Beyond Endophenotypes: Direct and Indirect Effects of Sustained Attention and Behavioral Inhibition on Attention Deficit Hyperactivity Disorder

Current theoretical accounts investigating the etiology of Attention Deficit Hyperactivity Disorder (ADHD) rely on cognitive or motivational deficits, neuronal impairments, and genetic predispositions. Relying on the endophenotype concept, this thesis provides a theoretical framework to integrate these lines of research. The framework moves beyond a mere endophenotype approach as both direct effects of cognitive and motivational functions on ADHD symptoms and indirect effects of cognitive or motivational functions on ADHD symptoms through higher-order psychological functions are considered. Both, sustained attention and behavioral inhibition, are related to risky decision-making and risky decision- making in turn is associated with impulsivity and ADHD symptoms. Hence, this thesis addresses the question whether indirect effects through risky decision-making can account for relations between sustained attention, behavioral inhibition, and ADHD symptoms. Method. Ninety-five children (71 males; 40 children with a diagnosed ADHD) aged between 7;4 and 13;8 years met inclusion criteria for the current study. Children worked on three computerized cognitive tasks measuring sustained attention and behavioral inhibition as well as three behavioral tasks measuring risky decision-making. Results. A sustained attention composite score significantly predicted ADHD symptoms, F(1, 67) = 20.10, p < .001, ηp2 = .231. The effect was partially mediated by risky decision-making, b = 0.19, 90% CI: [0.01, 0.41], and an additional indirect of behavioral inhibition on ADHD symptoms through risky decision-making was observed, b = 8.57, 99% CI: [1.38, 21.20]. Children who had difficulties in sustained attention or behavioral inhibition made a higher number of risky decisions and in turn had more or stringer ADHD symptoms. Conclusion. Theoretical accounts investigating the etiology of ADHD should consider sustained attention as a core deficit of ADHD and incorporate indirect effects through higher-order psychological functions.Aktuelle Theorien, welche die Ätiologie der Aufmerksamkeitsdefizit-/Hperaktivitätsstörung (ADHS) erklären, fokussieren auf kognitive und motivationale Defizite, neuronale Veränderungen oder genetische Prädispositionen. Diese unterschiedlichen Erklärungsmodelle werden in dieser Arbeit in ein Rahmenkonzept integriert. Das Rahmenkonzept basiert auf traditionellen Endophenotypenansätzen und erweitert diese, indem nicht nur direkte Effekte von kognitiven und motivationalen Funktionen auf ADHS Symptome berücksichtigt werden, sondern auch indirekte Effekte von kognitiven und motivationalen Funktionen über höhere psychologische Funktionen. Sowohl andauernde Aufmerksamkeit als auch Verhaltensinhibition sagen riskantes Entscheidungsverhalten vorher und riskantes Entscheidungsverhalten wiederum hängt mit Impulsivität und ADHS Symptomen zusammen. Daher wird in dieser Arbeit untersucht, inwiefern indirekte Effekte über riskantes Entscheidungsverhalten direkte Zusammenhänge zwischen andauernder Aufmerksamkeit, Verhaltensinhibition und ADHS Symptomen erklären können. Methode. Insgesamt erfüllten 95 Kinder (71 Jungen; 40 Kinder mit einer ADHS Diagnose) im Alter von 7;4 und 13;8 Jahren die Einschlusskriterien in die Studie. Die Kinder bearbeiteten drei computerisierte kognitive Aufgaben zur Messung andauernder Aufmerksamkeit und Verhaltensinhibition sowie drei Aufgaben zur Messung riskanten Entscheidungsverhaltens. Ergebnisse. ADHS Symptome konnten signifikant durch Defizite in andauernder Aufmerksamkeit erklärt werden, F(1, 67) = 20.10, p < .001, ηp2 = .231. Dieser Effekt wurde partiell durch riskantes Entscheidungsverhalten mediiert, b = 0.19, 90% KI: [0.01, 0.41]. Ein weiterer indirekter Effekt von Verhaltensinhibition über riskantes Entscheidungsverhalten auf ADHS Symptome wurde beobachtet, b = 8.57, 99% KI: [1.38, 21.20]. Kinder mit Schwierigkeiten in Daueraufmerksamkeit oder Verhaltensinhibition trafen häufiger riskante Entscheidungen und wiesen daher stärkere ADHS Symptome auf. Schlussfolgerung. Theorien, welche die Ätiologie der ADHS erklären, sollten Defizite in andauernder Aufmerksamkeit als ein Kerndefizit von Kindern mit ADHS aufnehmen. Außerdem sollten die Theorien neben direkten Effekten kognitiver oder motivationaler Defizite auf ADHS Symptome auch indirekte Effekte kognitiver oder motivationaler Defizite über höhere psychologische Funktionen berücksichtigen

