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Attention deficit hyperactivity disorder (ADHD) is among the most frequent disorders within child and adolescent psychiatry, with a prevalence of over 5%. Nosological systems, such as the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) and the International Classification of Diseases, editions 10 and 11 (ICD-10/11) continue to define ADHD according to behavioral criteria, based on observation and on informant reports. Despite an overwhelming body of research on ADHD over the last 10 to 20 years, valid neurobiological markers or other objective criteria that may lead to unequivocal diagnostic classification are still lacking. On the contrary, the concept of ADHD seems to have become broader and more heterogeneous. Thus, the diagnosis and treatment of ADHD are still challenging for clinicians, necessitating increased reliance on their expertise and experience. The first part of this review presents an overview of the current definitions of the disorder (DSM-5, ICD-10/11). Furthermore, it discusses more controversial aspects of the construct of ADHD, including the dimensional versus categorical approach, alternative ADHD constructs, and aspects pertaining to epidemiology and prevalence. The second part focuses on comorbidities, on the difficulty of distinguishing between "primary" and "secondary" ADHD for purposes of differential diagnosis, and on clinical diagnostic procedures. In the third and most prominent part, an overview of current neurobiological concepts of ADHD is given, including neuropsychological and neurophysiological researches and summaries of current neuroimaging and genetic studies. Finally, treatment options are reviewed, including a discussion of multimodal, pharmacological, and nonpharmacological interventions and their evidence base., Neuropediatrics, 51 (5)

The COVID-19 outbreak has profoundly affected adolescents' life. Adolescents with pre-existing psychiatric disorders have been at particular risk of increased mental health problems and problematic media use. 178 patients, aged 12–18 years, referred before the COVID-19 outbreak to child and adolescent psychiatry, participated in an anonymous online survey on the impact of the lockdown on media use and mental well-being. The survey was conducted approximately one month after the first easing of restrictions following a six-week lockdown in Switzerland. Based on self-report, half of the patients had been diagnosed with internalizing disorders (ID; depression or anxiety disorder) and the other half with other disorders (non-ID, e.g. ADHD, autistic spectrum disorder). Patients with ID reported higher emotional distress during the lockdown, and a larger number of patients with ID indicated a deterioration of pre-existing symptoms compared to non-ID patients. Although more patients with ID than with non-ID indicated spending a large amount of time on social media, social media time per day in hours was not significantly higher in ID. Patients with ID indicated a higher impact of media use on well-being and mood in everyday life during the lockdown. Social media time was higher in worsened than in improved non-ID patients, while the opposite was found in ID patients, indicating a possible protective effect of media use at least for some ID patients. The results confirm positive as well as negative associations between mental health, emotional well-being and media use for adolescents with ID during the lockdown.

Objective: We investigated the impact of the pre-training neuropsychological (NP) impairment and of the training progress on the NP and behavioural outcome after computerized cognitive training (Co...

Die COVID-19-Pandemie stellte alle Familien vor noch nie dagewesene Herausforderungen: Kontaktverbote und das Fehlen von Alternativen der Freizeitgestaltung führten dazu, dass digitale Medien einen grösseren Stellenwert erhielten als je zuvor. Kinder und Jugendliche mit psychischen Vorerkrankungen waren von den Auswirkungen der Pandemie in ganz besonderer Weise betroffen und es bestand die Sorge, es könne gerade in einer Population mit Risiko für Sucht oder dysfunktionalem Verhalten zu einem Anstieg von problematischem Internetgebrauch kommen.

La pandémie Covid-19 a confronté toutes les familles à des défis sans précédent: suite à l’interdiction de contacts et l’absence d’alternatives de loisirs, les médias numériques ont pris une plus grande importance que jamais. Les enfants et adolescents avec des troubles psychiques préexistants étaient particulièrement affectés par les effets de la pandémie et la crainte était grande que précisément dans une population à risque de consommation de drogues ou de comportements dysfonctionnels, se manifeste une surconsommation problématique d’internet.

BACKGROUND Neurofeedback is considered a promising intervention for the treatment of attention-deficit hyperactivity disorder (ADHD). NEWROFEED is a prospective, multicentre, randomized (3:2), reference drug-controlled trial in children with ADHD aged between 7 and 13 years. The main objective of NEWROFEED was to demonstrate the noninferiority of personalized at-home neurofeedback (NF) training versus methylphenidate in the treatment of children with ADHD. METHODS The NF group (n = 111) underwent eight visits and two treatment phases of 16 to 20 at-home sessions with down-training of the theta/beta ratio (TBR) for children with high TBR and enhancing the sensorimotor rhythm (SMR) for the others. The control group (n = 67) received optimally titrated long-acting methylphenidate. The primary endpoint was the change between baseline and endpoint in the Clinician ADHD-RS-IV total score in the per-protocol population (90 NF/59 controls). TRIAL REGISTRATION US National Institute of Health, ClinicalTrials.gov #NCT02778360. RESULTS Our study failed to demonstrate noninferiority of NF versus methylphenidate (mean between-group difference 8.09 90% CI [8.09; 10.56]). However, both treatment groups showed significant pre-post improvements in core ADHD symptoms and in a broader range of problems. Reduction in the Clinician ADHD-RS-IV total score between baseline and final visit (D90) was 26.7% (SMD = 0.89) in the NF and 46.9% (SMD = 2.03) in the control group. NF effects increased whereas those of methylphenidate were stable between intermediate and final visit. CONCLUSIONS Based on clinicians' reports, the effects of at-home NF were inferior to those of methylphenidate as a stand-alone treatment.

