Björn Albrecht

Distinct EEG effects related to neurofeedback training in children with ADHD: a randomized controlled trial.

In a randomized controlled trial, neurofeedback (NF) training was found to be superior to a computerised attention skills training concerning the reduction of ADHD symptomatology (Gevensleben et al., 2009). The aims of this investigation were to assess the impact of different NF protocols (theta/beta training and training of slow cortical potentials, SCPs) on the resting EEG and the association between distinct EEG measures and behavioral improvements. In 72 (of initially 102) children with ADHD, aged 8-12, EEG changes after either a NF training (n=46) or the control training (n=26) could be studied. The combined NF training consisted of one block of theta/beta training and one block of SCP training, each block comprising 18 units of 50 minutes (balanced order). Spontaneous EEG was recorded in a two-minute resting condition before the start of the training, between the two training blocks and after the end of the training. Activity in the different EEG frequency bands was analyzed. In contrast to the control condition, the combined NF training was accompanied by a reduction of theta activity. Protocol-specific EEG changes (theta/beta training: decrease of posterior-midline theta activity; SCP training: increase of central-midline alpha activity) were associated with improvements in the German ADHD rating scale. Related EEG-based predictors were obtained. Thus, differential EEG patterns for theta/beta and SCP training provide further evidence that distinct neuronal mechanisms may contribute to similar behavioral improvements in children with ADHD.

Delay and reward choice in ADHD: an experimental test of the role of delay aversion

Children with attention deficit/hyperactivity disorder (ADHD) choose smaller sooner (SS) over larger later (LL) rewards more than controls. Here we assess the contributions of impulsive drive for immediate rewards (IDIR) and delay aversion (DAv) to this pattern. We also explore the characteristics of, and the degree of familiality in, ADHD SS responders. We had 360 ADHD probands; 349 siblings and 112 controls (aged between 6 to 17 years) chose between SS (1 point after 2 s) and LL reward (2 points after 30 s) outcomes on the Maudsley Index of Delay Aversion (Kuntsi, Oosterlaan, & Stevenson, 2001): Under one condition SS choice led to less overall trial delay under another it did not. ADHD participants chose SS more than controls under both conditions. This effect was larger when SS choice reduced trial delay. ADHD SS responders were younger, had lower IQ, more conduct disorder and had siblings who were more likely to be SS responders themselves. The results support a dual component model in which both IDIR and DAv contribute to SS choice in ADHD. SS choice may be a marker of an ADHD motivational subtype.

Performance variability, impulsivity errors and the impact of incentives as gender-independent endophenotypes for ADHD.

BACKGROUND Attention-deficit hyperactivity disorder (ADHD) is one of the most common and highly heritable child psychiatric disorders. There is strong evidence that children with ADHD show slower and more variable responses in tasks such as Go/Nogo tapping aspects of executive functions like sustained attention and response control which may be modulated by motivational factors and/or state-regulation processes. The aim of this study was (1) to determine if these executive functions may constitute an endophenotype for ADHD; (2) to investigate for the first time whether known modulators of these executive functions may also be familial; and (3) to explore whether gender has an impact on these measures. METHODS Two hundred and five children with ADHD combined type, 173 nonaffected biological siblings and 53 controls with no known family history of ADHD were examined using a Go/Nogo task in the framework of a multi-centre study. Performance-measures and modulating effects of event-rate and incentives were examined. Shared familial effects on these measures were assessed, and the influence of gender was tested. RESULTS Children with ADHD responded more slowly and variably than nonaffected siblings or controls. Nonaffected siblings showed intermediate scores for reaction-time variability, false alarms and omission errors under fast and slow event-rates. A slower event-rate did not lead to reduced performance specific to ADHD. In the incentive condition, mean reaction-times speeded up and became less variable only in children with ADHD and their nonaffected siblings, while accuracy was improved in all groups. Males responded faster, but also committed more false alarms. There were no interactions of group by gender. CONCLUSIONS Reaction-time variability and accuracy parameters could be useful neuropsychological endophenotypes for ADHD. Performance-modulating effects of incentives suggested a familially driven motivational dysfunction which may play an important role on etiologic pathways and treatment approaches for ADHD. The effects of gender were independent of familial effects or ADHD-status, which in turn suggests that the proposed endophenotypes are independent of gender.