Behavioural outcomes of children born with intrauterine growth restriction: protocol for a systematic review and meta-analysis

INTRODUCTION Intrauterine growth restriction (IUGR) is a pregnancy condition, which is associated with poor perinatal outcomes and long-term neurodevelopmental impairment. Several studies also investigated the impact of IUGR on child behaviour (eg, internalising and externalising behaviour, social competencies). However, so far, no systematic review or meta-analysis has been conducted that summarises these effects while considering relevant third variables such as type of IUGR diagnosis and control group, or concurrent cognitive abilities. The objective of this study is to summarise the current evidence regarding the relationship between IUGR and behavioural outcomes from early childhood to young adulthood. Additionally, to explore how third variables such as type of control group, or cognitive abilities, relate to this association. METHODS Search strategy: The following electronic databases will be searched-Web of Science, Medline Ovid, PsycInfo, Cochrane Library, Scopus and Embase. INCLUSION CRITERIA observational (eg, cohort studies and case-control studies) and intervention studies (if standard care is used and norm values are reported for the control group) will be included if they quantitatively compare children with and without IUGR from the age of 2 to 18 years. The main outcomes are internalising and externalising behaviour, and social competencies. ETHICS AND DISSEMINATION No ethics approval was necessary for this protocol. Dissemination of findings will be done by publishing the results in peer-reviewed journals. The results of this systematic review will provide guidance for practice and counselling for clinicians and therapists facing patients affected by IUGR and their families. PROSPERO REGISTRATION NUMBER CRD42022347467

Duration Discrimination Predicts Delay of Gratification In Children with and without ADHD

AbstractThe ability to delay gratification, to wait for a larger but delayed reward in the presence of a smaller but constantly available reward, has been shown to be predictive for various aspects of everyday life. For instance, preschool children who were better able to delay gratification achieved better school grades, a higher education, a better ability to cope with stress, as well as a reduced risk for being overweight or consume drugs up to 30 years later (Mischel et al., 2011). However, despite the importance of delay of gratification cognitive factors underlying individual differences are only poorly understood. Wittmann and Paulus (2008) suggested that individuals who overestimate the duration of time intervals experience waiting times as more costly and are, therefore, less likely to delay gratification. Furthermore, a recent study revealed an association between less accurate internal clock speed and a behavioral choice delay task (Corvi, Juergensen, Weaver, & Demaree, 2012). Further evidence for an association between temporal processing and delay of gratification can be derived from studies using clinical samples. For instance, children with attention-deficit/hyperactivity disorder (ADHD) consistently prefer smaller, immediate rewards over larger, delayed rewards and show impaired temporal processing (Sonuga-Barke, Bitsakou, & Thompson, 2010). However, no study has directly tested an association between a measure of temporal processing and a classical delay of gratification task in children with and without ADHD so far.As part of a larger study, 64 children (29 with ADHD) aged between 8 to 12 years performed a version of an auditory duration discrimination task and a delay of gratification task. In the duration discrimination task, the children were presented with two unfilled intervals indicated by two brief tones each. The baseline interval lasted for 400ms, while the comparison interval was always longer and adjusted up or down in 10ms steps securing an accuracy of 80%. In the delay of gratification task, the children were instructed that they could either opt for one chocolate bar immediately or that they could wait to receive two chocolate bars. Unbeknownst to the children, the waiting time lasted 25minutes but children were told that they could decide for the immediate chocolate bar at any time by ringing a bell.Children with ADHD did not differ in their performance from children without ADHD in the duration discrimination task or the delay of gratification task. However, in the whole sample of children with and without ADHD, children who waited for the additional chocolate bar showed a better duration discrimination than children who failed to wait for the additional chocolate bar [t(62) = -2.52, p = .01].We demonstrated an association between temporal processing ability and the ability to delay gratification. These results need to be replicated in further studies with larger sample sizes. Moreover, different tasks measuring temporal processing and delay of gratification should be used to further clarify the relationship of temporal processing, delay of gratification, and ADHD