Background To investigate the consequences of COVID-19 lockdown on screen media use in children and adolescents with mental health problems, an online survey was conducted on leisure media use before, during and after the lockdown of spring 2020. Method Parents of patients (10-18 yrs) referred to child and adolescent psychiatry participated in an anonymous online survey, approximately six weeks after the first easing of lockdown measures. Parents rated the amount, the content and the psychological impact of their children's media use before, during and after the lockdown. Results N = 477 parents completed the survey. Patients showed a significant increase in media time during the lockdown (including devices such as mobile, tablet/PC, video game console, TV, and activities such as gaming, social media) and a moderate increase in the negative impact of media use on everyday life. After the lockdown, total media time returned to pre-COVID-19 levels in most patients, but remained slightly higher in males. A worsening of the main psychopathological problem during lockdown was related to elevated media time in children (10-13 yrs), but not in adolescents (14-18 yrs). Conclusion According to parents' retrospective ratings, the increase in screen media time was reversible, and seems to reflect an expected coping strategy during lockdown. However, male patients did not completely return to pre-COVID-19 gaming time, and a small number continued to display excessive gaming., Comprehensive Psychiatry, 109, ISSN:0010-440X, ISSN:1532-8384

Accepted Manuscript, BACKGROUND: Lateralized dysfunction has been suggested in obsessive-compulsive disorder (OCD). However, it is currently unclear whether OCD is characterized by abnormal patterns of brain structural asymmetry. Here we carried out what is by far the largest study of brain structural asymmetry in OCD.METHODS: We studied a collection of 16 pediatric datasets (501 patients with OCD and 439 healthy control subjects), as well as 30 adult datasets (1777 patients and 1654 control subjects) from the OCD Working Group within the ENIGMA (Enhancing Neuro Imaging Genetics through Meta Analysis) Consortium. Asymmetries of the volumes of subcortical structures, and of measures of regional cortical thickness and surface areas, were assessed based on T1-weighted magnetic resonance imaging scans, using harmonized image analysis and quality control protocols. We investigated possible alterations of brain asymmetry in patients with OCD. We also explored potential associations of asymmetry with specific aspects of the disorder and medication status.RESULTS: In the pediatric datasets, the largest case-control differences were observed for volume asymmetry of the thalamus (more leftward; Cohen's d = 0.19) and the pallidum (less leftward; d = -20.21). Additional analyses suggested putative links between these asymmetry patterns and medication status, OCD severity, or anxiety and depression comorbidities. No significant case-control differences were found in the adult datasets.CONCLUSIONS: The results suggest subtle changes of the average asymmetry of subcortical structures in pediatric OCD, which are not detectable in adults with the disorder. These findings may reflect altered neurodevelopmental processes in OCD., This research was funded by the Max Planck Society (Germany). Additional funding was from the Japan Society for the Promotion of Science (KAKENHI Grant No. 18K15523 [to YA], KAKENHI Grant No. 16K04344 [to YH], KAKENHI Grant Nos. 16K19778 and 18K07608 [to TNakam], and KAKENHI Grant No. 26461762 [to AN]); the Carlos III Health Institute (Grant No. PI14/00419 [to PA], Grant No. PI040829 cofunded by European Regional Development Fund [to LL], Grant No. FI17/00294 [to IM-Z], Grant No. PI16/00950 [to JMM], and Grant Nos. CPII16/00048, PI13/01958, and PI16/00889 cofunded by European Regional Development Funds [to CS-M]); the Ontario Mental Health Foundation (Research Training Fellowship [to SHA]); Alberta Innovates Translational Health Chair in Child and Youth Mental Health (to PDA), the Ontario Brain Institute (to PDA); the National Institute of Mental Health (Grant No. K23MH104515 [to JTB], Grant No. K23-MH092397 [to BPB], Grant No. K23MH082176 [to KDF), Grant No. R21MH101441 [to RM], Grant No. R01MH081864 [to JO and JP], and Grant No. R01MH085900 [to JO and JF], Grant No. R21MH093889 [to HBS]); Fundação de Amparo à Pesquisa do Estado de São Paulo (Grant No. 2011/21357–9 [to MCB], Grant No. 2011/21357–9 [to GFB], Grant No. 2011/21357–9 [to MQH], and Grant No. 2011/21357–9 [to ECM]); the Swiss National Science Foundation (Grant No. 320030_130237 [to SB; principal investigator, Susanne Walitza]); the Hartmann Müller Foundation (Grant No. 1460 [to SB]); the David Judah Fund at the Massachusetts General Hospital (to BPB); EU FP7 Project TACTICS (Grant No. 278948 [to JB]); the National Natural Science Foundation of China (Grant No. 81560233 [to YC] and Grant No. 81371340 [to ZW]); the International OCD Foundation (Grant No. K23 MH115206 [to PG]); the Wellcome Sir Henry Dale Fellowship (Grant No. 211155/Z/18/Z [to TUH]); the Jacobs Foundation (to TUH); the Brain and Behavior Research Foundation (2018 NARSAD Young Investigator Grant No. 27023 [to TUH]); the Agency for Medical Research and Development (Grant No. JP18dm0307002 [to YH]); the Michael Smith Foundation for Health Research (to FJ-F); the Federal Ministry of Education and Research of Germany (Grant No. BMBF-01GW0724 [to NK]); the Deutsche Forschungsgemeinschaft (Grant No. KO 3744/7–1 [to KK]); the Helse Vest Health Authority (Grant Nos. 911754 and 911880 [to GK]); the Norwegian Research Council (Grant No. HELSEFORSK 243675 [to GK]); the Marató TV3 Foundation (Grant Nos. 01/2010 and 091710 [to LL]); the Agency for Management of University and Research Grants (Grant No. 2017 SGR 881 [to LL] and 2017 SGR 1247 from the Generalitat de Catalunya [to JMM]); Fundação para a Ciência e a Tecnologia (Grant No. PDE/BDE/113604/2015 from the PhD-iHES Program [to RM], Grant No. PDE/BDE/113601/2015 from the PhD-iHES Program [to PSM]); the Japanese Ministry of Education, Culture, Sports, Science and Technology (Grant-in-Aid for Scientific Research (Grant Nos. 22591262, 25461732, and 16K10253 [to TNakao]); the Government of India Department of Science and Technology (DST INSPIRE Faculty Grant No. -IFA12-LSBM-26 [to JCN] and Grant No. SR/S0/HS/0016/2011 [to YCJR]); the Government of India Department of Biotechnology (Grant No. BT/06/IYBA/2012 [to JCN] and Grant No. BT/PR13334/Med/30/259/2009 [to YCJR]); the New York State Office of Mental Health (to HBS); the Italian Ministry of Health (Grant No. RC13-14-15-16A [to GS]); the National Center for Advancing Translational Sciences (Grant No. UL1TR000067/KL2TR00069 [to ERS]); the Canadian Institutes of Health Research (to SES); the Michael Smith Foundation for Health Research (to SES); the British Columbia Provincial Health Services Authority (to SES); the Netherlands Organization for Scientific Research (Grant No. NWO/ZonMW Vidi 917.15.318 [to GAvW]); the Wellcome-DBT India Alliance (Grant No. 500236/Z/11/Z [to GV]); the Shanghai Key Laboratory of Psychotic Disorders (Grant No. 13dz2260500 [to ZW]).

