Hospital-Based Modified Cogmed Working Memory Training for Youth With ADHD

Objective: This study evaluated a modified working memory training program, Cogmed, for ADHD youth. Method: Forty youth were randomized to modified Cogmed training (MCT) or treatment as usual (CON). MCT was delivered in an outpatient mental health clinic in 3 weekly 35-minute sessions with a dedicated coach for 10 weeks. Participants completed assessments at baseline, after the intervention, and again 3 months later. Results: After controlling for baseline, groups were comparable on working memory, academics, and ADHD symptoms. The MCT group was rated by parents and teachers as having fewer executive function challenges and youth endorsed better self-concept compared with the CON group. Conclusions: MCT was associated with some improvement, which could not be attributed to increased working memory capacity and may reflect other facets of the program. Results question the usefulness of Cogmed but highlight considerations for optimizing adherence, engagement, and the therapeutic alliance in interventions for ADHD youth.

Impact of COVID-19 on Youth With ADHD: Predictors and Moderators of Response to Pandemic Restrictions on Daily Life

We examined COVID-19 symptoms and infection rates, disruptions to functioning, and moderators of pandemic response for 620 youth with ADHD and 614 individually matched controls (70% male; Mage = 12.4) participating in the Adolescent Brain and Cognitive Development study. There were no group differences in COVID-19 infection rate; however, youth with ADHD were more likely to exhibit COVID-19 symptoms ( d = 0.25), greater sleep problems ( d = −0.52), fear and negative emotions to infection risk ( d = −0.56), trouble with remote learning ( d = −0.54), rule-breaking behavior related to COVID-19 restrictions ( d = −0.23), family conflict ( d = −0.13), and were less prepared for the next school year ( d = 0.38). Youth with ADHD were less responsive to protective environmental variables (e.g., parental monitoring, school engagement) during the pandemic and may need more specialized support with return to in-person schooling and daily activities.

Association of a Novel EEG Metric of Sleep Depth/Intensity with Attention-Deficit/Hyperactivity, Learning and Internalizing Disorders and their Pharmacotherapy in Adolescence

Study Objectives Psychiatric/learning disorders are associated with sleep disturbances, including those arising from abnormal cortical activity. The odds ratio product (ORP) is a standardized electroencephalogram metric of sleep depth/intensity validated in adults, while ORP data in youth are lacking. We tested ORP as a measure of sleep depth/intensity in adolescents with and without psychiatric/learning disorders. Methods 418 adolescents (median 16y) underwent a 9-hour, in-lab polysomnography. Of them, 263 were typically developing (TD), 89 were unmedicated and 66 were medicated for disorders including attention-deficit/hyperactivity (ADHD), learning (LD) and internalizing (ID). Central ORP during non-rapid eye movement (NREM) sleep was the primary outcome. Secondary/exploratory outcomes included central and frontal ORP during NREM stages, in the 9-seconds following arousals (ORP-9), in first and second halves of the night, during REM sleep and wakefulness. Results Unmedicated youth with ADHD/LD had greater central ORP than TD during stage 3 and in central and frontal regions during stage 2 and the second half of the sleep period, while ORP in youth with ADHD/LD on stimulants did not significantly differ from TD. Unmedicated youth with ID did not significantly differ from TD in ORP, while youth with ID on antidepressants had greater central and frontal ORP than TD during NREM and REM sleep, and higher ORP-9. Conclusion The greater ORP in unmedicated youth with ADHD/LD, and normalized levels in those on stimulants, suggests ORP is a useful metric of decreased NREM sleep depth/intensity in ADHD/LD. Antidepressants are associated with greater ORP/ORP-9, suggesting these medications induce cortical arousability.

