Gloria García-Banda

Neurofeedback and standard pharmacological intervention in ADHD: A randomized controlled trial with six-month follow-up

The present study is a randomized controlled trial that aims to evaluate the efficacy of Neurofeedback compared to standard pharmacological intervention in the treatment of attention deficit/hyperactivity disorder (ADHD). The final sample consisted of 23 children with ADHD (11 boys and 12 girls, 7-14 years old). Participants carried out 40 theta/beta training sessions or received methylphenidate. Behavioral rating scales were completed by fathers, mothers, and teachers at pre-, post-treatment, two-, and six-month naturalistic follow-up. In both groups, similar significant reductions were reported in ADHD functional impairment by parents; and in primary ADHD symptoms by parents and teachers. However, significant academic performance improvements were only detected in the Neurofeedback group. Our findings provide new evidence for the efficacy of Neurofeedback, and contribute to enlarge the range of non-pharmacological ADHD intervention choices. To our knowledge, this is the first randomized controlled trial with a six-month follow-up that compares Neurofeedback and stimulant medication in ADHD.

Neuroticism and cortisol: Pinning down an expected effect

BACKGROUND There are strong theoretical arguments that those high on Neuroticism (N) should normally exhibit higher prevailing levels of the stress-linked hormone cortisol (C), but findings are inconsistent, probably reflecting methodological weaknesses especially in taking account of Cs diurnal cycle. METHODS High and low N students [Total N=118; mean age=20.99years] were recruited and their salivary cortisol measured, ensuring that saliva samples were numerically adequate to assess Cs diurnal cycle over two days with objective verification of sample timing. RESULTS Cortisol secretion was approximately 20% higher in High N than low N participants in the period of 12h after awakening (p<.008), but no differences in secretion were evident during the first 0.75 of this period, when typically the Cortisol Awakening Response (CAR) rapidly takes cortisol to its daily peak. N effects were thus confined to the 0.75h-12h period (p<.007). Males had approximately 25% higher cortisol secretion levels than females, also confined to the 0.75h-12h period (p<.003). No significant differences between N groups were evident for dynamic measures of cortisol change, viz. the magnitude of CAR rise and subsequent diurnal fall. All effects were controlled for cohort date of study entry, age, smoking status, study day and time of awakening. DISCUSSION With careful control, it appears that an important theoretically predicted effect exists, and is replicated in different student intake cohorts recruited in different years. Most importantly, findings support several lines of evidence that the period of massive rise in the brief 0-0.75h CAR period should be seen as quite separate from the rest of the diurnal cycle, underpinned by different control mechanisms, and with potentially different correlates.

Sluggish Cognitive Tempo and Attention-Deficit/Hyperactivity Disorder (ADHD) Inattention in the Home and School Contexts: Parent and Teacher Invariance and Cross-Setting Validity.

This study examined whether sluggish cognitive tempo (SCT) and attention-deficit/hyperactivity disorder (ADHD) inattention (IN) symptoms demonstrated cross-setting invariance and unique associations with symptom and impairment dimensions across settings (i.e., home SCT and ADHD-IN uniquely predicting school symptom and impairment dimensions, and vice versa). Mothers, fathers, primary teachers, and secondary teachers rated SCT, ADHD-IN, ADHD-hyperactivity/impulsivity (HI), oppositional defiant disorder (ODD), anxiety, depression, academic impairment, social impairment, and peer rejection dimensions for 585 Spanish 3rd-grade children (53% boys). Within-setting (i.e., mothers, fathers; primary, secondary teachers) and cross-settings (i.e., home, school) invariance was found for both SCT and ADHD-IN. From home to school, higher levels of home SCT predicted lower levels of school ADHD-HI and higher levels of school academic impairment after controlling for home ADHD-IN, whereas higher levels of home ADHD-IN predicted higher levels of school ADHD-HI, ODD, anxiety, depression, academic impairment, and peer rejection after controlling for home SCT. From school to home, higher levels of school SCT predicted lower levels of home ADHD-HI and ODD and higher levels of home anxiety, depression, academic impairment, and social impairment after controlling for school ADHD-IN, whereas higher levels of school ADHD-IN predicted higher levels of home ADHD-HI, ODD, and academic impairment after controlling for school SCT. Although SCT at home and school was able to uniquely predict symptom and impairment dimensions in the other setting, SCT at school was a better predictor than ADHD-IN at school of psychopathology and impairment at home. Findings provide additional support for SCT’s validity relative to ADHD-IN.