Neurofeedback is going through a renaissance. Advances in brain imaging and computing have renewed efforts to modify brain activity and behaviour using this technique. Here, over 80 neurofeedback researchers present a consensus-derived checklist – CRED-nf – for reporting and experimental design standards in the field., Neurofeedback has begun to attract the attention and scrutiny of the scientific and medical mainstream. Here, neurofeedback researchers present a consensus-derived checklist that aims to improve the reporting and experimental design standards in the field.

There is controversy regarding the clinical efficacy of neurofeedback (NF) and computerized cognitive training (CogT) as treatments for ADHD. Meta-analyses claim that probably blinded teachers observe smaller effects than parents, because they are less biased. We investigated informant-specific effects by manipulating the involvement of informants, by controlling for waiting time effects, and by adding a blinded outcome measure. Seventy-seven children with ADHD were randomly allocated to slow cortical potential NF or to individualized CogT (of attention, working memory or inhibition). The training was conducted in schools (NF: n = 19, CogT: n = 19) or in outpatient clinics (NF: n = 19, CogT: n = 20). Three assessments were scheduled: baseline, followed by a waiting period, pre-training, and post-training. Multivariate Analyses of Variance were conducted to assess parent- and teacher-rated changes in ADHD symptoms and executive functions (EF), and changes according to standardized classroom observations. Both treatments resulted in significant improvements according to informants, with larger effects for parents (ADHD symptoms: parent η 2 = .32; teacher η 2 = .10), and according to observations (η 2 = .19). The setting had no effect on outcome. Considerable waiting time effects were revealed for ADHD symptom ratings by both informants, for EF ratings only by teachers. Changed classroom behavior was uncorrelated with teacher-rated changes. Overall, the results do not support the notion that teachers are more objective while being as sensitive to change as parents. The three sources seem to contribute differential and mostly unrelated pieces of information to the evaluation of treatments.

ADHD Attention Deficit and Hyperactivity Disorders, 6 (3), ISSN:1866-6647

This checklist is intended to encourage robust experimental design and clear reporting for clinical and cognitive-behavioural neurofeedback experiments.

A time-processing deficit has been proposed as a neuropsychological candidate endophenotype for Attention Deficit Hyperactivity Disorder (ADHD), but its developmental trajectory still needs to be explored. In the present study, children (N = 33) and adults (N = 22) with ADHD were compared to normal controls on two time-processing tasks. For time reproduction, ADHD-related impairment was found in the full group, but not when adults were analyzed separately. For the discrimination of brief intervals, children and adults with ADHD showed different patterns of deficit. We conclude that in ADHD some time-processing deficits are still present in adults, but may take on age-related different forms.

OBJECTIVE: The purpose of this study was to investigate the overlap between executive functions and temperament as measured by two questionnaires and to examine characteristic profiles in children with ADHD and clinical controls.METHOD: Parents of 111 clinically referred children, half of whom were diagnosed with ADHD and half with other or no diagnoses, completed the Behavior Rating Inventory of Executive Function (BRIEF) and the Cloninger Junior Temperament and Character Inventory (JTCI).RESULTS: Factor analysis of both instruments resulted in three common factors representing aspects of (1) cognitive regulation, (2) behavioral regulation, and (3) anxious/rigid tendencies. Factor (4) represented strengths and positive resources and loaded on JTCI scales only. Both instruments discriminated significantly between ADHD and non-ADHD children. Conduct disorder/oppositional defiant disorder (CD/ODD) but not ADHD accounted for problems in BRIEF Emotional Control and Self-Monitor and JTCI low Cooperativeness.CONCLUSION: The two instruments only partially overlap and may complement each other.

Zusammenfassung: In diesem Übersichts-Artikel wird eine Taxonomie exekutiver Funktionen auf der Basis neuropsychologischer Modelle vorgestellt, an der sich eine klinische Diagnostik orientieren kann. Unterschieden werden vier Regulationsebenen, kognitive Regulation, Aktivitätsregulation, emotionale Regulation und soziale Regulation, denen sich klinisch beobachtbare Phänomene bei Störungen exekutiver Funktionen zuordnen lassen. Schließlich werden die besonderen Probleme thematisiert, die sich bei der Diagnostik exekutiver Funktionen hinsichtlich ökologischer Validität, Konstruktvalidität, Reliabilität und anderer methodischer Kriterien stellen.

