Marieke M. Lansbergen

Stroop Interference and Attention-Deficit/Hyperactivity Disorder: A Review and Meta-Analysis

Previous reviews and meta-analyses that addressed abnormal Stroop interference in attention-deficit/hyperactivity disorder (ADHD) yielded mixed results. The authors of the present study argue that the inconsistencies may reflect the problematic nature of 2 frequently used methods to quantify Stroop interference-the difference score and Goldens method (C. J. Golden, 1978). Goldens method correction for base-word reading is inadequate, and the difference score is sensitive to the nature of the outcome variable. The latter can be remedied with a ratio score. Contrasting previous meta-analyses, this meta-analysis covers all age groups and all Stroop test variants, and it excludes studies using the Golden quantification method. Mean effect sizes for interference in ADHD as quantified by difference scores relative to control scores were 0.24 across all studies but 1.11 for time-per-item studies; outcome variable was a significant moderator variable, reflecting the sensitivity of the difference score to this variable. Consistency analysis of ratio scores across 19 studies reveals more interference for the ADHD groups relative to the control groups. It is concluded that interference control is consistently compromised in individuals with ADHD.

ADHD and EEG-neurofeedback: a double-blind randomized placebo-controlled feasibility study

Electroencephalography (EEG)-neurofeedback has been shown to offer therapeutic benefits to patients with attention-deficit/hyperactivity disorder (ADHD) in several, mostly uncontrolled studies. This pilot study is designed to test the feasibility and safety of using a double-blind placebo feedback-controlled design and to explore the initial efficacy of individualized EEG-neurofeedback training in children with ADHD. Fourteen children (8–15xa0years) with ADHD defined according to the DSM-IV-TR criteria were randomly allocated to 30 sessions of EEG-neurofeedback (nxa0=xa08) or placebo feedback (nxa0=xa06). Safety measures (adverse events and sleep problems), ADHD symptoms and global improvement were monitored. With respect to feasibility, all children completed the study and attended all study visits and training sessions. No significant adverse effects or sleep problems were reported. Regarding the expectancy, 75% of children and their parent(s) in the active neurofeedback group and 50% of children and their parent(s) in the placebo feedback group thought they received placebo feedback training. Analyses revealed significant improvements of ADHD symptoms over time, but changes were similar for both groups. This pilot study shows that it is feasible to conduct a rigorous placebo-controlled trial to investigate the efficacy of neurofeedback training in children with ADHD. However, a double-blind design may not be feasible since using automatic adjusted reward thresholds may not work as effective as manually adjusted reward thresholds. Additionally, implementation of active learning strategies may be an important factor for the efficacy of EEG-neurofeedback training. Based on the results of this pilot study, changes are made in the design of the ongoing study.

The increase in theta/beta ratio on resting-state EEG in boys with attention-deficit/hyperactivity disorder is mediated by slow alpha peak frequency.

Attention-deficit/hyperactivity disorder (ADHD) was found to be characterized by a deviant pattern of electrocortical activity during resting state, particularly increased theta and decreased beta activity. The first objective of the present study is to confirm whether individuals with slow alpha peak frequency contribute to the finding of increased theta activity in ADHD. The second objective is to explore the relation between resting-state brain oscillations and specific cognitive functions. From 49 boys with ADHD and 49 healthy control boys, resting-state EEG during eyes open and eyes closed was recorded, and a variety of cognitive tasks were administered. Theta and beta power and theta/beta ratio were calculated using both fixed frequency bands and individualized frequency bands. As expected, theta/beta ratio, calculated using fixed frequency bands, was significantly higher in ADHD children than control children. However, this group effect was not significant when theta/beta ratio was assessed using individualized frequency bands. No consistent relation was found between resting-state brain oscillations and cognition. The present results suggest that previous findings of increased theta/beta ratio in ADHD may reflect individuals with slow alpha peak frequencies in addition to individuals with true increased theta activity. Therefore, the often reported theta/beta ratio in ADHD can be considered a non-specific measure combining several distinct neurophysiological subgroups such as frontal theta and slowed alpha peak frequencies. Future research should elucidate the functional role of resting-state brain oscillations by investigating neurophysiological subgroups, which may have a clearer relation to cognitive functions than single frequency bands.

The effectiveness of EEG-feedback on attention, impulsivity and EEG: a sham feedback controlled study.