Neurofeedback in children with ADHD: Specific event-related potential findings of a randomized controlled trial

OBJECTIVE In a randomized controlled trial, we could demonstrate clinical efficacy of neurofeedback (NF) training for children with ADHD (Gevensleben et al., 2009a). The present investigation aimed at learning more about the neuronal mechanisms of NF training. METHODS Children with ADHD either completed a NF training or a computerized attention skills training (ratio 3:2). NF training consisted of one block of theta/beta training and one block of slow cortical potential (SCP) training, each comprising 18 training units. At three times (pre-training, between the two training blocks and at post-training), event-related potentials (ERP) were recorded during the Attention Network Test. ERP analysis focused on the P3, reflecting inter alia attentional resources for stimulus evaluation, and the contingent negative variation (CNV), primarily related to cognitive preparation. RESULTS After NF training, an increase of the CNV in cue trials could be observed, which was specific for the SCP training. A larger pre-training CNV was associated with a larger reduction of ADHD symptomatology for SCP training. CONCLUSIONS CNV effects reflect neuronal circuits underlying resource allocation during cognitive preparation. These distinct ERP effects are closely related to a successful NF training in children with ADHD. In future studies, neurophysiological recordings could help to optimize and individualize NF training. SIGNIFICANCE The findings contribute to a better understanding of the mechanisms underlying NF training in children with ADHD.

Response inhibition deficits in externalizing child psychiatric disorders: An ERP-study with the Stop-task

BackgroundEvidence from behavioural studies suggests that impaired motor response inhibition may be common to several externalizing child psychiatric disorders, although it has been proposed to be the core-deficit in AD/HD. Since similar overt behaviour may be accompanied by different covert brain activity, the aim of this study was to investigate both brain-electric-activity and performance measures in three groups of children with externalizing child psychiatric disorders and a group of normal controls.MethodsA Stop-task was used to measure specific aspects of response inhibition in 10 children with attention-deficit hyperactivity disorder (AD/HD), 8 children with oppositional defiant disorder/conduct disorder (ODD/CD), 11 children with comorbid AD/HD+ODD/CD and 11 normal controls. All children were between 8 and 14 years old. Event-related potentials and behavioural responses were recorded. An initial go-signal related microstate, a subsequent Stop-signal related N200, and performance measures were analyzed using ANCOVA with age as covariate.ResultsGroups did not differ in accuracy or reaction time to the Go-stimuli. However, all clinical groups displayed reduced map strength in a microstate related to initial processing of the Go-stimulus compared to normal controls, whereas topography did not differ. Concerning motor response inhibition, the AD/HD-only and the ODD/CD-only groups displayed slower Stop-signal reaction times (SSRT) and Stop-failure reaction time compared to normal controls. In children with comorbid AD/HD+ODD/CD, Stop-failure reaction-time was longer than in controls, but their SSRT was not slowed. Moreover, SSRT in AD/HD+ODD/CD was faster than in AD/HD-only or ODD/CD-only. The AD/HD-only and ODD/CD-only groups displayed reduced Stop-N200 mean amplitude over right-frontal electrodes. This effect reached only a trend for comorbid AD/HD+ODD/CD.ConclusionFollowing similar attenuations in initial processing of the Go-signal in all clinical groups compared to controls, distinct Stop-signal related deficits became evident in the clinical groups. Both children with AD/HD and ODD/CD showed deficits in behavioural response-inhibition accompanied by decreased central conflict signalling or inhibition processes. Neither behavioural nor neural markers of inhibitory deficits as found in AD/HD-only and ODD/CD-only were additive. Instead, children with comorbid AD/HD+ODD/CD showed similar or even less prominent inhibition deficits than the other clinical groups. Hence, the AD/HD+ODD/CD-group may represent a separate clinical entity.

Differences in Neurophysiological Markers of Inhibitory and Temporal Processing Deficits in Children and Adults with ADHD

We compared ADHD-related temporal processing and response inhibition deficits in children and adults using event-related potentials (ERPs) during cued continuous performance tasks (CPT, O-X-version, plus a more demanding flanker version). ERP markers of temporal processing (Cue CNV) and inhibition (NoGo P300) were obtained in matched groups of children (32 with ADHD, mean age 11.2 years, and 31 controls, mean age 11.1 years) and adults (22 ADHD, mean age 42.7 years, and 22 controls, mean age 44.0 years). ERP markers and performance reflected both age and ADHD status. Performance was poorer, and Cue CNV and NoGo P300 were weaker in ADHD children and adults compared to their matched controls. ADHD-related ERP differences in children were more prominent at posterior scalp sites but more pronounced at anterior scalp sites in adults, paralleling the prominent topographic changes of both ERP markers with development. The fact that differences in the same test and the same processing period appear in both childr...