This review evaluates the clinical utility of tools for systematic behavioral observation in different settings for children and adolescents with ADHD. A comprehensive search yielded 135 relevant results since 1990. Observations from naturalistic settings were grouped into observations of classroom behavior (n = 58) and of social interactions (n = 25). Laboratory observations were subdivided into four contexts: independent play (n = 9), test session (n = 27), parent interaction (n = 11), and peer interaction (n = 5). Clinically relevant aspects of reliability and validity of employed instruments are reviewed. The results confirm the usefulness of systematic observations. However, no procedure can be recommended as a stand-alone diagnostic method. Psychometric properties are often unsatisfactory, which reduces the validity of observational methods, particularly for measuring treatment outcome. Further efforts are needed to improve the specificity of observational methods with regard to the discrimination of comorbidities and other disorders.

Hyperkinetische Storungen bzw. ADHS zahlen mit einer Pravalenz von etwa 5 % zu einer der haufigsten kinder- und jugendpsychiatrischen Storungen. Sie sind durch die Kernsymptome Unaufmerksamkeit, Hyperaktivitat und Impulsivitat gekennzeichnet. Die Storung beginnt im Kindesalter und hat einen chronischen Verlauf. ADHS fuhrt zu einer Beeintrachtigung in mehreren psychosozialen Lebensbereichen und wird in mehr als 2/3 der Falle durch eine andere psychische Storung begleitet. Dabei ist besonders die Storung des Sozialverhaltens uberdurchschnittlich haufig, es kommen aber auch Lernstorungen, Tics, depressive Episoden und Angststorungen vermehrt vor. Bei ADHS wird von einer multifaktoriellen Genese ausgegangen, wobei der Genetik eine entscheidende ursachliche Rolle zukommt. Bei der ADHS handelt es sich um eine sehr heterogene Storung, die sich bezuglich der Kernsymptome im Krankheitsverlauf meistens verandert. Die Hyperaktivitat tritt ab dem Jugendalter eher in den Hintergrund, wahrend die Aufmerksamkeitsstorung und Impulsivitat haufig bis ins Erwachsenenalter bestehen bleiben. Wie bei anderen Krankheitsbildern in der Kinder- und Jugendpsychiatrie erfolgt die Diagnostik multiaxial und sollte sehr sorgfaltig und wie die Therapie leitlinienorientiert durchgefuhrt werden. Die Therapie der ADHS ist multimodal ausgerichtet und schliest kind-, eltern- und schulzentrierte Masnahmen mit ein.

Two types of biofeedback (BF), tomographic electroencephalogram (EEG) neurofeedback (NF) and electromyographic biofeedback (EMG-BF), both with phasic and tonic protocols, were compared for treatment effects and specificity in attention-deficit/hyperactivity disorder (ADHD). Thirteen children with ADHD trained their brain activity in the anterior cingulate cortex (ACC), and twelve trained activity of arm muscles involved in fine motor skills. In each training session, resting state 24-channel EEG and training performances were recorded. Both groups showed similar behavioral improvements and artifact reduction in selected conditions, with no significant advantages despite medium effect sizes on primary outcomes for NF. Only the EMG-BF group, however, showed clear improvement in training regulation performance, and specific motor coordination effects. The NF group tended to present individual normalization of trained frequency bands in the ACC during rest across training. The results provide evidence for some specific effects in our small sample, albeit only to a small extent.

BackgroundObsessive–compulsive disorder (OCD) has been linked to functional abnormalities in fronto-striatal networks as well as impairments in decision making and learning. Little is known about the neurocognitive mechanisms causing these decision-making and learning deficits in OCD, and how they relate to dysfunction in fronto-striatal networks.MethodWe investigated neural mechanisms of decision making in OCD patients, including early and late onset of disorder, in terms of reward prediction errors (RPEs) using functional magnetic resonance imaging. RPEs index a mismatch between expected and received outcomes, encoded by the dopaminergic system, and are known to drive learning and decision making in humans and animals. We used reinforcement learning models and RPE signals to infer the learning mechanisms and to compare behavioural parameters and neural RPE responses of the OCD patients with those of healthy matched controls.ResultsPatients with OCD showed significantly increased RPE responses in the anterior cingulate cortex (ACC) and the putamen compared with controls. OCD patients also had a significantly lower perseveration parameter than controls.ConclusionsEnhanced RPE signals in the ACC and putamen extend previous findings of fronto-striatal deficits in OCD. These abnormally strong RPEs suggest a hyper-responsive learning network in patients with OCD, which might explain their indecisiveness and intolerance of uncertainty.

Attention-deficit/hyperactivity disorder (ADHD) rating scales such as the Conners’ Rating Scales (CRS) are valuable adjuncts for diagnosis, since they offer parent, teacher, and self-ratings of children susceptible for ADHD. Even though the scales are widely used internationally, cross-cultural comparability has rarely been verified, and culture and language invariance have only been presumed. The Conners 3(®) rating scales are the updated version of the CRS, though hardly any studies report the psychometric properties apart from the results published in the test edition itself. To our knowledge there are no studies on the various adaptations of the Conners 3(®) in other languages.The German translations of the Conners 3(®) were completed by 745 children, 953 parents, and 741 teachers (children’s age range: 6–18 years, mean: 11.74 years of age). Exploratory and confirmatory factor analyses on content scale items were conducted to obtain the factor structure for the German version and to replicate the factor structure of the original American models. Cronbach’s α was calculated to establish internal consistency.The exploratory analyses for the German model resulted in factor structures globally different from the American model, though confirmatory analyses revealed very good model fi ts with highly satisfying Cronbach’s αs. We were able to provide empirical evidence for the subscale Inattention which had only hypothetically been derived by Conners (2008).Even though the exploratory analyses resulted in different factor structures, the confirmatory analyses have such excellent psychometric properties that use of the German adaptation of the Conners 3(®) is justifi ed in international multicenter studies.