EEG-feedback, also called neurofeedback, is a training procedure aimed at altering brain activity, and is used as a treatment for disorders like Attention Deficit/Hyperactivity Disorder (ADHD). Studies have reported positive effects of neurofeedback on attention and other dependent variables. However, double-blind studies including a sham neurofeedback control group are lacking. The inclusion of such group is crucial to control for unspecific effects. The current work presents a sham-controlled, double-blind evaluation. The hypothesis was that neurofeedback enhances attention and decreases impulsive behavior. Participants (n=27) were students selected on relatively high scores on impulsivity/inattention questionnaires (Barrat Impulsivity Scale and Broadbent CFQ). They were assigned to a neurofeedback treatment or a sham group. (sham)Neurofeedback training was planned for 15 weeks consisting of a total of 30 sessions, each lasting 22 min. Before and after 16 sessions (i.e., interim analyses), qEEG was recorded and impulsivity and inattention was assessed using a stop signal task and reversed continuous performance task and two questionnaires. Results of the interim analyses showed that participants were blind with respect to group inclusion, but no trend towards an effect of neurofeedback on behavioral measures was observed. Therefore in line with ethical guidelines the experiment was ceased. These results implicate a possible lack of effect of neurofeedback when one accounts for non-specific effects. However, the specific form of feedback and application of the sham-controlled double-blind design may have diminished the effect of neurofeedback.

Relation between resting EEG to cognitive performance and clinical symptoms in adults with attention-deficit/hyperactivity disorder.

Attention-deficit/hyperactivity disorder (ADHD) in children is characterized by elevated levels of slow wave activity and reduced fast wave activity in resting-state electroencephalogram (EEG). In adults with ADHD, resting-state EEG findings are scarce and inconsistent. The present study examined whether the disparate findings are due EEG recording conditions (i.e., eyes-open vs. eyes-closed). A second goal of the current study was to assess relations between EEG spectral indices to performance measures obtained using a stop-signal task, and to behavioral ADHD symptoms. The present study included 24 adults with ADHD and 24 control adults. The EEG results showed a greater reduction in alpha power from eyes-closed to eyes-open (i.e., alpha attenuation) in ADHD compared to controls. In addition, theta/beta ratio was negatively correlated to the speed of responding to choice stimuli. These findings were interpreted vis-à-vis a biophysical model assuming that the hypo-arousal in ADHD is due to an overdrive of the nucleus coeruleus resulting in inhibitory activity of the thalamic reticular nucleus.

Impulsivity and conflict in the stroop task: an ERP study

Abstract. It has been suggested that impulsive behavior can be attributed to weaker interference control. The present research used a Stroop task to test whether impulsivity within the normal population is associated with weaker interference control. Sixteen high- and 16 low-impulsive healthy volunteers performed a Stroop task, which varied in the proportion of incongruent trials to induce high conflict and provoke more impulsive behavior. Event-related brain potentials (ERP) were recorded to assess the brain correlates of Stroop interference (N/P450 and SP [sustained potential]), which have been suggested to reflect conflict processing and attentional control, respectively. Higher conflict resulted in more Stroop interference and enhanced N/P450 and SP. Source analyses indicated that the neural generators of the N/P450 and the SP may both be located near the anterior cingulate cortex (ACC), suggesting that both may reflect aspects of conflict processing. Differences in Stroop interference in terms of err...

Neural correlates of stopping and self-reported impulsivity

OBJECTIVEnTo examine the relation between self-reported impulsivity, inhibitory control, and the neural correlates of stopping performance within the normal population.nnnMETHODSnHealthy individuals scoring high and low on trait impulsivity performed an auditory stop-signal task. Stopping performance and neural correlates of stopping (i.e. N1 and stop P3) were compared between the impulsive groups as well as between participants who were slow and fast in stopping.nnnRESULTSnAs expected, N1 and stop P3 were larger for successful relative to failed stops (i.e. N1 and stop P3 effects). Participants scoring high relative to low on impulsivity showed equal stopping performance, had larger stop P3, but similar N1 effects. Slow as compared to fast stoppers had reduced stop P3, but similar N1 effects.nnnCONCLUSIONSnParticipants scoring high relative to low on impulsivity may need more effortful inhibitory control to yield equal stopping performance. Slow relative to fast stoppers may have weaker inhibition processes and abnormal error processing. In contrast to ADHD, both high impulsives as well as slow stoppers had an intact N1 effect.nnnSIGNIFICANCEnSubjective impulsivity and slow stopping in healthy individuals cannot be generalized to ADHD.

