that the non-affected siblings of ADHD probands would exhibit deficits in response inhibition and fine motor functioning intermediate between that of the controls and the ADHD probands. The most striking finding from the study on response inhibition (chapter 2) was that the non-affected siblings had results similar to those of the ADHD probands, which demonstrated that deficient response inhibition might constitute a cognitive endophenotype of ADHD. The results of the study on motor functioning (chapter 3) revealed that the non-affected siblings experienced fine motor problems similar to those of their affected siblings, but only in movements that required high levels of executive functioning. The study described in chapter 4 investigated whether executive function deficits could identify a meaningful familial subtype of ADHD. To examine the hypothesis that familial ADHD may represent a distinct and meaningful subtype of ADHD characterised by executive dysfunctioning, the cognitive performance of 29 ADHD probands with a family history of ADHD was compared with the performance of 26 ADHD probands without a family history of the disorder, and with that of 28 controls. Different measures of response inhibition, higher-order controlled motor functioning and attentional control were used. Contrary to the hypothesis, none of the executive functions, except for one aspect of attentional control, could differentiate between the familial- and nonfamilial ADHD groups. The study in chapter 5 examined familial clustering of executive functioning to provide support for the notion that different aspects of executive dysfunctioning might constitute endophenotypes to ADHD. Tasks measuring response inhibition, fine motor functioning, and attentional control were administered to 52 ADHD affected sibling pairs ranging in age from 6 to 18 years. Significant sibling correlations were found for measures of these aspects of executive functioning. With respect to fine motor functioning, only motor skills that made high demands on executive functioning showed significant sibling correlation. In chapter 6, attentional control, and mental flexibility were examined in the family-genetic study design that is used in the first two studies. The results revealed that the performance of the non-affected siblings did not differ from that of the ADHD probands on attentional control, nor on most measures of mental flexibility. The linear changes of these measures across the groups reflected an intermediate position of the non-affected siblings between the ADHD probands and controls. Chapter 7 presented the results of a post hoc principal component analysis in which the cognitive measures that are used in the experimental studies (chapter 2 up to 6) were included to identify interpretable underlying constructs of executive functioning in a sample of ADHD siblings. The PCA revealed that a three-factor model was the best solution to summarize the data: attentional and motor control, mental flexibility, and response inhibition. Chapter 8 provided a discussion of the overall findings, and implications for future research and clinical practice

Working memory training in children with neuropsychiatric disorders and mild to borderline intellectual functioning, the role of coaching; a double-blind randomized controlled trial

Abstract Background Working memory training (WMT) has been shown to offer therapeutic benefits to both patients with Attention-Deficit Hyperactivity Disorder (ADHD) and patients with mild to borderline Intellectual Disabilities (MBID; 60 < IQ < 85). However, robust evidence for transfer effects and treatment benefits of WMT over placebo training are lacking. Owing to the nature of double-blind research designs in RCTs, children have received non-specific coaching not based on their actual training performance. Active coaching based on individual training results (such as in clinical practice) might enhance the efficacy of Cogmed WMT. Furthermore, clinical experience and the general treatment approach to these vulnerable children has shown that the intensity and duration of WMT is often too stressful. This study therefore investigated the efficacy of a less intensive, but more prolonged Cogmed WMT (including active personalized coaching and feedback) in reducing behavioral symptoms and improving neurocognitive functioning and academic achievements in children with MBID and neuropsychiatric disorders. Methods/design A double-blind RCT with children (age 10.0–13.11) with neuropsychiatric disorders (ADHD and/or autism spectrum disorder (ASD)) and MBID (IQ: 60 < IQ < 85). Two groups (each n = 26) will receive Cogmed WMT (version R/M) at home or at school for 8 weeks, 4 days a week, at 30 min a day. One group will receive active personalized coaching and feedback based on their actual individual performance during Cogmed training. The other group will only receive general non-personalized coaching (i.e. no receive personalized coaching and feedback). Both groups will undergo a neurocognitive assessment (working memory, executive functioning, academic achievements) before and after training and complete several questionnaires (behavioral problems, parenting style) with a 6 months follow-up. Discussion This study will add to the literature since the role of coaching in Cogmed WMT has not been studied before. It will also provide opportunities to investigate an alternative version of WMT in a large group of vulnerable children, for whom few evidence-based treatments are available. Ultimately, this will allow us to advise mental health care professionals and special education schools about the use of this type of intervention for children with MBID and neuropsychiatric disorders. Trial registration Dutch Trial Register. NTR5223 . Registration date 06–09-2015

fMRI Neurofeedback Training for Increasing Anterior Cingulate Cortex Activation in Adult Attention Deficit Hyperactivity Disorder. An Exploratory Randomized, Single-Blinded Study.

Attention Deficit Hyperactivity Disorder (ADHD) is characterized by poor cognitive control/attention and hypofunctioning of the dorsal anterior cingulate cortex (dACC). In the current study, we investigated for the first time whether real-time fMRI neurofeedback (rt-fMRI) training targeted at increasing activation levels within dACC in adults with ADHD leads to a reduction of clinical symptoms and improved cognitive functioning. An exploratory randomized controlled treatment study with blinding of the participants was conducted. Participants with ADHD (n = 7 in the neurofeedback group, and n = 6 in the control group) attended four weekly MRI training sessions (60-min training time/session), during which they performed a mental calculation task at varying levels of difficulty, in order to learn how to up-regulate dACC activation. Only neurofeedback participants received continuous feedback information on actual brain activation levels within dACC. Before and after the training, ADHD symptoms and relevant cognitive functioning was assessed. Results showed that both groups achieved a significant increase in dACC activation levels over sessions. While there was no significant difference between the neurofeedback and control group in clinical outcome, neurofeedback participants showed stronger improvement on cognitive functioning. The current study demonstrates the general feasibility of the suggested rt-fMRI neurofeedback training approach as a potential novel treatment option for ADHD patients. Due to the study's small sample size, potential clinical benefits need to be further investigated in future studies.ISRCTN12390961

COTAPP:De digitale test voor aandacht, informatieverwerking en executieve functies

Waarom presteert een kind minder goed dan je op basis van zijn IQ zou verwachten? Zijn er problemen in de aandacht of het werkgeheugen? Hoe verwerkt hij/zij informatie en duidt dit op de aanwezigheid van een ontwikkelingsstoornis?Met de COTAPP meet u aandacht, informatieverwerking en executieve functies bij kinderen van 6 tot en met 12 jaar. De resultaten geven u inzicht in de cognitieve vaardigheden die een rol spelen in het schoolse leren en het dagelijks leven