Attention across modalities as a longitudinal predictor of early outcomes: the case of fragile X syndrome

Background: Fragile X syndrome (FXS) is an early diagnosed monogenic disorder, associated with a striking pattern of cognitive/attentional difficulties and a high risk of poor behavioural outcomes. FXS therefore represents an ideal model disorder to study prospectively the impact of early attention deficits on behaviour. Methods: Thirty‐seven boys with FXS aged 4–10 years and 74 typically developing (TD) boys took part. Study 1 was designed to assess visual and auditory attention at two time‐points, 1 year apart. Study 2 investigated attention to multimodal information. Both tested attention markers as longitudinal predictors of risk for poor behaviour in FXS. Results: Children with FXS attended less well than mental‐age matched TD boys and experienced greater difficulties with auditory compared to visual stimuli. In addition, unlike TD children, they did not benefit from multimodal information. Attention markers were significant predictors of later behavioural difficulties in boys with FXS. Conclusions: Findings demonstrate, for the first time, greater difficulties with auditory attention and atypical processing of multimodal information, in addition to pervasive global attentional difficulties in boys with FXS. Attention predicted outcomes longitudinally, underscoring the need to dissect what drives differing developmental trajectories for individual children within a seemingly homogeneous group.     

Trouble du déficit de l’attention/hyperactivité avec ou sans troubles associés : mise en évidence de différences attentionnelles et exécutives

Background

Children with attention-deficit hyperactivity disorder (ADHD) manifest deficits in attentional and executive domains. Yet, although ADHD is often associated with other neurodevelopmental syndromes such as developmental dyslexia (DD) and developmental coordination disorder (DCD), very few studies exploring the impact of these associated disorders on cognitive abilities of children with ADHD are available. Whether and how these comorbid disorders may influence attentional and executive abilities among ADHD patients remained to be explored.

Attentional ability among survivors of leukaemia

Attentional ability in 19 survivors of acute lymphoblastic leukaemia and 19 sibling controls was assessed using a neuropsychological model of attention. Analysis revealed that children who had received treatment for leukaemia exhibited significantly poorer performance on measures of the "focus encode" and "focus execute" elements of attention and on measures of the ability to respond to external cues and feedback. No significant differences in performance were found for measures of sustained attention and the ability to shift attention. These results indicate that children who have received treatment for leukaemia may experience highly specific attentional deficits that could have an impact on academic performance, particularly mathematical and reading skills. It is suggested that this underlying attentional deficit might be the source of the neuropsychological sequelae associated with the disease. Future attempts at remediation should incorporate activities specifically designed to ameliorate focusing difficulties.     

Attentional ability among survivors of leukaemia.

Attentional ability in 19 survivors of acute lymphoblastic leukaemia and 19 sibling controls was assessed using a neuropsychological model of attention. Analysis revealed that children who had received treatment for leukaemia exhibited significantly poorer performance on measures of the "focus encode" and "focus execute" elements of attention and on measures of the ability to respond to external cues and feedback. No significant differences in performance were found for measures of sustained attention and the ability to shift attention. These results indicate that children who have received treatment for leukaemia may experience highly specific attentional deficits that could have an impact on academic performance, particularly mathematical and reading skills. It is suggested that this underlying attentional deficit might be the source of the neuropsychological sequelae associated with the disease. Future attempts at remediation should incorporate activities specifically designed to ameliorate focusing difficulties.     

The relationship of otitis media in early childhood to attention dimensions during the early elementary school years

This study examined the impact of otitis media with effusion (OME) and associated hearing loss between 6 and 48 months of age on attention dimensions (i.e., selective/focus, sustained) during the elementary school years. A prospective cohort design in which 74 African American infants were recruited between ages 6 and 12 months. Ear examinations were done repeatedly using both otoscopy and tympanometry, and hearing was assessed using standard audiometric procedures between 6 and 48 months. Multiple measures of attention (i.e., direct assessment, behavioral observations, parent/teacher ratings) were administered from kindergarten through second grade to assess two theoretical dimensions of attention: selective/focused and sustained. The home environment was assessed annually. Results indicated that neither early childhood OME nor hearing loss showed significant correlations with any of the longitudinal or cross-sectional measures of selective/focused attention and sustained attention. In contrast, children with mothers who had fewer years of education and who lived in less responsive and supportive home environments scored higher on both parent and teacher ratings of sustained attention (i.e., hyperactivity) through the second grade of elementary school. For NEPSY Auditory Attention in second grade, a significant interaction between the Home Observation for Measurement of the Environment and hearing loss was uncovered. This interaction showed that children with hearing loss from poor home environments experienced greater difficulties on the NEPSY Auditory Attention task than those with hearing loss from good home environments. These findings do not support a direct linkage of a history of OME and associated hearing loss to difficulties in selective/focused attention or sustained attention in early elementary school children. Relationships between sociodemographic variables and attention-related functions appear stronger and should be considered as mediators in any examination of the linkages between early OME and subsequent attention functions.     