Evaluation of a Four-Item DSM–5 Limited Prosocial Emotions Specifier Scale Within and Across Settings With Spanish Children.

The objective was to evaluate a 4-item measure of the DSM–5 Limited Prosocial Emotions (LPE) specifier (a 4-item measure of prosocial emotions). Mothers, fathers, primary teachers, and ancillary teachers completed measures of prosocial emotions (PE), oppositional defiant disorder (ODD), attention-deficit/hyperactivity disorder (ADHD)-inattention (IN), ADHD-hyperactivity/impulsivity (HI), academic and social impairment on 811 Spanish first-grade children (46% girls). Confirmatory factor and structural regression analyses showed PE symptom scores to have (a) good reliability for the 4 sources (80% to 89% true score variance), (b) invariance of like-symptom loadings and intercepts across the 4 sources, (c) strong convergent and discriminant validity within home and school settings, (d) no convergent validity across settings, and (e) associations with academic and social impairment independent of the ODD dimension (the unique effects of PE also remained significant after controlling for ODD, ADHD-IN, and ADHD-HI for mothers and ancillary teachers). A graded response item response theory analysis indicated that PE scores provided an accurate measure of the PE trait across a wide trait range and especially at low PE trait levels (i.e., scores in the clinical range). Findings also supported the DSM–5 diagnostic criteria of 2 or more LPE symptoms in 2 or more settings (e.g., high levels of the LPE trait were associated with the occurrence of 2 or more symptoms with 4% of the sample showing 2 or more symptoms in both settings). Although additional studies are still required, the PE measure appears useful as a brief measure of the LPE specifier.

Hypoarousal non-stationary ADHD biomarker based on echo-state networks

Attention-Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity and impulsivity. It is one of the most commonly diagnosed neurodevelopmental and psychiatric disorders of childhood and therefore presents a very high prevalence rate. However the high rate of ADHD misdiagnosis makes the discovery of neurophysiological ADHD biomarkers an important clinical challenge. This study proposes a novel non-stationary ADHD biomarker based on Echo State Networks to quantify EEG dynamical changes between low attention/arousal states (resting with eyes closed, or EC) and normal attention/arousal states (resting with eyes open, or EO). Traditionally, EEG biomarkers have revealed an increase in stationary power in the theta band along with a decrease in beta, with these frequencies largely accepted to be altered in the ADHD population. We successfully verify the hypothesis that measured differences between these two conditions are altered in the ADHD population. Statistically significant differences between a group of ADHD subjects and an aged-matched control population were obtained in theta and beta rhythms. Our network discriminates between EO/EC EEG regimes in the ADHDs better than in controls, suggesting that differences in EEG patterns between low and normal arousal/attention states are larger in the ADHD population.

Consistency of Limited Prosocial Emotions Across Occasions, Sources, and Settings: Trait- or State-Like Construct in a Young Community Sample?

Limited prosocial emotions (LPE, also referred to as callous-unemotional [CU] traits) are considered to reflect a more trait- than state-like construct. Our first objective was to determine the amount true score variance in CU/LPE that was consistent (trait consistency) over two occasions (12-month interval) of measurement versus specific (occasion-specificity) to each occasion. Our second objective was to determine the convergent validity of the consistent (trait) and occasion-specific (state) variance in CU/LPE symptom ratings within and across settings. Mothers, fathers, primary teachers, and ancillary teachers rated the CU/LPE symptoms in sample of 811 Spanish children (55% boys) on two occasions (i.e., end of first and second grades). CU/LPE symptom ratings showed more trait consistency than occasion-specificity for mothers and fathers, slightly more occasion-specificity than trait consistency for primary teachers, and much more occasion-specificity than trait consistency for ancillary teachers. Convergent validity for trait consistency was strong for fathers with mothers but weaker for primary with ancillary teachers. There was essentially no convergent validity for either trait consistency or occasion-specificity across home and school settings. CU/LPE symptom ratings within this age range represented a more trait-like construct for mothers and fathers and more state-like construct for primary teachers and ancillary teachers. In contrast, earlier studies showed ADHD and ODD ratings to be trait-like within and across home and school. The study of CU/LPE in young children should therefore include multiple sources in multiple settings across occasions to better understand the consistent and occasion-specific nature of the CU/LPE construct.