Caterina Gawrilow

Implementation Intentions Facilitate Response Inhibition in Children with ADHD

Attention Deficit/Hyperactivity Disorder (ADHD) is associated with action control problems such as failure to inhibit inappropriate responses. Two studies investigated whether self-regulation by implementation intentions (if-then plans; Gollwitzer, P. M. (1999). Implementation intentions: Strong effects of simple plans. American Psychologist, 54, 493–503) facilitates response inhibition in children with ADHD. In Study 1, children with ADHD who furnished a suppression goal with implementation intentions improved inhibition of an unwanted response on a Go/No-Go task to the same level observed in children without ADHD. Study 2 showed that a combination of implementation intentions and psychostimulant medication resulted in the highest level of suppression performance in children with ADHD. Theoretical and applied implications of these results are discussed.

Set shifting and working memory in adults with attention-deficit/hyperactivity disorder

Compared to the high number of studies that investigated executive functions (EF) in children with attention-deficit/hyperactivity disorder (ADHD), a little is known about the EF performance of adults with ADHD. This study compared 37 adults with ADHD (ADHDtotal) and 32 control participants who were equivalent in age, intelligence quotient (IQ), sex, and years of education, in two domains of EF—set shifting and working memory. Additionally, the ADHDtotal group was subdivided into two subgroups: ADHD patients without comorbidity (ADHD−, nxa0=xa019) and patients with at least one comorbid disorder (ADHD+, nxa0=xa018). Participants fulfilled two measures for set shifting (i.e., the trail making test, TMT and a computerized card sorting test, CKV) and one measure for working memory (i.e., digit span test, DS). Compared to the control group the ADHDtotal group displayed deficits in set shifting and working memory. The differences between the groups were of medium-to-large effect size (TMT: dxa0=xa00.48; DS: dxa0=xa00.51; CKV: dxa0=xa00.74). The subgroup comparison of the ADHD+ group and the ADHD− group revealed a poorer performance in general information processing speed for the ADHD+ group. With regard to set shifting and working memory, no significant differences could be found between the two subgroups. These results suggest that the deficits of the ADHDtotal group are attributable to ADHD rather than to comorbidity. An influence of comorbidity, however, could not be completely ruled out as there was a trend of a poorer performance in the ADHD+ group on some of the outcome measures.

If-Then Plans Benefit Delay of Gratification Performance in Children With and Without ADHD

Children with impulse control deficits (i.e., children with ADHD) are known to have special problems with delaying gratifications. As making if-then plans (i.e., forming implementation intentions) has been found to benefit self-control even in individuals whose action control is chronically hampered (e.g., critical samples such as patients with frontal lobe damage, the elderly), we analyzed whether delay of gratification is facilitated in children with and without ADHD who have formed respective implementation intentions. In Study 1, forty-five inpatient children with ADHD (Magexa0=xa010.7xa0years) increased delay of gratification performance after having formed respective implementation intentions. Study 2 replicated this finding in an outpatient sample of children with ADHD (nxa0=xa047, Magexa0=xa010.3xa0years) and also in a comparison group of children without ADHD (nxa0=xa040, Magexa0=xa011.3xa0years). Results are discussed with respect to their implications for action control in children with ADHD as well as research on implementation intentions and delay of gratification.

If--then planning modulates the P300 in children with attention deficit hyperactivity disorder.

Children with attention deficit hyperactivity disorder have difficulties with tasks that require response inhibition. We measured electroencephalographic data of nonmedicated children with attention deficit hyperactivity disorder and control children in two conditions: (a) a neutral condition without a self-regulation strategy and (b) a condition that involved the making of if–then plans (i.e. ‘If situation X is encountered, then I will perform the goal-directed behavior Y’). If–then plans improved response inhibition and increased the P300 in children with attention deficit hyperactivity disorder compared with the neutral condition. The present results encourage the application of self-regulation using if–then plans in addition or as an alternative to common medical therapy.

Preschool development of very low birth weight children born 1994–1995

This study reports on the developmental outcome of a sample of pre-term children with a birth weight ≤1500xa0g born in 1994 and 1995 studied at the age of 5 to 6 years. The sample included 60 out of 81 surviving pre-term children (74.1%) of a German neonatal intensive care unit which was matched to a control group of 60 kindergarten children of the same region. The results show significant differences between term and pre-term children with regard to their intellectual development, language comprehension, attentiveness, and hyperactivity. Moreover, the pre-term children required more early intervention to compensate for developmental problems. The developmental deficits were intensified by the presence of biological risk factors like increasingly low birth weight, bronchopulmonary dysplasia and intraventricular haemorrhage. Conclusion: differences between term and pre-term children still exist, although the early 1990s witnessed fundamental changes in the treatment of pre-term children. The persistence of these differences is explained mainly by the increase in the survival rate of children with high biological risk factors.

Methylphenidate and if-then plans are comparable in modulating the P300 and increasing response inhibition in children with ADHD

A disturbed functioning of the prefrontal cortex, the anterior cingulate cortex, and an accordingly reduced P300 presumably underlies executive function deficits of children with attention deficit hyperactivity disorder (ADHD). Using a combined classification and Go/NoGo task paradigm, the present study investigated whether medication with methylphenidate (MPH) modulates the P300 as measured by a high-density electroencephalogram (EEG) and facilitates response inhibition in children with ADHD. Further, effects of MPH were compared with effects of self-regulation by if-then plans (Gollwitzer in Am Psychol 54: 493–503, 1999). MPH as well as if-then plans modulated the P300 and improved inhibition of an unwanted response on a Go/NoGo task to the same level observed in children without ADHD. Importantly, self-regulation strategies might be a valuable alternative to medication with MPH in children with ADHD.