Attentional functions in children and adolescents with ADHD,depressive disorders,and the comorbid condition

Background: Attention‐deficit hyperactivity disorder (ADHD) and depressive disorders (DDs) often co‐occur in children and adolescents, but evidence on the respective influence of these disorders on attention parameters is inconsistent. This study examines the influence of DDs on ADHD in a model‐oriented approach that includes selectivity and intensity attention parameters. Methods: Ten‐ to fifteen‐year‐olds with ADHD (n = 63), DDs (n = 61), ADHD+DDs (n = 64), and healthy controls (n = 64) completed a battery of tests including five neuropsychological tasks (i.e., alertness, sustained attention, divided attention, go/no‐go, and attentional set‐shifting). Results: All clinical groups showed attentional problems, especially in more complex attentional tasks and in the intensity aspects of attention. We observed the most severe attentional impairments in children with ADHD that was independent from a comorbid DD. Conclusion: The clinical groups were significantly different from the healthy control group, especially in more complex attentional tasks and in the intensity aspects of attention. Some differences between ADHD, DDs and ADHD+DDs groups were detected on neuropsychological attentional performance, but the effects were not strong enough to differentiate the clinical groups from each other.     

Sustained attention and response inhibition in young children at risk for Attention Deficit/Hyperactivity Disorder

BACKGROUND: Studies of school-aged children, adolescents, and adults with Attention Deficit/Hyperactivity Disorder (ADHD) have variably shown ADHD-related impairment in both inhibitory control and sustained attention. However, few studies have examined ADHD-associated patterns of performance on these tasks among younger children (below age 7 years). METHODS: A combined continuous performance test and go/no-go task (CPT/GNG) and the Day-Night Stroop Task (DNST) were administered to an ethnically diverse sample of 3.44- to 6.95-year-old children rated by parents and teachers as being either high risk or low risk for ADHD. All children performed the DNST (N = 71) and a subset of the sample (N = 44) performed the CPT/GNG. Analyses assessed task validity as well as the effects of age and risk status. RESULTS: Significant main effects for age and risk status were found on all tasks. In addition, age x condition interactions were found for the CPT and DNST, which suggest that the tasks were sensitive to age-related changes in sustained attention and inhibitory control respectively. No significant risk status x condition interactions were found, suggesting that young children at risk for ADHD do not exhibit specific deficits in either inhibitory control or sustained attention. The most consistent effect related to risk status across tasks was the greater number of errors and longer and more variable reaction times on the part of children at risk for ADHD irrespective of condition. CONCLUSIONS: ADHD-associated decrements in performance on these tasks appear to be attributable either to generalized behavioral dysregulation or poor state regulation rather than to deficient inhibitory control.     

Girls with attention deficit disorder: a silent minority? A report on behavioral and cognitive characteristics

A sample of girls and boys with attention deficit disorder (ADD) were examined for within-group sex differences and compared with control boys and girls on historical, behavioral, and cognitive characteristics. Profiles of essential and secondary features of ADD support the Diagnostic and Statistical Manual of Mental Disorders nosology for ADD with and without hyperactivity as clinically distinct subtypes of ADD, with the girls and boys with ADD with hyperactivity exhibiting attentional, behavioral, and cognitive impairments, and the children with ADD without hyperactivity exhibiting deficits along an attentional/cognitive axis. Management problems and antisocial behaviors were correlates of hyperactivity, and increased impulsivity was not associated with attentional deficits in the absence of hyperactivity. Within the ADD with hyperactivity group, the girls demonstrated more severe cognitive impairments, particularly in the area of language function, were younger at the time referral for medical attention, and tended to come from families of lower socioeconomic status. Disruptive, uncontrolled behaviors were more frequent among the boys with ADD with hyperactivity. The girls with ADD without hyperactivity demonstrated poorer self-esteem and were significantly older than the boys with ADD without hyperactivity at referral. Girls in both ADD with and without hyperactivity groups were more likely to suffer peer rejection than their male counterparts. The results of this study suggest that girls with ADD may be underidentified and that cognitive deficits have a more prominent role in the identification of girls, whereas behavioral disturbances increase the likelihood of identification for boys.     