Subjective impulsivity and baseline EEG in relation to stopping performance

Impulsivity is a personality trait within the normal population, but also a feature of many psychiatric disorders that have been associated with poor inhibitory control. The aim of the present study was to examine the relation between subjective impulsivity, theta/beta EEG ratio, and inhibitory control in healthy individuals. In 15 high and 14 low impulsive healthy volunteers (as assessed by the I(7) questionnaire), resting state EEG was recorded during an eyes open condition to obtain estimates for theta and beta activity. Subsequently, a stop-signal task was presented where participants responded to go-signals and had to stop their initiated response to stop-signals. Stopping performance and EEG activity were compared between the impulsive groups as well as between high vs. low theta/beta ratio groups. Results showed that subjective impulsivity was not related to stopping behavior or to theta/beta ratio. In contrast to our expectations that individuals with high theta/beta ratios would show relatively long stopping reaction times, analyses revealed that the low theta/beta ratio group had longer stopping reaction times. Given that increased theta/beta ratio may reflect reduced cortical inhibition over subcortical drives, it is proposed that healthy individuals with relative high theta/beta ratios are more motivated to maximize inhibition-related performance.

Stroop interference and the timing of selective response activation.

OBJECTIVEnTo examine the exact timing of selective response activation in a manual color-word Stroop task.nnnMETHODSnHealthy individuals performed two versions of a manual color-word Stroop task, varying in the probability of incongruent color-words, while EEG was recorded.nnnRESULTSnStroop interference effect was manifested as longer reaction times for incongruent relative to congruent color-words, and was larger in a task version where incongruent color-words were presented less frequently. Whereas the congruence between color display and word meaning did not affect average stimulus- and response-locked lateralized readiness potential (LRP) onset latencies nor response-locked LRP amplitudes, P3 peak latencies were longer and stimulus-locked LRPs were smaller for incongruent than congruent trials.nnnCONCLUSIONSnThese data are consistent with the idea that behavioral Stroop interference reflects delays in processing stages preceding color-based selective response activation in a subset of trials. They also do not exclude additional delays after color-based selective response activation, at least up until some 200ms before the overt response.nnnSIGNIFICANCEnThis chronometric analysis allows for a parcellation of the Stroop interference process that may be applied in psychopathology.

Acute effects of MDMA (3,4-methylenedioxymethamphetamine) on EEG oscillations: alone and in combination with ethanol or THC (delta-9-tetrahydrocannabinol)

RationaleTypical users of 3,4-methylenedioxymethamphetamine (MDMA or “ecstasy”) are polydrug users, combining MDMA with alcohol or cannabis [most active compound: delta-9-tetrahydrocannabinol (THC)].ObjectivesThe aim of the present study was to investigate whether co-administration of alcohol or THC with MDMA differentially affects ongoing electroencephalogram (EEG) oscillations compared to the administration of each drug alone.MethodsIn two separate experiments, 16 volunteers received four different drug conditions: (1) MDMA (100xa0mg); (2) alcohol clamp (blood alcohol concentrationu2009=u20090.6‰) or THC (inhalation of 4, 6 and 6xa0mg, interval of 1.5xa0h); (3) MDMA in combination with alcohol or THC; and (4) placebo. Before and after drug administration, electroencephalography was recorded during an eyes closed resting state.ResultsTheta and alpha power increased after alcohol intake compared to placebo and reduced after MDMA intake. No interaction between alcohol and MDMA was found. Significant MDMA × THC effects for theta and lower-1-alpha power indicated that the power attenuation after the combined intake of MDMA and THC was less than the sum of each drug alone. For the lower-2-alpha band, the intake of MDMA or THC alone did not significantly affect power, but the intake of combined MDMA and THC significantly decreased lower-2-alpha power.ConclusionsThe present findings indicate that the combined intake of MDMA and THC, but not of MDMA and alcohol, affects ongoing EEG oscillations differently than the sum of either one drug alone. Changes in ongoing EEG oscillations may be related to the impaired task performance that has often been reported after drug intake.