Background: This longitudinal electrophysiological study investigated the course of multiple impaired cognitive brain functions in attention-deficit/hyperactivity disorder (ADHD) from childhood to adulthood by comparing developmental trajectories of individuals with ADHD and typically developing controls. Methods: Subjects with ADHD (N = 11) and normal controls (N = 12) diagnosed in childhood [mean age ADHD/CTRL = 10.9 years [SD 1.72]/10.0 years (SD 1.03)] were followed up after 1.1 and 2.4 years, and as young adults [ADHD/CTRL: 21.9 years (SD 1.46)/21.1 years (SD 1.29)]. At all four times, event-related potential (ERP) maps were recorded during a cued continuous performance test (CPT). We focused on residual deficits as adults, and on developmental trajectories (time and time × group effects) for CPT performance and attentional (Cue P300), preparatory (CNV: contingent negative variation) and inhibitory (NoGo P300) ERP components. Results: All ERP components developed without significant time × group interactions. Only the CNV remained reduced in the ADHD group, although 8/11 individuals no longer met a full ADHD diagnosis as adults. Cue P300 and NoGo P300 group differences became nonsignificant in early adulthood. The CNV parameters correlated with reaction time (RT) and RT-SD. Perceptual sensitivity improved and the groups' trajectories converged with development, while RT-SD continued to be elevated in adult ADHD subjects. Conclusions: Attentional and preparatory deficits in ADHD continue into adulthood, and the attenuated CNV appears to reflect a particularly stable ADHD marker. Although some deficit reductions may have gone undetected due to small sample size, the findings challenge those developmental lag models postulating that most ADHD-related deficits become negligible with brain maturation.

Zusammenfassung.Es wurde untersucht, ob bei der Diagnostik exekutiver Störungen bei Erwachsenen mit Aufmerksamkeits-Defizit/Hyperaktivitätsstörung (ADHS) Diskrepanzen zwischen Selbst- und Fremdangaben sowie zwischen Fragebögen und Testergebnissen auftreten. Erwachsene mit ADHS und Kontrollprobanden füllten das Dysexecutive Questionnaire (DEX) und die Frankfurter Selbstkonzeptskalen (FSKN) aus und bearbeiteten exekutive Testverfahren. Es zeigte sich, dass Erwachsene mit ADHS sowohl in Selbst- als auch Fremdurteil im DEX auffälliger waren als Kontrollprobanden. Selbst- und Fremdurteile stimmten in beiden Gruppen etwa gleich gut überein. Bei Patienten und bei Kontrollen erbrachte die Selbsteinschätzung auffälligere Werte als die Fremdeinschätzung durch Angehörige. Zusammenhänge zwischen DEX-Einschätzungen und Testleistungen waren gering bis höchstens moderat. Die Ergebnisse zeigen, dass Selbstangaben von Erwachsenen mit ADHS zu exekutiven Funktionsbeeinträchtigungen als überwiegend zuverlässig angesehen werden können.

Obsessive compulsive disorder (OCD) is a frequent psychiatric disorder with a prevalence of 1 3 and it places an enormous burden on patients and their relatives. Up to 50 of all cases suffer from onset in childhood or adolescence and the disorder often takes a chronic course with a poor long term prognosis. Paediatric OCD with its high familiality is often referred to as a distinct OCD subtype that coincides with a developmental period in which the prefrontal cortex exhibits extensive structural and functional maturation. In the present review we included all studies examining cognitive brain activation in children and/or adolescents with OCD. We conducted extensive literature searches for relevant articles (Pubmed ScienceDirect) and summarize tabulate and discuss their results. For the eight activation studies using functional magnetic resonance imaging we also performed preliminary meta analyses to assess the most consistent hypo and hyperactivation in paediatric OCD patients during cognitive task performance. The review of literature as well as our preliminary meta analyses of paediatric studies indicated altered functional activation in the same brain regions of affective and cognitive cortico striatalthalamic (CST) circuits as for adult OCD patients despite some variations in the direction of activation difference. The still small number of studies that examined brain activation in paediatric OCD patients thereby largely converged with previous findings in adult patients and with the established neurobiological models of CST circuit dysfunction in OCD. © Springer Verlag 2012.

Neurofeedbacktraining hat sich zunehmend als eine klinische Behandlungsmethode für Kinder mit ADHS etabliert, obwohl methodisch befriedigende Wirksamkeitsstudien lange fehlten. Der Überblicksartikel führt zunächst in die Grundlagen von Neurofeedback bei ADHS ein und stellt die wichtigsten Methoden und Protokolle vor. Anschliessend werden aktuelle Studien mit verschiedenen Kontrollbedingungen, Bildgebungsbefunde und Ansätze, die den Zusammenhang zwischen kortikaler Regulation und klinischen Verbesserungen untersuchen, zusammengefasst. Neben vielen offenen methodischen Fragen gibt es auch einige wenige Ergebnisse, die eine spezifische Wirkung von Neurofeedbacktraining stützen. In welchem Ausmass aber die gelernte kortikale Regulation tatsächlich kausal zu den klinischen Verbesserungen beiträgt, müssen zukünftige Untersuchungen noch zeigen.