Survey and 10-Day Diary Data on Infant Nutrition, Development, and Home Learning Environment during the COVID-19 Pandemic from the LEARN-COVID Pilot Study

The LEARN-COVID pilot study collected data on infants and their parents during the COVID-19 pandemic. Assessments took place between April and July 2021. Parents (N = 357) from Switzerland (predominantly), Germany, and Austria answered a baseline questionnaire on their behaviour related to the pandemic, social support, infant nutrition, and infant regulation. Subsequently, parents (n = 222) answered a 10-day evening diary on infant nutrition, infant regulation, parental mood, and parental soothing behaviour. Data and documentation are stored on Zenodo, https://doi.org/10.5281/zenodo.6946048. These data may be valuable to researchers interested in infant development and parenting during the pandemic as well as to researchers interested in daily variability in infant behaviour, parenting, and nutrition

Infant regulation during the pandemic: Associations with maternal response to the COVID-19 pandemic, well-being, and socio-emotional investment

In the transition to parenthood, the COVID-19 pandemic poses an additional strain on parental well-being. Confirmed infections or having to quarantine, as well as public health measures negatively affect parents and infants. Contrary to previous studies mainly focusing on the well-being of school-aged children and their parents during lockdown periods, the present study investigated how mothers of infants respond to the COVID-19 pandemic and whether this is related to maternal well-being, maternal socio-emotional investment, and infant regulation. Between April and June 2021, 206 mothers of infants (Mage = 7.14 months, SDage = 3.75 months) reported on COVID-19 infections, their response to the COVID-19 pandemic, their well-being, socio-emotional investment, and their infant's regulation. Exploratory factor analyses yielded five dimensions of maternal response to the COVID-19 pandemic: social distancing, worrying about the child, birth anxiety, distancing from the child, and information on COVID-19-related parenting behavior and support. These dimensions were related to mother-reported infant regulatory problems. Path analyses revealed paths via reduced maternal well-being and maternal socio-emotional investment. Maternal perceptions of infant regulatory problems are related to how the mothers respond to the COVID-19 pandemic. Better information about COVID-19-related parenting behavior and support might buffer against these effects

Maternal self-efficacy development from pregnancy to 3 months after birth

The present study uses a prospective longitudinal study design to investigate the development of maternal self-efficacy in the transition phase to parenthood, drawing on a large sample of socially and/or culturally disadvantaged families (N = 292). Parity, maternal education, migration, informal and formal social support are considered as potential predictors. Results indicate that previous birth experience, being born abroad, and higher levels of formal and informal social support during pregnancy jointly predict higher levels of maternal self-efficacy three months after birth. First-time mothers and mothers born in Germany (where the study was conducted) benefit more from formal support than mothers with previous experience and mothers born outside of Germany. Overall, maternal self-efficacy increases significantly. Implications for prenatal maternal care are discussed

Survey and 10-Day Diary Data on Infant Nutrition, Development, and Home Learning Environment during the COVID-19 Pandemic from the LEARN-COVID Pilot Study

The LEARN-COVID pilot study collected data on infants and their parents during the COVID-19 pandemic. Assessments took place between April and July 2021. Parents (N = 357) from Switzerland (predominantly), Germany, and Austria answered a baseline questionnaire on their behaviour related to the pandemic, social support, infant nutrition, and infant regulation. Subsequently, parents (n = 222) answered a 10-day evening diary on infant nutrition, infant regulation, parental mood, and parental soothing behaviour. Data and documentation are stored on Zenodo, https://doi. org/10.5281/zenodo.6946048. These data may be valuable to researchers interested in infant development and parenting during the pandemic as well as to researchers interested in daily variability in infant behaviour, parenting, and nutrition

