The impact of childhood deprivation on adult neuropsychological functioning is associated with ADHD symptom persistence

Background: Institutional deprivation in early childhood is associated with neuropsychological deficits in adolescence. Using 20-year follow-up data from a unique natural experiment – the large scale adoption of children exposed to extreme deprivation in Romanian institutions in the 1980s – we examined, for the first time, whether such deficits are still present in adulthood and whether they are associated with deprivation-related symptoms of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD).Methods: Adult neuropsychological functioning was assessed across five domains (inhibitory control, facial emotion recognition, decision-making, prospective memory and IQ) in 70 previously-institutionalized adoptees (mean age= 25.3, 50% female) and 22 non-deprived UK adoptees (comparison group, mean age= 24.6, 41% female). ADHD and ASD symptoms were assessed using parent-completed questionnaires.Results: Early institutionalization was associated with impaired performance on all tasks in adulthood. Prospective memory deficits persisted after controlling for IQ. ADHD and ASD symptoms were positively correlated. After controlling for ASD symptoms, ADHD symptoms remained associated with deficits in IQ, prospective memory, proactive inhibition, decision-making quality and emotionrecognition. ASD symptoms were not independently associated with neuropsychological deficits when accounting for their overlap with ADHD symptoms. Multiple regression analysis revealed that the link between childhood deprivation and adult ADHD symptoms was statistically explained by deprivation-related differences in adult IQ and prospective memory.Conclusions: These results represent some of the most compelling evidence to date of the enduring power of early, time-limited childhood adversity to impair neuropsychological functioning across the lifespan – effects that are linked specifically to deprivation-related adult ADHD symptoms

Why does early childhood deprivation increase the risk for depression and anxiety in adulthood? A developmental cascade model

Abstract Background: Using data from the English & Romanian Adoptees (ERA) study we recently reported that early time-lmited exposure to severe institutional deprivation is associated with early onset and persistent neurodevelopmental problems and later onset emotional problems. Here we examine possible reasons for the late emergence of emotional problems in this cohort. Our main focus is on testing a developmental cascade mediated via the functional impact of early-appearing neurodevelopmental problems on late adolescent functioning. We also explore a second putative pathway via sensitization to stress. Methods: The ERA study includes 165 Romanian individuals who spent their early lives in grossly depriving institutions and were subsequently adopted into UK families, along with 52 UK adoptees with no history of deprivation. Age six years symptoms of neurodevelopmental problems and age 15 anxiety/depression symptoms were assessed via parental reports. Young adult symptoms of depression and anxiety were assessed by both parent and self-reports; young adults also completed measures of stress reactivity , exposure to adverse life events and functioning in work and interpersonal relationships. Results: The path between early institutional deprivation and adult emotional problems was mediated via the impact of early neurodevelopmental problems on unemployment and poor friendship functioning during the transition to adulthood. The findings with regard to early deprivation, later life stress reactivity and emotional problems were inconclusive. Conclusions: Our analysis suggests that the risk for adult depression and anxiety following extreme institutional deprivation is explained through the effects of early neurodevelopmental problems on later social and vocational functioning. Future research should more fully examine the role of stress susceptibility in this model

Developing the Premonitory Urges for Tic Disorders Scale–Revised (PUTS-R)

Background: Patients with Gilles de la Tourette syndrome (GTS) or chronic tic disorders frequently experience premonitory urges prior to tics. The ‘Premonitory Urges for Tic Disorders Scale’ (PUTS) is commonly used in order to assess urge severity in patients with tics. Several studies suggest that the PUTS might measure more than one dimension of urges. These include the quality and severity of premonitory urges. Methods: This study aims to replicate and extend previous findings concerning the psychometric properties of the PUTS and its underlying dimensions in a large sample of 241 patients with GTS including both adults (n=93; mean age=34.2±12.84; 73 male) and minors (n=148; mean age=11.8±2.86; 123 male), pooled from three different recruitment sites. Results: Data analysis confirmed good reliability across the PUTS items for both minors and adults and acceptable item characteristics for items 2–8. A factor analysis of items 1–8 confirmed the existence of two factors in both age groups. Conclusions: The results suggest that the PUTS might benefit from several further small modifications, such as rephrasing items 1 and 9 to increase convergence with the overall construct of the scale. Finally, we propose a revised version of the PUTS, consisting of two subscales: one for urge severity and another one for urge quality by including several new items