Background The role of a developmental lag for deficits of higher brain functions in attention-deficit/hyperactivity disorder (ADHD) has not yet been tested in longitudinal studies. We examined the development of neurophysiological markers of attention (Cue P300; contingent negative variation [CNV]) and inhibition (NoGo P300) in ADHD and control groups from childhood to adolescence for support of the developmental lag hypothesis of ADHD. Methods ADHD ( n = 28/3 girls) and control ( n = 22/5 girls) subjects were assessed at baseline (Time 1; ADHD age 10.8 ± 1.8 years, controls 10.4 ± 1.1 years) and at two follow-up examinations (Time 2 after 1.2 years, Time 3 after 2.5 years). Event-related potential maps were recorded during a cued Continuous Performance Test (CPT) at all assessments and analyzed using scalp and source (sLORETA) measures. Results CPT performance showed common effects of ADHD and younger age, consistent with (but not specific to) developmental lag. The NoGo P300 developed earlier and became stronger in control subjects than in the ADHD group, again consistent with an initial developmental lag. In contrast, the attenuation of the Cue P300 and the CNV with ADHD at all assessments was opposite to the enhancement with younger age and thus inconsistent with developmental lag. The sLORETA source localization also differed between ADHD and developmental effects. Conclusions These results provide strong evidence for multiple and persistent neural processing deficits in ADHD. They do not support the developmental lag hypothesis for attentional dysfunction in ADHD despite partial evidence that developmental lag contributes to inhibitory brain dysfunction during early adolescence.

Obwohl neuropsychologische Tests zwischen Kindern mit und ohne ADHS unterscheiden, ist doch ihr Beitrag zur klinischen Diagnose oft unklar. Daher wurde untersucht, wie gut eine computergestützte Testbatterie zur Aufmerksamkeitsprüfung bei Kindern (KITAP) zwischen Kindern mit und ohne ADHS trennt und welchen Beitrag sie bei der diagnostischen Klassifikation leisten kann. In der Studie führten 50 Kinder mit ADHS und 50 gesunde Kinder im Alter von sieben bis zehn Jahren Untertests zu Alertness, Flexibilität, Inhibitionskontrolle, Daueraufmerksamkeit, geteilter Aufmerksamkeit und Ablenkbarkeit durch. Es zeigte sich, dass vier der sechs Aufgaben zwischen den Gruppen signifikant trennten. Die Kombination von zwei oder mehr beeinträchtigten Untertests erwies sich zwar als bester Prädiktor für ADHS, war aber für klinisch-diagnostische Zwecke unzureichend. Es wird die Schlussfolgerung gezogen, dass eine computergestützte Testbatterie zwar wichtige Hinweise auf das individuelle Leistungsprofil gibt, sich eine diagnostische Klassifikation von Kindern mit und ohne ADHS aber kaum auf Normabweichungen in diesem Leistungstest stützen kann.

We compared ADHD-related temporal processing and response inhibition deficits in children and adults using event-related potentials (ERPs) during cued continuous performance tasks (CPT, O-X-version, plus a more demanding flanker version). ERP markers of temporal processing (Cue CNV) and inhibition (NoGo P300) were obtained in matched groups of children (32 with ADHD, mean age 11.2 years, and 31 controls, mean age 11.1 years) and adults (22 ADHD, mean age 42.7 years, and 22 controls, mean age 44.0 years). ERP markers and performance reflected both age and ADHD status. Performance was poorer, and Cue CNV and NoGo P300 were weaker in ADHD children and adults compared to their matched controls. ADHD-related ERP differences in children were more prominent at posterior scalp sites but more pronounced at anterior scalp sites in adults, paralleling the prominent topographic changes of both ERP markers with development. The fact that differences in the same test and the same processing period appear in both children and adults, but that they present in different aspects of performance and different scalp topographies, leads to the conclusion that some ADHD-related deficits persist into adulthood despite alterations of their qualitative aspects.

OBJECTIVE Attention-deficit/hyperactivity disorder (ADHD) rating scales such as the Conners’ Rating Scales (CRS) are valuable adjuncts for diagnosis, since they offer parent, teacher, and self-ratings of children susceptible for ADHD. Even though the scales are widely used internationally, cross-cultural comparability has rarely been verified, and culture and language invariance have only been presumed. The Conners 3(®) rating scales are the updated version of the CRS, though hardly any studies report the psychometric properties apart from the results published in the test edition itself. To our knowledge there are no studies on the various adaptations of the Conners 3(®) in other languages. METHOD The German translations of the Conners 3(®) were completed by 745 children, 953 parents, and 741 teachers (children’s age range: 6–18 years, mean: 11.74 years of age). Exploratory and confirmatory factor analyses on content scale items were conducted to obtain the factor structure for the German version and to replicate the factor structure of the original American models. Cronbach’s α was calculated to establish internal consistency. RESULTS The exploratory analyses for the German model resulted in factor structures globally different from the American model, though confirmatory analyses revealed very good model fi ts with highly satisfying Cronbach’s αs. We were able to provide empirical evidence for the subscale Inattention which had only hypothetically been derived by Conners (2008). CONCLUSIONS Even though the exploratory analyses resulted in different factor structures, the confirmatory analyses have such excellent psychometric properties that use of the German adaptation of the Conners 3(®) is justifi ed in international multicenter studies.

OBJECTIVE: The aim of this follow-up study was to investigate the course of performance in attentional tasks in children with ADHD and normal controls in late childhood and preadolescence over short periods of time. The development of two dimensions of attention was compared: alertness/arousal and inhibitory control. METHOD: Children with ADHD (N=28) and normal controls (N=25) were examined at three times: at baseline (age mean=10.8 years, SD=1.5), after one year (age mean=12.0 years, SD=1.6), and after 2.6 years (age mean=13.3 years, SD=1.6). They performed two tasks of a computerized battery for attentional performance: Alertness--a test of simple reaction time to visual stimuli contrasting a condition with and without auditory warning signal, and Incompatibility--a test of spatial interference/inhibitory control. Clinical diagnosis according to DSM-III-R criteria was established at time 1 and time 3 by structured diagnostic interviews. RESULTS: In the Alertness task significant group differences regarding increased reaction time variability in ADHD, but not for reaction time itself, were found at time 1 and more pronounced at time 2. At time 3 group differences had disappeared. In the Incompatibility task group differences in number of errors were not observed at time 1, whereas children with ADHD made significantly more errors at time 2 and less pronounced at time 3. The degree of clinical symptom remission after 2.6 years was not related to changes in neuropsychological performance. CONCLUSION: When measuring attentional functions, the selection of an appropriate time window seems to be essential for the detection of group differences between ADHD children and controls, because group differences are most pronounced before adolescence. The different developmental course of selective components of attention should be taken into account.