From co-regulation to self-regulation: Maternal soothing strategies and self-efficacy in relation to maternal reports of infant regulation at 3 and 7 months

This study, conducted in Germany, examines the role of maternal soothing strategies to explain the association of maternal self-efficacy with infant regulation (crying and sleeping behavior). Questionnaire data of 150 mothers, living in Germany, with mixed ethnic and educational backgrounds were collected when infants were 3 and 7 months old. Two types of maternal soothing strategies were distinguished: close soothing, involving close physical and emotional contact, and distant soothing, involving physical and emotional distancing from the infant. A cross-sectional SEM at 3 months indicated that maternal self-efficacy is associated with reported infant regulation through distant soothing strategies. Low maternal self-efficacy was associated with frequent maternal use of distant soothing, which in turn was related to reported infant regulation problems, that is, non-soothability and greater crying frequency. Frequent use of close soothing was associated with reported infant sleeping behavior, that is, frequent night-time awakenings. A longitudinal SEM further indicated that the effects of close soothing persisted at least until the infants' age of 7 months. The study showed how low maternal self-efficacy, increased use of distant soothing, and reported early infant regulation problems are intertwined and that, due to their persisting positive effect on infant soothability, close soothing better supports infant development

Effect of Early High-Dose Recombinant Human Erythropoietin on Behavior and Quality of Life in Children Aged 5 Years Born Very Preterm: Secondary Analysis of a Randomized Clinical Trial

IMPORTANCE In light of the promising neuroprotective properties of recombinant human erythropoietin (RHEpo), the Swiss EPO Neuroprotection Trial was started to investigate its effect on neurodevelopment in very preterm infants. The results of the primary and secondary outcome analysis did not show any effect of RHEpo on cognitive performance, neuromotor outcomes, or somatic growth of the study participants at ages 2 or 5 years. OBJECTIVE To investigate whether early high-dose RHEpo improves behavioral outcomes and health-related quality of life (HRQoL) at age 5 years. DESIGN, SETTING, AND PARTICIPANTS This was a prespecified secondary analysis of the double-blind, placebo-controlled, multicenter Swiss EPO Neuroprotection randomized clinical trial, which was conducted at 5 level-III perinatal centers in Switzerland. Infants born between 26 weeks 0 days' and 31 weeks 6 days' gestation were recruited between 2005 and 2012 and followed-up until age 5 years (last follow-up in 2018). Data were analyzed from January 6 to December 31, 2021. INTERVENTIONS Infants were assigned to receive either RHEpo (3000 IU/kg) or placebo (saline, 0.9%) intravenously 3 times within the first 42 hours after birth. MAIN OUTCOMES AND MEASURES The prespecified parent-reported measures of behavioral outcomes and health-related quality of life (HRQoL) of their children at the age of 5 years were assessed by two standardized questionnaires: the Strengths and Difficulties Questionnaire (behavioral outcomes) and the KIDSCREEN-27 (HRQoL). RESULTS Among 448 randomized infants, 228 infants were assigned to the RHEpo group and 220 infants were assigned to the placebo group. Questionnaire data were available for 317 children (71%) at a mean (SD) age of 5.8 (0.4) years (mean [SD] gestational age at birth, 29.3 [1.6] weeks; mean [SD] birth weight 1220 [340] grams; 128 [40%] female infants). At the age 5 years follow-up, the mean (SD) total difficulties score in the RHEpo group (8.41 [5.60] points) was similar to that of the placebo group (7.76 [4.81]) (P = .37). There were no statistically significant differences between the groups in any other outcome measures. CONCLUSIONS AND RELEVANCE This secondary analysis of a randomized clinical trial showed no evidence for an effect of early high-dose RHEpo administration on behavioral outcomes or HRQoL in children born very preterm at early school age. TRIAL REGISTRATION - ClinicalTrials.gov Identifier: NCT00413946