Mateu Servera

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.

Distinctions Between Sluggish Cognitive Tempo, ADHD-IN, and Depression Symptom Dimensions in Spanish First-Grade Children

The objective of this study was to evaluate the validity of a new parent rating scale of Sluggish Cognitive Tempo (SCT). SCT was defined with 10 symptom domains—daydreams; attention fluctuates; absentminded; loses train of thought; easily confused; seems drowsy; thinking is slow; slow-moving; low initiative; and easily bored, needs stimulation—with each domain represented by multiple examples. Mothers’ and fathers’ ratings of SCT, ADHD-IN, ADHD-HI, oppositional defiant disorder (ODD), and depression symptoms along with ratings of academic and social impairment were obtained for a sample of 802 Spanish first-grade children (54% boys). SCT Symptom Domains 4 to 8 showed substantial loadings on the SCT factor (i.e., convergent validity) and substantially higher loadings on the SCT factor than the ADHD-IN factor (i.e., discriminant validity). This 5-domain measure of SCT showed good interrater and test–retest reliability for a 6-week interval. Higher scores on the 5-domain measure of SCT predicted higher levels of academic and social impairment even after controlling for ADHD-IN and depression. In contrast, higher levels of SCT were not uniquely related (or uniquely negatively related) to ADHD-HI and ODD, whereas ADHD-IN and depression were uniquely positively related to ADHD-HI and ODD. The new measure of SCT more clearly establishes that SCT, ADHD-IN, and depression represent independent symptom dimensions, thus providing a measurement tool to help determine if SCT and ADHD-IN dimensions have unique biological correlates and if SCT and ADHD meet the criteria for different disorders.

External Validity of ADHD Inattention and Sluggish Cognitive Tempo Dimensions in Spanish Children With ADHD

Objective: Few studies have examined whether separate dimensions of Sluggish Cognitive Tempo (SCT)—inconsistent alertness and slowness—have different external correlates from each other as well as symptoms of ADHD inattention (ADHD-IN). Method: Participants were 131 Spanish children (ages 6-16; 72% boys) diagnosed with ADHD. Results: In regression analyses, ADHD-IN was positively associated with hyperactivity/impulsivity, conduct problems, defiance/aggression, anxiety, peer relations problems, and learning problems. SCT-inconsistent alertness was positively associated with hyperactivity/impulsivity and peer relations problems. In contrast, SCT-slowness was negatively associated with hyperactivity/impulsivity and conduct problems and positively associated with depression and learning problems. Results were consistent after controlling for depression, medication status, and sex. Conclusion: The findings support SCT to be a construct with two dimensions that have unique correlates relative to each other as well as ADHD-IN. Future research on SCT should separate these dimensions of SCT to provide a better understanding of the construct.

Construct Validity of ADHD/ODD Rating Scales: Recommendations for the Evaluation of Forthcoming DSM-V ADHD/ODD Scales

Exploratory structural equation modeling (SEM) was applied to a multiple indicator (26 individual symptom ratings) by multitrait (ADHD-IN, ADHD-HI and ODD factors) by multiple source (mothers, fathers and teachers) model to test the invariance, convergent and discriminant validity of the Child and Adolescent Disruptive Behavior Inventory with 872 Thai adolescents and the ADHD Rating Scale-IV and ODD scale of the Disruptive Behavior Inventory with 1,749 Spanish children. Most of the individual ADHD/ODD symptoms showed convergent and discriminant validity with the loadings and thresholds being invariant over mothers, fathers and teachers in both samples (the three latent factor means were higher for parents than teachers). The ADHD-IN, ADHD-HI and ODD latent factors demonstrated convergent and discriminant validity between mothers and fathers within the two samples. Convergent and discriminant validity between parents and teachers for the three factors was either absent (Thai sample) or only partial (Spanish sample). The application of exploratory SEM to a multiple indicator by multitrait by multisource model should prove useful for the evaluation of the construct validity of the forthcoming DSM-V ADHD/ODD rating scales.

Validity of Sluggish Cognitive Tempo in South America An Initial Examination Using Mother and Teacher Ratings of Chilean Children

Objective: To examine the validity of sluggish cognitive tempo (SCT) and ADHD–inattention (ADHD-IN) symptoms in children from Chile. Method: Mothers and teachers rated SCT, ADHD-IN, ADHD–hyperactivity/impulsivity (ADHD-HI), oppositional defiant disorder (ODD), anxiety, depression, academic impairment, social impairment, and peer rejection (teachers only) in 652 Chilean children (55% boys) aged 6 to 14 years. Results: For both mother and teacher ratings, the eight SCT symptoms and nine ADHD-IN symptoms showed substantial loadings on their respective factors (convergent validity) along with loadings close to zero on the alternative factor (discriminant validity). ADHD-IN showed a uniquely stronger relationship than SCT with ADHD-HI and ODD whereas SCT showed a uniquely stronger relationship than ADHD-IN with anxiety and depression. Although ADHD-IN uniquely predicted academic impairment and social difficulties, SCT did not. Conclusion: This study provides the first evidence for the validity of SCT among children outside of North America or Western Europe.