Objective To study the course of attention-deficit/hyperactivity disorder (ADHD) in late childhood to adolescence using a multi-informant and multi-assessment procedure. Method Subjects were 35 children with ADHD and 35 matched controls with a mean age of 10 years at first assessment. DSM-III-R-based structured diagnostic interviews and behavioral questionnaires based on parents, teachers, and youth informants were used. Cross-informant behavioral syndromes were obtained by use of the Child Behavior Checklist, the Teacher's Report Form, and the Youth Self-Report. Subjects were reassessed after 1.5 and 2.6 years. Results Behavioral differences between the two groups were significant for the majority of scales for all three informants at all three times. Diagnostic interviews revealed a persistence rate of 46% over 2.6 years. However, there were only few significant behavioral differences across informants between the nonpersistent and the persistent groups. The fit between interview-derived syndrome scores reflecting subtypes of ADHD and both parents and youth questionnaire data was good, whereas for the teacher ratings it was poor. A high rate of 89% correct classification of the outcome diagnoses was possible based on behavioral data at time 1. Conclusions The study of the course of ADHD should be based both on interview and questionnaire data and should include several informants. Operationally defined diagnoses alone may lead to an underestimation of persistent behavioral problems.

BACKGROUND: Difficulties with performance and brain activity related to attentional orienting (Cue-P3), cognitive or response preparation (Cue-CNV) and inhibitory response control (Nogo-P3) during tasks tapping executive functions are familial in ADHD and may represent endophenotypes. The aim of this study was to clarify the impact of dopamine receptor D4 (DRD4) and dopamine transporter (DAT1) gene polymorphisms on these processes in ADHD and control children.METHODS: Behavioural and electrophysiological parameters from cued continuous performance tests with low and high attentional load were assessed in boys with ADHD combined type (N = 94) and controls without family history of ADHD (N = 31). Both groups were split for the presence of at least one DRD4 7-repeat allele and the DAT1 10-6 haplotype.RESULTS: Children with ADHD showed diminished performance and lower Cue-P3, CNV and Nogo-P3 amplitudes. Children with DRD4 7R showed similar performance problems and lower Cue-P3 and CNV, but Nogo-P3 was not reduced. Children with the DAT1 10-6 haplotype had no difficulties with performance or Cue-P3 and CNV, but contrary to expectations increased Nogo-P3. There were no Genotype by ADHD interactions.CONCLUSIONS: This study detected specific effects of DRD4 7R on performance and brain activity related to attentional orienting and response preparation, while DAT1 10-6 was associated with elevated brain activity related to inhibitory response control, which potentially compensates increased impulsivity. As these genotype effects were additive to the impact of ADHD, the current results indicate that DRD4 and DAT1 polymorphisms are functionally relevant risk factors for ADHD and presumably other disorders sharing these endophenotypes.

Applied Psychophysiology and Biofeedback, 38 (2), ISSN:1090-0586, ISSN:1573-3270

Objective: To compare psychopathology and personality in parents of children with ADHD and control parents. Method: A total of 140 parents were subdivided according to presence and duration of ADHD. Assessment was based on various ADHD self-rating scales, the revised Symptom Checklist (SCL-90-R), the Patient Health Questionnaire (PHQ), and the revised NEO Five Factors Inventory (NEO-FFI). Results: Parents with lifelong persistent ADHD were most abnormal on all dimensions of ADHD psychopathology, the SCL-90-R, the PHQ, and the neuroticism and conscientiousness dimensions of the NEO-FFI. The scores of parents with current ADHD approached those of parents with persistent ADHD on most dimensions, and both groups scored higher than did parents with either remitted ADHD or no ADHD, or controls. The scores of the latter three groups were not significantly different from each other. Conclusion: Among parents of children with ADHD, parents with lifelong persistent or current ADHD show highest scores of psychopathology.

Brain Topography, 26 (1), ISSN:0896-0267, ISSN:1573-6792

Psychological Medicine, 43 (9), ISSN:0033-2917, ISSN:1469-8978

This longitudinal electrophysiological study investigated the course of multiple impaired cognitive brain functions in attention-deficit/hyperactivity disorder (ADHD) from childhood to adulthood by comparing developmental trajectories of individuals with ADHD and typically developing controls.Subjects with ADHD (N = 11) and normal controls (N = 12) diagnosed in childhood [mean age ADHD/CTRL = 10.9 years [SD 1.72]/10.0 years (SD 1.03)] were followed up after 1.1 and 2.4 years, and as young adults [ADHD/CTRL: 21.9 years (SD 1.46)/21.1 years (SD 1.29)]. At all four times, event-related potential (ERP) maps were recorded during a cued continuous performance test (CPT). We focused on residual deficits as adults, and on developmental trajectories (time and time × group effects) for CPT performance and attentional (Cue P300), preparatory (CNV: contingent negative variation) and inhibitory (NoGo P300) ERP components.All ERP components developed without significant time × group interactions. Only the CNV remained reduced in the ADHD group, although 8/11 individuals no longer met a full ADHD diagnosis as adults. Cue P300 and NoGo P300 group differences became nonsignificant in early adulthood. The CNV parameters correlated with reaction time (RT) and RT-SD. Perceptual sensitivity improved and the groups' trajectories converged with development, while RT-SD continued to be elevated in adult ADHD subjects.Attentional and preparatory deficits in ADHD continue into adulthood, and the attenuated CNV appears to reflect a particularly stable ADHD marker. Although some deficit reductions may have gone undetected due to small sample size, the findings challenge those developmental lag models postulating that most ADHD-related deficits become negligible with brain maturation.