Pitfalls in the use of a continuous performance test as a diagnostic tool in attention deficit disorder

Although automated continuous performance tests (CPT) are gaining popularity as aids to the diagnosis of attention deficit disorder (ADD), little is known of their validity in this context. Our preliminary experience with a commercially available visual CPT indicated that as many as a third of children meeting the DMS-III criteria for ADD may score well enough on this measure to escape detection. We therefore analyzed the results of neuropsychological testing as well as CPT performance in 14 ADD children and six non-ADD children in an effort to determine whether CPT performance might reflect higher level cognitive variables other than attention and/or impulsivity. We found that those ADD children classified as "abnormal" on the basis of the CPT scored significantly below those classified as "normal" on measures of abstract reasoning and logical problem solving, simple verbal reasoning, nonverbal problem solving, and simple arithmetic skills. The non-ADD group contained a high proportion (83%) of subjects with CPT performance outside of the normal range. These data suggest that CPT may yield both false negative and false positive results when used as screening tools for ADD, and we recommend therefore that caution be used in their interpretation.     

Attention deficit disorder with and without hyperactivity: clinical response to three dose levels of methylphenidate

The response of 23 children with attention deficit disorder (ADD) with hyperactivity (+H) and 17 children with ADD without hyperactivity (-H) to three doses of methylphenidate (5, 10, and 15 mg twice a day) was evaluated in a triple-blind, placebo-controlled cross-over design using parent and teacher ratings of behavior, laboratory tests of ADD symptoms, and behavioral observations during academic performance. Results indicated that the children with ADD+H were rated as having more pervasive behavioral problems at home and more pervasive and severe conduct problems at school than the children with ADD-H. Laboratory tests found the children with ADD+H to be impaired in behavioral inhibition and vigilance whereas children with ADD-H were more impaired in the consistent retrieval of verbally learned material Drug effects were noted on the parent and teacher ratings and on most laboratory measures, with all three doses typically producing significant changes but rarely differing among themselves in effectiveness. The groups were not found to differ significantly on any measures in their response to methylphenidate. However, more children with ADD-H were clinically judged as having either no clinical response (24%) or responding best to the low dose (35%) of medication. In contrast, most ADD+H (95%) children were judged to be positive responders and most were recommended to receive the moderate to high dose (71%).     

Assessment of attention following pre-school traumatic brain injury: a behavioural attention measure

This study investigated attentional impairments and recovery in pre-school children following traumatic brain injury (TBI). Children aged between 3-8 years were assigned to two groups on the basis of severity of injury: (i) mild TBI and (ii) severe TBI. Children were evaluated at the acute stage postinjury (0-3 months) and again at 6 months on a range of standardized intellectual and attention measures. In addition, a specifically developed behavioural attention measure was employed. Results revealed a tendency for children with severe injuries to exhibit greater attentional impairments in the acute phase post-injury. In addition, children who sustained a severe TBI demonstrated significant recovery in attentional functioning over time. Results indicated differential recovery rates for separate components of attention. Both groups demonstrated a trend towards recovery of arousal and motivation over time, while focused attention, impulsivity and hyperactivity remained stable.     

Adolescence and its discontents: attentional disorders among teenagers and young adults

Attention deficit disorder (ADD) is the most commonly diagnosed childhood behavioral condition in the United States. This condition has important implications for and influences on adolescent development and adult functioning including emotional and conduct disorders, poor socialization, and school underachievement. In addition it has only been appreciated recently that some symptoms of ADD persist and can be identified among adolescents and young adults. In some situations, ADD may be newly identified during adolescence. Similar to younger children with ADD, a multi-modality approach to the management of adolescents with ADD is recommended.     

Attention deficit disorder and the mediating effect of age on academic and behavioral variables

Seventy-nine children, independently diagnosed as having attention deficit disorder (ADD) with or without hyperactivity and ranging in age from 6 years, 0 months, to 12 years, 11 months, were administered the Wechsler Intelligence Scale for Children-Revised (WISC-R), the Wide Range Achievement Test (WRAT), and the Child Behavior Checklist (CBC). Multiple regression analyses indicated a significant multiple correlation between age and achievement variables (R = 0.42, p = 0.003) and age and behavioral (CBC) variables (R = 0.55, p = 0.01). Post hoc analyses indicated that much of this variance was accounted for by a significant negative association between age and Full Scale IQ-WRAT Arithmetic difference scores, and significant positive correlations between age and scores on the Social Withdrawal and Uncommunicative scales from the CBC. A nonparametric chi-square analysis indicated that older children with ADD are significantly more likely (p = 0.037) than younger ADD children to have a discrepancy of 15 or more points between IQ and math achievement scores. Results suggest that older ADD children are more likely than younger ADD children to experience academic and socioemotional difficulties.     

Attention deficit disorder: diagnosis, prevalence, management and outcome

Some of the clinical and research problems associated with so-called attention deficit disorder (ADD), minimal brain dysfunction (MBD) and hyperactivity in childhood are surveyed. It is concluded that there is no international consensus as regards diagnostic criteria, prevalence of severe disorders is in the range of 1-5% of all preschool children, management is dependent on a wide variety of treatment facilities and that outcome is relatively poor in the 5- to 10-year perspective but that it may be somewhat better if the children are followed up to adult life.     

