Hagai Maoz

Stimulants improve theory of mind in children with attention deficit/hyperactivity disorder

Impairments in ‘theory of mind’ (ToM) were linked to social cognition and reciprocal relationships deficits in children with attention deficit/hyperactivity disorder (ADHD). Twenty-four children with ADHD (13 with inattentive type and 11 with combined type, mean age 10.2 years) completed the Interpersonal Reactivity Index (IRI), a self-reported empathy questionnaire. All children performed the ‘faux pas’ task and a computerized ToM task in two different sessions either with or without administration of methylphenidate (MPH). Administration of MPH was associated with an improvement in cognitive and affective ToM. Children with ADHD-combined type had significantly lower scores in total IRI and the fantasy scale compared to children with ADHD-inattentive type. We conclude that deficits in empathy and ToM may play an important role in the impairments in social cognition and peer relationship in children with ADHD, especially children a hyperactive component. Stimulants may improve ToM and empathic functions. Future studies including larger samples and additional cognitive tasks are warranted in order to generalize these results and to identify possible underlying mechanisms for improvement in ToM following the administration of MPH.

Can Computerized Cognitive Tests Assist in the Clinical Diagnosis of Attention-Deficit Hyperactivity Disorder?

A group of 34 children and adolescents suspected of having attention-deficit hyperactivity disorder were referred for a computerized evaluation that included sustained attention, working memory, planning, and set-shifting. Although only sustained attention had reasonable specificity, all tests had questionable contribution to the diagnostic evaluation.

Association Between Continuous Performance and Response Inhibition Tests in Adults With ADHD

Objective: The study of ADHD uses various computerized tests to assess cognitive functions. Uncertainty exists regarding the association between deficits found by different tools testing similar or different cognitive functions (e.g., continuous performance tests [CPT] and response inhibition [RI] tests).We hypothesized that different tools that measure continuous performance will be better correlated between themselves than with a tool that examines RI. Method: Thirty-six adults with ADHD performed two different CPTs and a RI task. We analyzed correlations between different measures examined by the tasks. Results: There were strong correlations between corresponding measures in the CPTs. Correlations between the results in CPT and the RI task were only minimal. Conclusion: These findings support the specificity of impairments in different cognitive domains (continuous attention vs. RI) beyond the specific test used in the study of ADHD. Also, these findings strengthen the importance of specific discriminative cognitive domains in ADHD.

Exploring Reliability and Validity of the Deployment Risk and Resilience Inventory-2 Among a Nonclinical Sample of Discharged Soldiers Following Mandatory Military Service

The Deployment Risk and Resilience Inventory (DRRI) is a widely used questionnaire assessing deployment-related risk and resilience factors among war veterans. Its successor, the DRRI-2, has only been validated and used among veterans deployed for overseas military missions, but because many countries still enforce compulsory military service, validating it among nonclinical samples of healthy discharged soldiers following mandatory service is also a necessity. In the current study, a sample of 101 discharged Israeli soldiers (39 males, 62 females; mean time since discharge 13.92, SD = 9.09 years) completed the DRRI-2. There were 52 participants who completed the questionnaire at a second time point (mean time between assessments 19.02, SD = 6.21 days). Both physical and mental health status were examined, as well as symptomatology of depression, anxiety, and posttraumatic stress disorder. Cronbachs αs for all latent variables in the inventory ranged from .47 to .95. The DRRI-2 risk factors were negatively associated with psychological functioning, whereas resilience factors were positively associated with better self-reported mental health. Test-retest reliability coefficients were generally high (Pearson correlations were .61 to .94, all p values < .01). Our study provides evidence for the reliability and validity of the DRRI-2 in assessing salient deployment experiences among a nonclinical sample following mandatory military service.

Evaluating Computer Screen Time and Its Possible Link to Psychopathology in the Context of Age: A Cross-Sectional Study of Parents and Children

Background Several studies have suggested that high levels of computer use are linked to psychopathology. However, there is ambiguity about what should be considered normal or over-use of computers. Furthermore, the nature of the link between computer usage and psychopathology is controversial. The current study utilized the context of age to address these questions. Our hypothesis was that the context of age will be paramount for differentiating normal from excessive use, and that this context will allow a better understanding of the link to psychopathology. Methods In a cross-sectional study, 185 parents and children aged 3–18 years were recruited in clinical and community settings. They were asked to fill out questionnaires regarding demographics, functional and academic variables, computer use as well as psychiatric screening questionnaires. Using a regression model, we identified 3 groups of normal-use, over-use and under-use and examined known factors as putative differentiators between the over-users and the other groups. Results After modeling computer screen time according to age, factors linked to over-use were: decreased socialization (OR 3.24, Confidence interval [CI] 1.23–8.55, p = 0.018), difficulty to disengage from the computer (OR 1.56, CI 1.07–2.28, p = 0.022) and age, though borderline-significant (OR 1.1 each year, CI 0.99–1.22, p = 0.058). While psychopathology was not linked to over-use, post-hoc analysis revealed that the link between increased computer screen time and psychopathology was age-dependent and solidified as age progressed (p = 0.007). Unlike computer usage, the use of small-screens and smartphones was not associated with psychopathology. Conclusions The results suggest that computer screen time follows an age-based course. We conclude that differentiating normal from over-use as well as defining over-use as a possible marker for psychiatric difficulties must be performed within the context of age. If verified by additional studies, future research should integrate those views in order to better understand the intricacies of computer over-use.