Normal response inhibition in boys with Tourette syndrome

BackgroundInhibitory deficits are often a matter of debate in the pathophysiology of Tourette syndrome (TS). Previous neuropsychological studies on behavioral inhibition revealed equivocal results.MethodsTo overcome existing shortcomings (e.g. confounders like medication status, comorbid conditions) we compared medication naïve boys (10–14 years) suffering exclusively from TS with age, gender and IQ matched healthy controls using a highly demanding Go/Nogo task that controls for novelty effects.ResultsThe performance did not differ between boys with TS and healthy boys.ConclusionIn TS normal response inhibition performance as measured by a Go/Nogo task can be assumed. However, there might be neurophysiological abnormalities in TS possibly related to compensatory mechanisms to control for tics. Hence, further studies combining neuropsychological and neurophysiological methods (e.g. electroencephalography, fMRI) using the same strictly controlled design along the whole range of development and tic severity are recommended.

Brain networks involved in early versus late response anticipation and their relation to conflict processing

Previous electrophysiological studies have clearly identified separable neural events underlying early and late components of response anticipation. Functional neuroimaging studies, however, have so far failed to account for this separation. Here, we performed functional magnetic resonance imaging (fMRI) of an anticipation paradigm in 12 healthy adult subjects that reliably produced early and late expectancy waves in the electroencephalogram. We furthermore compared fMRI activations elicited during early and late anticipation to those associated with response conflict. Our results demonstrate the existence of distinct cortical and subcortical brain regions underlying early and late anticipation. Although late anticipatory behavior was associated with activations in dorsal ACC, frontal cortex, and thalamus, brain responses linked to the early expectancy wave were localized mainly in motor and premotor cortical areas as well as the caudate nucleus. Additionally, late anticipation was associated with increased activity in midbrain dopaminergic nuclei, very likely corresponding to the substantia nigra. Furthermore, whereas regions involved in late anticipation proved to be very similar to activations elicited by response conflict, this was not the case for early anticipation. The current study supports a distinction between early and late anticipatory processes, in line with a plethora of neurophysiological work, and for the first time describes the brain structures differentially involved in these processes.

May posterror performance be a critical factor for behavioral deficits in attention-deficit/hyperactivity disorder?

BACKGROUND Although the performance of children with attention-deficit/hyperactivity disorder (ADHD) is impaired in a variety of cognitive tasks, the specific capacity of strategic readaptation after errors as a source of behavioral deficits is not sufficiently understood. This study used an extended and refined behavioral parameterization to assess performance monitoring and posterror adaptation in children with ADHD. METHODS Twenty-eight healthy control subjects and 47 ADHD patients (7-16 years of age, all males, matched for age and IQ) performed a visual flanker task in which targets were congruent or incongruent with preceding flankers. Posterror adaptation was measured for response speed (posterror slowing), accuracy, and variability by using normalized individual rates of change. Markers of error detection and general performance were also analyzed. RESULTS Postcorrect response speed and accuracy did not differ between the groups, in contrast to posterror behaviors. Whereas posterror slowing was not evident in any of the groups, the error rate and performance instability (reaction time variance) substantially increased after errors only in ADHD patients, not in control subjects. No reliable between-group differences were found for error detection and global performance. CONCLUSIONS In healthy children, posterror adaptation preserves performance at its ongoing level. No such adaptation was evident in ADHD, leading to consecutive errors and increased behavioral instability. Performance deficits in ADHD were only present after error but not after correct behaviors, which shapes the general profile of performance impairment in ADHD. The findings have practical implications for strategic designs of behavioral therapy in ADHD.

Action monitoring in children with or without a family history of ADHD - Effects of gender on an endophenotype parameter

Attention-deficit/hyperactivity disorder (ADHD) is a frequent and highly heritable disorder overrepresented in boys. In a recent study investigating boys only, we found that action monitoring deficits as reflected by certain behavioral and electrophysiological parameters were familially driven. As gender may also have an important impact, this was examined in the current study with nonaffected children aged 8-15 years having relatives suffering from ADHD (N=37, 21 female symbol) and with age-matched controls without family history of ADHD (N=33, 11 female symbol). Extending our previous findings that action monitoring is a potential endophenotype for boys with ADHD, familially driven deficits were confirmed independently of gender. Thus, despite sharing the phenotype with controls, nonaffected siblings showed ADHD-like impairments albeit of smaller magnitude. However, girls performed generally more accurately, which in turn may have produced the differences between nonaffected siblings and controls in affective error processing that were not present in our boys-only assessment.