Cortisol and inflammatory biomarker levels in youths with attention deficit hyperactivity disorder (ADHD): evidence from a systematic review with meta-analysis

Several studies reported abnormal cortisol and inflammatory biomarker levels in youths with attention deficit hyperactivity disorder (ADHD), but the results have not been conclusive. We conducted a systematic review followed by a meta-analysis of case-control studies assessing blood or saliva cortisol levels and blood levels of inflammatory biomarkers in youth with ADHD. The effect sizes (ES) were synthesized by using a random-effects model. In the 19 studies on cortisol levels (totaling n = 916 youth with ADHD and n = 947 typically developing (TD), healthy youth), youth with ADHD have lower basal cortisol levels at any time-points during the day (effect size: .68; p = 0.004) and lower cumulative levels of cortisol (ES: .39, p = .008) throughout the day than TD youth. Moreover, morning cortisol levels were lower in ADHD youth when compared with TD youth (14 studies, n = 1679, ES: .84, p = 0.003), while there is no difference for the afternoon cortisol levels (p = 0.48). The meta-analysis on inflammation biomarker was conducted on 4 studies (totaling n = 404 youth) showed that Tumour Necrosis Factor-alpha (TNF-α) was lower in ADHD when compared with TD (3 studies, n = 257 youth, p = 0.004), while no differences for Interleukin-1β(IL-1β) (p = 0.21), IL-6 (p = 0.09) and IL-10 (p = 0.77). The lower cortisol in the context of low TNF-α levels may indicate a specific pattern of biomarkers in ADHD, and further investigation is warranted.

The Differential Impact of Acute Exercise and Mindfulness Meditation on Executive Functioning and Psycho-Emotional Well-Being in Children and Youth With ADHD

This study investigated how acute exercise and mindfulness meditation impacts executive functioning and psycho-emotional well-being in 16 children and youth with ADHD aged 10–14 (male = 11; White = 80%). Participants completed three interventions: 10 min of exercise, 10 min of mindfulness meditation, and 10 min of reading (control). Before and after each intervention, executive functioning (inhibitory control, working memory, task-switching) and psycho-emotional well-being (mood, self-efficacy) were assessed. Mindfulness meditation increased performance on all executive functioning tasks whereas the other interventions did not (d = 0.55–0.86). Exercise enhanced positive mood and self-efficacy whereas the other interventions did not (d = 0.22–0.35). This work provides preliminary evidence for how acute exercise and mindfulness meditation can support differential aspects of executive and psycho-emotional functioning among children and youth with ADHD.

The effect of comorbid anxiety in youth with ADHD: an ERP analysis of attentional control and impulse control

Differences in attentional and impulse control may underlie the increased impairment associated with youth with ADHD and comorbid anxiety (ADHD+ANX) compared to youth with ADHD without anxiety; however, findings from studies using behavioural and self-report measures have been mixed. This study addressed this issue by exploring the impact of the addition of anxiety on attentional and impulse control at a neural level, using event-related potentials (ERPs). Youth aged 11 to 17 with ADHD without anxiety (n = 34) and ADHD+ANX (n = 33) completed a Go/No-Go and Selective Auditory Attention task. Results indicated that the addition of anxiety in youth with ADHD was associated with enhanced early attentional processing, as well as stronger activation of impulse control, as exhibited by greater EFP and N2 amplitudes, respectively. Future directions and clinical implications of these results are discussed.

The effect of comorbid anxiety in youth with ADHD: an ERP analysis of attentional control and impulse control

Differences in attentional and impulse control may underlie the increased impairment associated with youth with ADHD and comorbid anxiety (ADHD+ANX) compared to youth with ADHD without anxiety; however, findings from studies using behavioural and self-report measures have been mixed. This study addressed this issue by exploring the impact of the addition of anxiety on attentional and impulse control at a neural level, using event-related potentials (ERPs). Youth aged 11 to 17 with ADHD without anxiety (n = 34) and ADHD+ANX (n = 33) completed a Go/No-Go and Selective Auditory Attention task. Results indicated that the addition of anxiety in youth with ADHD was associated with enhanced early attentional processing, as well as stronger activation of impulse control, as exhibited by greater EFP and N2 amplitudes, respectively. Future directions and clinical implications of these results are discussed.