Theory of Mind and Empathy in Children With ADHD

Objective: The current study compared empathy and theory of mind (ToM) between children with ADHD and healthy controls, and assessed changes in ToM among children with ADHD following administration of methylphenidate (MPH). Method: Twenty-four children with ADHD (mean age = 10.3 years) were compared with 36 healthy controls. All children completed the interpersonal reactivity index (IRI), a self-reported empathy questionnaire, and performed the “faux-pas” recognition task (FPR). Children with ADHD performed the task with and without MPH. Results: Children with ADHD showed significantly lower levels of self-reported empathy on most IRI subscales. FPR scores were significantly lower in children with ADHD and were improved, following the administration of MPH, to a level equal to that found in healthy controls. Conclusion: Children with ADHD show impaired self-reported empathy and FPR when compared with healthy controls. Stimulants improve FPR in children with ADHD to a level equal to that in healthy controls.

Methylphenidate mediated change in prosody is specific to the performance of a cognitive task in female adult ADHD patients.

Objectives. Prosody production is highly personalized, related to both the emotional and cognitive state of the speaker and to the task being performed. Fundamental frequency (F main) is a central measurable feature of prosody, associated with having an attention deficit hyperactive disorder (ADHD). Since methylphenidate is an effective therapy for ADHD, we hypothesized that it will affect the fundamental frequency of ADHD patients. Methods. The answers of 32 adult ADHD patients were recorded while performing two computerized tasks (cognitive and emotional). Evaluations were performed at baseline and an hour after patients received methylphenidate. Results. A significant effect of methylphenidate was observed on the fundamental frequency, as opposed to other parameters, of prosody. This change was evident while patients performed a cognitive, as opposed to an emotional, task. This change was seen in the 14 female ADHD patients but not in the 18 male ADHD patients. The fundamental frequency while performing a cognitive task without methylphenidate was not different in the female ADHD group, from 22 female controls. Conclusions. This pilot study supports prosodic changes as possible objective and accessible dynamic biological marker of treatment responses specifically in female ADHD.

When Can We Predict the Outcome of an Electroconvulsive Therapy Course in Adolescents?: A Retrospective Study

Objective There is a dearth of up-to-date literature regarding electroconvulsive therapy (ECT) in adolescents, and the question of when to pronounce course failure has not been properly addressed. The current study aims to evaluate trajectories of clinical status throughout ECT courses in adolescent patients. Methods We retrieved detailed data of 36 patients who received ECT in our treatment center. Clinical records were retrospectively assessed and evaluated every 6 ECT sessions to quantify Clinical Global Impressions-Improvement (CGI-I) scores. Results The mean number of sessions per course was 24.4 ± 14.2. The mean CGI-I score at the conclusion of the ECT courses was 2.47 ± 1.19. At the end of the acute treatment stage, 26 patients (72.2%) were much or very much improved, based on CGI-I scores. Only 5 patients exhibited a significant response after 6 sessions or fewer, whereas 21 patients (56.6%) improved after 12 sessions. Pearson correlations between CGI-I scores throughout the course of ECT showed no significant correlation between CGI-I scores after 6 sessions and the final CGI-I scores. However, a significant correlation was found between CGI-I scores after 12 sessions and the final CGI-I score. Conclusions An improvement in the clinical status of adolescents treated by ECT might occur only after a substantial number of sessions. An early lack of response does not necessarily predict a failed ECT course.

Deep TMS augmentation treatment for fibromyalgia: A safety and feasibility study

Introduction: Fibromyalgia (FM) is a prevalent chronic pain syndrome, with limited therapeutic options. Repetitive Transcranial Magnetic Stimulation (rTMS) is emerging as a potential new treatment modality for FM. Deep TMS (dTMS) is a novel modification of standard rTMS, capable of delivering stimulation to a greater depth. This preliminary study is the first to explore the efficacy of dTMS as an augmentation treatment in FM. Method: Eleven FM patients completed a 20-day treatment protocol, in order to examine left dorsal-lateral prefrontal cortex (DLPFC) excitation via dTMS using the h-coil. Clinical and psychophysical measurements of pain were evaluated each week, and 2 weeks after study completion. The primary outcomemeasures were the changes in pain measures from baseline to visit 20: Short FormMcGill Pain Questionnaire (SF-Mcgill) and Brief Pain Inventory (BPI). Secondary outcomes were FM clinical measures such as the Fibromyalgia Pain Questionnaire (FIQ). Demographic and clinical measures are summarized in Table 1. Results: Patients demonstrated a significant reduction in pain symptoms (p1⁄4.024) and improved functioning (p1⁄4.022) at visit 20 (figure 1) Demographic and clinical measures are summarized in Table 1. A significant decrease in FM symptoms that are not directly linked to pain (sleep disturbances, cognitive impairments and tiredness) was found only at followup (p1⁄4.044). Depressive symptoms were not reduced, indicating that pain reduction among our subjects could not be attributed to the antidepressant effect of dTMS. Treatment was well tolerated and no significant side effects were reported. Discussion: dTMS was safe and tolerable as augmentation treatment for FM patients. It reduced pain intensity in FM, improved function, and may have induced changes in neuroplasticity. Further double-blinded controlled studies, with a larger sample, are required to confirm and more accurately assess the therapeutic utility of dTMS in FM.