注意缺陷多动障碍不同亚型注意力特征分析

目的 探讨注意缺陷多动障碍（ADHD）儿童不同亚型的注意力特征,为临床干预提供依据。方法 对 345 例 ADHD 儿童进行分型,使用整合视听持续性操作测试（IVA-CPT）进行注意力评估,比较不同亚型的视觉和听觉注意力特征。以 122 例正常儿童作为对照。结果 3 种亚型 ADHD 儿童综合注意力商数和综合控制力商数得分均明显低于正常儿童,差异有统计学意义（PPPP结论 ADHD 儿童注意功能低于正常儿童,且视觉注意功能受损重于听觉;不同亚型 ADHD 儿童在视觉和听觉注意力特征上的功能受损程度无差别。     

Attention deficit disorder children with or without hyperactivity. Which behaviors are helped by stimulants?

Each patient with Attention Deficit Disorder (ADD), with or without hyperactivity, is unique in the variety and severity of the handicapping conditions associated with ADD. The use of a well-designed teacher rating scale can provide the clinician with a behavioral profile of each patient. The importance of knowing the child's specific problems is emphasized by the results of this research, which show that methylphenidate has a major effect in improving attention, is helpful in decreasing activity level, but often has only a minor effect on deficient social skills and oppositional (aggressive) behavior.     

Deficits in selective and sustained attention processes in early treated children with phenylketonuria — result of impaired frontal lobe functions?

Twenty normally intelligent children with early treated phenylketonuria (PKU) (IQ: mean=101.4, SD=10.0; age: mean=10 years 11 months, SD=1.3 years) and 20 healthy controls, matched for age, sex and IQ, were assessed for their selective (Stroop Task) and sustained attention (Test-d-2). Using positron emission tomography an activation of the frontal lobe during the Stroop task had previously been demonstrated. In addition to the Stroop Task and the Test-d-2, a short-term memory test as a non-frontal-lobe-function-task was administered to all subjects. Group comparisons demonstrated that PKU children had specific deficits in selective and sustained attention, which were significantly correlated with the concurrent serum phenylalanine concentration.Conclusion The results give evidence that even dietary treated children with PKU were suffering from impaired attentional control mechanisms in spite of a normal IQ. The deficits might be the result of impaired frontal lobe functions.     

Situational Variation in Problem Behavior at Home and School in Attention Deficit Disorder with Hyperactivity: a Factor Analytic Study

The present investigation assesses situational variation in problem behaviors of children with Attention Deficit Disorder with Hyperactivity. Principal-component factors (VARIMAX rotation) were computed for the Home/School Situations Questionnaires (HSQ/SSQ). For the HSQ, four factors emerged, accounting for 61% of variance. For the SSQ, three factors emerged, accounting for 68% of variance. Factors were similar to those previously derived with non-referred children. To assess discriminative power, factors were compared (t-tests) to previous data. All factors significantly discriminated ADD/H from non-referred children. These data suggest the factors add to the utility of the HSQ/SSQ in assessing ADD/H.     

Sustained Attention and Pervasive Hyperactivity

A sustained attention deficit is defined as a significant decrement in task performance with task duration (time-on-task). Time-on-task effects are reported using a self-paced paper and pencil cancellation test (PPCT) in normals and in subgroups of pervasively hyperactive children. The hyperactive subgroups were pervasively hyperactive both at home and at school. They differed in degree of pervasiveness in three laboratory conditions. Task inefficiency was most pronounced in the most pervasively hyperactive group. There was no evidence in favour of a sustained attention deficit in hyperactivity: no differences were found in decline in task efficiency between the controls and the subgroups of hyperactive children.     

Psychomotricité et trouble du déficit de l’attention/hyperactivité : évaluation d’un programme de rééducation basé sur des mises en situation rythmique

Aim of the studyThis study aimed at investigating the effects of a rhythm-based therapeutic program among ADHD children by assessing performance in attentional and executive domains.Participants and methodTwenty-one children (mean age: 9.1, SD: 1.8; 3 females) who previously received a diagnosis of ADHD benefited from a rhythm-based training program (8 to 12 training sessions) delivered during a psychomotor therapy. The program consisted of rhythmic perceptuo-motor exercises, including sensorimotor synchronization to external beats (metronome, music). Attentional and executive performances were assessed with a test-retest experimental design.ResultsAttentional and executive performance improved in different domains: inhibition, cognitive impulsiveness and visuo-spatial working memory. A slight improvement was visible for divided attention, whereas sustained auditory attention, selective visual attention and delay aversion did not change after intervention.ConclusionThese results are in favor of tight relations between a rhythmic training program and some attentional and executive functions among ADHD children, with beneficial effects of the training on a variety of cognitive performances. This study seems promising for the purpose of supplementing chemical treatments among a range of ADHD patients in cognitive domain.