The behavioural profiles in N = 69 index children with attention-deficit/hyperactivity disorder (ADHD), N = 32 siblings with ADHD, N = 35 siblings without ADHD, and N = 36 normal controls were compared by the use of standardized parent and teacher rating scales. The four groups were matched by age and IQ. The behavioural profiles of the two ADHD groups were very similar not only in the behavioural domains of ADHD, but also in scales measuring emotional and conduct problems. Siblings without ADHD shared more similarities with normal controls except for more emotional problems. These general trends were stronger in the parent compared to the teacher ratings. These findings indicate that not only ADHD-related but also other behaviours show a strong family aggregation. The informant differences may reflect context dependent differences in child behaviour and contrast effects particularly in parental ratings.

Objective Tomographic neurofeedback (tNF) training was evaluated as a treatment for attention-deficit/hyperactivity disorder (ADHD). To investigate the specificity of the treatment, outcomes were related to learning during tNF. Methods Thirteen children with ADHD trained over 36 lessons to regulate their brain activity in the anterior cingulate cortex (ACC) using both theta-beta frequency and slow cortical potential (SCP) protocols. Thirty-channel electroencephalogram (EEG) was used to calculate low-resolution electromagnetic tNF and to assess the course of the training. Pre- and post-assessments included questionnaires, tests of attention, EEG recordings, and cognitive event-related potentials. Results Despite behavioural improvement and EEG artefact reduction, only partial learning was found for ACC parameters. Successful regulation was observed only for a simple feedback variant of SCP training, but with ACC-specific effects. Over training, resting EEG analysis indicated individual frequency normalisation rather than unidirectional changes across subjects. Conclusions These results indicate that clinical improvement after ACC-tNF training can parallel artefact reduction without substantial learning of improved cortical control. However, individual normalisation of resting EEG activity and partial SCP control proved possible in this specific brain region affected in ADHD using tNF. Further studies are needed to clarify which critical aspects mediate region-specific learning in neurofeedback. Significance This study is the first to systematically investigate tNF in children suffering from a psychiatric disorder.

The current study investigated prospective memory (PM) performance in children with attention deficit/hyperactivity disorder (ADHD) and controls and aimed at exploring possible underlying factors of PM performance. Twenty-two children with ADHD and 39 age- and ability-matched typically developing children performed a computerized time-based PM task. As predicted, children with ADHD had fewer correct PM responses than controls. Neither differences in overall ongoing task performance nor, remarkably, differences in overall frequency and accuracy of time monitoring were found. Exploratory analyses suggest that individual differences in time monitoring in the final interval before target times may be related to PM performance in ADHD.

Reward-related processes are impaired in children with ADHD. Whether these deficits can be ascribed to an aversion to delay or to an altered responsiveness to magnitude, frequency, valence, or the probability of rewards still needs to be explored. In the present study, children with ADHD and normal controls aged 7 to 10 years performed a simple probabilistic discounting task. They had to choose between alternatives where the magnitude of rewards was inversely related to the probability of outcomes. As a result, children with ADHD opted more frequently for less likely but larger rewards than normal controls. Shifts of the response category after positive or negative feedback, however, occurred as often in children with ADHD as in control children. In children with ADHD, the frequency of risky choices was correlated with neuropsychological measures of response time variability but unrelated to measures of inhibitory control. It is concluded that the tendency to select less likely but larger rewards possibly represents a separate facet of dysfunctional reward processing, independent of delay aversion or altered responsiveness to feedback.

This study compared changes in quantitative EEG (QEEG) and CNV (contingent negative variation) of children suffering from ADHD treated by SCP (slow cortical potential) neurofeedback (NF) with the effects of group therapy (GT) to separate specific from non-specific neurophysiological effects of NF. Twenty-six children (age: 11.1 +/- 1.15 years) diagnosed as having ADHD were assigned to NF (N = 14) or GT (N = 12) training groups. QEEG measures at rest, CNV and behavioral ratings were acquired before and after the trainings and statistically analyzed. For children with ADHD-combined type in the NF group, treatment effects indicated a tendency toward improvement of selected QEEG markers. We could not find the expected improvement of CNV, but CNV reduction was less pronounced in good NF performers. QEEG changes were associated with some behavioral scales. Analyses of subgroups suggested specific influences of SCP training on brain functions. To conclude, SCP neurofeedback improves only selected attentional brain functions as measurable with QEEG at rest or CNV mapping. Effects of neurofeedback including the advantage of NF over GT seem mediated by both specific and non-specific factors.

Summary.: Inappropriate risk-taking and disadvantageous decision-making have been described as major behavioural characteristics of patients with attention-deficit/hyperactivity disorder (ADHD). However these behaviours are difficult to measure in laboratory contexts and recent studies have yielded inconsistent results which might be related to task characteristics. The present study adopted the Game of Dice Task, a test procedure in which risks are made explicit and the load on working memory is minimal. As a result, preadolescents with ADHD (N = 23) made significantly more risky choices and suffered major losses of money compared to normal controls (N = 24) but only when they played the game a second time. Differences in risk-taking correlated significantly with hyperactivity as rated by parents and with inhibitory control, but not with working memory performance. The results are discussed in the context of current theories of ADHD