Physical Activity, Affect, and Cognition in Children With Symptoms of ADHD:

Objective: To examine the role of physical activity in determining the affect and executive functioning of children with symptoms of ADHD. Method: In Study 1, the association between physical activity and affect in the daily lives of children with varying degrees of hyperactivity was examined. In Study 2, children with ADHD were randomly assigned a physical activity or a sedentary task before working on a task requiring executive control. Results: Lack of physical activity was shown to relate to depressed affect, more strongly in participants with severe hyperactivity symptoms (Study 1). The physically active participants showed improved executive functioning after only 5 min of vigorous activity; the sedentary control participants showed no improvement (Study 2). Conclusion: These results indicate that interventions to increase the level of physical activity in children with and without ADHD might improve affect and executive functioning.

Multitasking in adults with ADHD.

Adults with ADHD have problems in everyday multitasking situations presumably because of deficits in executive functions. The present study aims to find out (a) whether adults with ADHD show deficient multitasking performance in a standardized task, (b) how they perceive the multitasking situation, and (c) which task structure might be beneficial for them as compared with adults without ADHD. Therefore, we experimentally compared task performance, mood, and motivation in a group of 45 men with ADHD (M-agexa0=xa034.47, SDxa0=xa09.95) with a comparison group of 42 men without ADHD (M-agexa0=xa031.12, SDxa0=xa010.59) in three conditions: (a) a multitasking paradigm, (b) an interleaving condition in which tasks had to be performed without planning or monitoring, and (c) a non-interleaving condition. Our results showed no impaired multitasking performance in adults with ADHD. However, they showed better mood and more motivation in the non-interleaving condition.

Flanker performance in female college students with ADHD: a diffusion model analysis

Attention-deficit hyperactivity disorder (ADHD) is characterized by poor adaptation to environmental demands, which leads to various everyday life problems. The present study had four aims: (1) to compare performance in a flanker task in female college students with and without ADHD (Nxa0=xa039) in a classical analyses of reaction time and error rate and studying the underlying processes using a diffusion model, (2) to compare the amount of focused attention, (3) to explore the adaptation of focused attention, and (4) to relate adaptation to psychological functioning. The study followed a 2-between (group: ADHD vs. control)xa0×xa02-within (flanker conflict: incongruent vs. congruent)xa0×xa02-within (conflict frequency: 20 vs. 80xa0%) design. Compared to a control group, the ADHD group displayed prolonged response times accompanied by fewer errors in a flanker task. Results from the diffusion model analyses revealed that the members of the ADHD group showed deficits in non-decisional processes (i.e., higher non-decision time) and leaned more toward accuracy than participants without ADHD (i.e., setting higher boundaries). The ADHD group showed a more focused attention and less adaptation to the task conditions which is related to psychological functioning. Deficient non-decisional processes and poor adaptation are in line with theories of ADHD and presumably typical for the ADHD population, although this has not been shown using a diffusion model. However, we assume that the cautious strategy of trading speed of for accuracy is specific to the subgroup of female college students with ADHD and might be interpreted as a compensation mechanism.

NIRS-based neurofeedback training in a virtual reality classroom for children with attention-deficit/hyperactivity disorder: study protocol for a randomized controlled trial

BackgroundChildren with attention-deficit/hyperactivity disorder (ADHD) suffer from attention deficits, motor hyperactivity, and impulsive behaviour. These impairments are experienced at home, at school, and with friends. Functional imaging studies show that ADHD behaviour and impairments in executive functions (EFs) are mirrored by aberrant neurophysiological functioning. Moreover, several studies show that ADHD behaviour, impairments in EFs, and a lack of self-control contribute to poor school performance. Non-pharmacological interventions such as neurofeedback training (NFT), for instance, aim at improving neurophysiological and neuropsychological functioning as well as behaviour. Consequently, NFT is expected to improve school performance, EFs, and self-control in children with ADHD. Generalization of acquired self-regulation skills from laboratory to real life is crucial for a transfer to everyday situations and is hypothesized to be facilitated via training using virtual reality (VR) environments. Consequently, experiencing NFT in VR is expected to yield greater effects than training in two dimensions (2D).Methods/designNinety children with a clinical diagnosis of ADHD will be included in the study. Participants may be medicated or unmedicated. After random assignation to one of three conditions, all participants receive 15 training sessions of either near-infrared spectroscopy (NIRS)-based NFT in VR, NIRS-based NFT in 2D, or electromyogram-based biofeedback training in VR. ADHD symptoms, self-control, EF, health-related quality of life, school performance, and motor activity measured via parent, teacher, and child reports or objectively will be assessed before and after the intervention and at a 6xa0months follow-up. Furthermore, we are interested in parents’ expectations about the training’s effects.DiscussionThis is, to our knowledge, the first study investigating the efficacy of NFT for children with ADHD in a VR compared to a 2D environment. Furthermore, this study will contribute to the discussion about the efficacy and specific and unspecific effects of NFTs in children with ADHD. In addition to commonly assessed variables such as ADHD symptoms, NIRS and behavioural data obtained in EF measures, health-related quality of life, and parents’ expectations about the intervention’s effects, this study will investigate the effects on self-control, school performance, and motor activity.Trial registrationClinicalTrials.gov, NCT02572180. Registered on 19 November 2015.