Neurological and psychiatric adverse effects of long-term methylphenidate treatment in ADHD: A map of the current evidence

Methylphenidate (MPH), the most common medication for children with Attention Deficit/Hyperactivity Disorder (ADHD) in many countries, is often prescribed for long periods of time. Any long-term psychotropic treatment in childhood raises concerns about possible adverse neurological and psychiatric outcomes. // We aimed to map current evidence regarding neurological and psychiatric outcomes, adverse or beneficial, of long-term MPH (> 1 year) treatment in ADHD. We coded studies using a “traffic light” system: Green: safe/favours MPH; Amber: warrants caution; Red: not safe/not well-tolerated. Un-categorisable study findings were coded as “Unclear”. // Although some evidence suggests an elevated risk of psychosis and tics, case reports describe remission on discontinuation. Several studies suggest that long-term MPH may reduce depression and suicide in ADHD. Evidence suggests caution in specific groups including pre-school children, those with tics, and adolescents at risk for substance misuse. // We identified a need for more studies that make use of large longitudinal databases, focus on specific neuropsychiatric outcomes, and compare outcomes from long-term MPH treatment with outcomes following shorter or no pharmacological intervention

The Neurocognitive Architecture of Individual Differences in Math Anxiety in Typical Children

Math Anxiety (MA) is characterized by a negative emotional response when facing math-related situations. MA is distinct from general anxiety and can emerge during primary education. Prior studies typically comprise adults and comparisons between high- versus low-MA, where neuroimaging work has focused on differences in network activation between groups when completing numerical tasks. The present study used voxel-based morphometry (VBM) to identify the structural brain correlates of MA in a sample of 79 healthy children aged 7–12 years. Given that MA is thought to develop in later primary education, the study focused on the level of MA, rather than categorically defining its presence. Using a battery of cognitive- and numerical-function tasks, we identified that increased MA was associated with reduced attention, working memory and math achievement. VBM highlighted that increased MA was associated with reduced grey matter in the left anterior intraparietal sulcus. This region was also associated with attention, suggesting that baseline differences in morphology may underpin attentional differences. Future studies should clarify whether poorer attentional capacity due to reduced grey matter density results in the later emergence of MA. Further, our data highlight the role of working memory in propagating reduced math achievement in children with higher MA

Anxiety is not enough to drive me away: A latent profile analysis on math anxiety and math motivation

Mathematics anxiety (MA) and mathematics motivation (MM) are important multi-dimensional non-cognitive factors in mathematics learning. While the negative relation between global MA and MM is well replicated, the relations between specific dimensions of MA and MM are largely unexplored. The present study utilized latent profile analysis to explore profiles of various aspects of MA (including learning MA and exam MA) and MM (including importance, self-perceived ability, and interest), to provide a more holistic understanding of the math-specific emotion and motivation experiences. In a sample of 927 high school students (13–21 years old), we found 8 distinct profiles characterized by various combinations of dimensions of MA and MM, revealing the complexity in the math-specific emotion-motivation relation beyond a single negative correlation. Further, these profiles differed on mathematics learning behaviors and mathematics achievement. For example, the highest achieving students reported modest exam MA and high MM, whereas the most engaged students were characterized by a combination of high exam MA and high MM. These results call for the need to move beyond linear relations among global constructs to address the complexity in the emotion-motivation-cognition interplay in mathematics learning, and highlight the importance of customized intervention for these heterogeneous groups

Diagnosing Developmental Dyscalculia on the Basis of Reliable Single Case FMRI Methods: Promises and Limitations

FMRI-studies are mostly based on a group study approach, either analyzing one group or comparing multiple groups, or on approaches that correlate brain activation with clinically relevant criteria or behavioral measures. In this study we investigate the potential of fMRI-techniques focusing on individual differences in brain activation within a test-retest reliability context. We employ a single-case analysis approach, which contrasts dyscalculic children with a control group of typically developing children. In a second step, a support-vector machine analysis and cluster analysis techniques served to investigate similarities in multivariate brain activation patterns. Children were confronted with a non-symbolic number comparison and a non-symbolic exact calculation task during fMRI acquisition. Conventional second level group comparison analysis only showed small differences around the angular gyrus bilaterally and the left parieto-occipital sulcus. Analyses based on single-case statistical procedures revealed that developmental dyscalculia is characterized by individual differences predominantly in visual processing areas. Dyscalculic children seemed to compensate for relative under-activation in the primary visual cortex through an upregulation in higher visual areas. However, overlap in deviant activation was low for the dyscalculic children, indicating that developmental dyscalculia is a disorder characterized by heterogeneous brain activation differences. Using support vector machine analysis and cluster analysis, we tried to group dyscalculic and typically developing children according to brain activation. Fronto-parietal systems seem to qualify for a distinction between the two groups. However, this was only effective when reliable brain activations of both tasks were employed simultaneously. Results suggest that deficits in number representation in the visual-parietal cortex get compensated for through finger related aspects of number representation in fronto-parietal cortex. We conclude that dyscalculic children show large individual differences in brain activation patterns. Nonetheless, the majority of dyscalculic children can be differentiated from controls employing brain activation patterns when appropriate methods are used

German version of the math anxiety questionnaire (FRA) for 6- to 9-year-old children

Math anxiety is a relatively frequent phenomenon and often related to dyscalculia. Thus, a standardised instrument to detect math anxiety as early as possible would be useful. The FRA is the first German math anxiety questionnaire for primary school children (original version: Thomas and Dowker, 2000). Objectives: Is the FRA a reliable and valid instrument? Are there any gender differences concerning math anxiety? Are there any developmental changes in this regard in the course of the early grades? Methods: Together with the dyscalculia test TEDI-MATH (Kaufmann et al., in preparation), the FRA was presented to a total of 450 children from the first to the third grade of primary school (at least 40 girls and 40 boys per semester). Results: The total scale has an internal consistency (Cronbach's alpha) between 0.83 and 0.91. Correlations between arithmetic skills and the FRA scales were mostly significant. The significantly higher negative scores for girls were taken into account by providing standard scores corrected for gender. No systematic developmental changes could be observed. Conclusions: The FRA is the first German math anxiety questionnaire for primary school children. High reliability, standard scores corrected for gender, and economic handling make it an instrument well suited for use in clinical settings (e.g., dyscalculia diagnostics and intervention). © 2007 by Verlag Hans Huber, Hogrefe AG