Longitudinal Correlates of Sluggish Cognitive Tempo and ADHD-Inattention Symptom Dimensions with Spanish Children

The objective was to examine the longitudinal correlates of sluggish cognitive tempo (SCT) and attention deficit/hyperactivity disorder (ADHD)-Inattention (IN) dimensions with mothers’ and fathers’ ratings of Spanish children. Mothers and fathers rated SCT, ADHD-IN, ADHD-hyperactivity/impulsivity (HI), oppositional defiant disorder (ODD), depression, academic impairment, and social impairment on 3 occasions (twice in first-grade year [6-week separation] and once in the second-grade year [12 months after the first assessment]) in Spanish children (758, 746, and 718 children at the 3 time-points with approximately 55% boys). The results showed that (a) higher levels of SCT from earlier assessments predicted higher levels of depression, academic impairment, and social impairment at Assessment 3 after controlling for ADHD-IN at earlier assessments; (b) higher levels of ADHD-IN from earlier assessments predicted higher levels of depression, academic impairment, and social impairment at Assessment 3 after controlling for SCT at earlier assessments; (c) higher levels of ADHD-IN from earlier assessments predicted higher levels of ADHD-HI and ODD at Assessment 3 after controlling for SCT from earlier assessments; and (d) higher levels of SCT from earlier assessments either showed no unique relationship with ADHD-HI and ODD or predicted lower levels of ADHD-HI and ODD at Assessment 3 after controlling for ADHD-IN from earlier assessments. Initial evidence is provided of SCTs unique longitudinal relationships with depression and academic/social impairment and different longitudinal relationships with ADHD-HI and ODD relative to ADHD-IN, thus adding to a growing body of research underscoring the importance of SCT as distinct from ADHD-IN.

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.

Ratings of ADHD symptoms and academic impairment by mothers, fathers, teachers, and aides: construct validity within and across settings as well as occasions.

A Multiple Indicator × Multiple Trait × Multiple Source × Multiple Occasion design was used to evaluate invariance, convergent and discriminant validity of ADHD-inattention (IN), ADHD-hyperactivity/impulsivity (HI), and academic impairment scores from the Child and Adolescent Disruptive Behavior Inventory (CADBI) using confirmatory factor analysis. Mothers, fathers, teachers, and aides completed the CADBI on 811 Spanish 1st-grade children (54% boys) twice (6-week separation). For mothers and fathers, like loadings, thresholds/intercepts, factor means, factor variances, and factor covariances/correlations were invariant across sources and occasions. All 3 factors also showed convergent (convergent correlations from .69 to .83) and significant discriminant validity. For teachers and aides, there was also invariance of parameters along with convergent and discriminant validity over sources and occasions (convergent correlations from .67 to .87). With construct validity established for home and school, it was meaningful to test construct validity between home and school. Like-item loadings and thresholds/intercepts were invariant between home and school, with the ADHD-HI factor mean being lower at school. Convergent validity of ADHD-IN, ADHD-HI, and academic impairment factors, especially ADHD-IN and ADHD-HI, was much weaker between home and school (convergent correlations from .36 to .47 for IN and HI). The strong convergent validity of ADHD-IN and ADHD-HI scores within home and school in conjunction with weak convergent validity across home and school has implications for the assessment and diagnosis of ADHD (i.e., the diagnostic criteria of symptom occurrence in 2 or more settings).

Testing for measurement invariance and latent mean differences across methods: interesting incremental information from multitrait-multimethod studies

Models of confirmatory factor analysis (CFA) are frequently applied to examine the convergent validity of scores obtained from multiple raters or methods in so-called multitrait-multimethod (MTMM) investigations. We show that interesting incremental information about method effects can be gained from including mean structures and tests of MI across methods in MTMM models. We present a modeling framework for testing MI in the first step of a CFA-MTMM analysis. We also discuss the relevance of MI in the context of four more complex CFA-MTMM models with method factors. We focus on three recently developed multiple-indicator CFA-MTMM models for structurally different methods [the correlated traits-correlated (methods – 1), latent difference, and latent means models; Geiser et al., 2014a; Pohl and Steyer, 2010; Pohl et al., 2008] and one model for interchangeable methods (Eid et al., 2008). We demonstrate that some of these models require or imply MI by definition for a proper interpretation of trait or method factors, whereas others do not, and explain why MI may or may not be required in each model. We show that in the model for interchangeable methods, testing for MI is critical for determining whether methods can truly be seen as interchangeable. We illustrate the theoretical issues in an empirical application to an MTMM study of attention deficit and hyperactivity disorder (ADHD) with mother, father, and teacher ratings as methods.