Neuronale Korrelate der Belastung durch chronischen Tinnitus

Subjektiver Tinnitus bezeichnet eine Geräuschwahrnehmung in Abwesenheit einer objek- tivierbaren Schallquelle. Etwa 5% der Bevölkerung sind von chronischem Tinnitus betroffen, von denen etwa 17% stark unter dem Ohrgeräusch leiden. Dieses Leiden hängt dabei nur schwach mit der Lautheit des Tinnitus zusammen. Unter anderem werden Aufmerksamkeitsfokus auf den Tinnitus und seine dysfunktionale Bewertung als Bedingungen für die Tinnitusbelastungsentstehung und -aufrechterhaltung gesehen. Verschiedene neurophysiologische Modelle betonen eine Rolle limbischer Regionen bei Tinntusbelastung. Daneben sollen frontale Regionen und der Precuneus eine Rolle spielen, wobei mehrere Studien besonders eine Beteiligung frontaler und limbischer Areale bei Tinnitusbelastung unterstützen.Ergänzend zu Resting-State Studien sollten neuronale Korrelate von Tinnitusbelastung erstmalig in einem aufgabengeleiteten (task-driven) Ansatz mittels funktioneller Magnetreso- nanztomographie untersucht werden. In zwei Studien wurden hoch und niedrig belastete Tinni- tusbetroffene sowie gesunde Kontrollprobanden untersucht Die Aktivierung von Hirnregionen, die mit Tinnitusbelastung assoziiert sind, sollte in Studie 1 über die Darbietung negativer tinni- tusbezogener Sätze angeregt werden. In Studie 2 wurde ein Emotional Stroop Task eingesetzt, um Prozesse selektiver Aufmerksamkeit auf tinnitusbezogene Wörter und deren emotionale Verarbeitung zu untersuchen.In Studie 1 zeigte die hoch belastete Gruppe stärkere Aktivierungen in frontalen und lim- bischen Arealen gegenüber gesunden Kontrollprobanden, sowie im Vergleich zu niedrig belaste- ten Tinnitusbetroffenen im linken mittleren frontalen Gyrus. Tinnitusbelastung korrelierte erwar- tungskonform mit der Stärke der Aktivität limbischer und frontaler Regionen. In Studie 2 zeigte sich auf Verhaltensebene kein Interferenzeffekt für tinnitusbezogene Wörter bei hoch belasteten Probanden. Neuronal zeigten hoch belastete Tinnitusbetroffene stärkere Aktivierungen in der rechten Insula und frontalen Arealen gegenüber der niedrig belasteten Gruppe. Es gab keine hypothesenkonformen Unterschiede im Vergleich zu gesunden Kontrollprobanden. Die Höhe der Tinnitusbelastung korrelierte allerdings erwartungskonform mit der Stärke der Aktivität in der rechten Insula und dem rechten inferioren frontalen Gyrus.Übereinstimmend fand sich in beiden Studien eine Beteiligung des linken mittleren und des rechten inferioren frontalen Gyrus sowie der zentralen Insula. Der linke mittlere frontale Gyrus könnte eine Funktion bei der Aufrechterhaltung negativer tinnitusbezogener Information im Arbeitsgedächtnis haben, während der rechte inferiore frontale Gyrus mit der Salienz von Reizen in Verbindung gebracht wird. Der zentrale Teil der Insula ist mit Interozeption assoziiert, die eng mit emotionaler Verarbeitung in Beziehung steht. Der linke mittlere und der rechte infer- iore frontale Gyrus könnten sich als Zielregionen für neuromodulatorische Ansätze eignen. Zu- künftige Studien sollten hochbelastete Tinnitusbetroffene vor und nach einer belastungsreduzie- renden kognitiven Verhaltenstherapie mittels funktioneller Magnetresonanztomographie untersuchen