Blink rate and blink timing in children with ADHD and the influence of stimulant medication.

Spontaneous eye blink rate is modulated by task demands and internal state, and is demonstrated to reflect central dopamine activity. Also, spontaneous eye blinks are strategically timed around salient stimuli. This study investigates whether children with attention deficit hyperactivity disorder (ADHD) show reduced blink rates, blink modulation and blink timing, and whether this is influenced by stimulant medication. The electrooculogram was measured in 18 typically developing children, 16 children with ADHD off methylphenidate (Mph), and 16 children with ADHD on Mph during a rest period and during performance of a 60-min visual selective attention task. Blink rate and timing was extracted from the electrooculogram. No evidence was found for aberrant blink rate or blink modulation in children with ADHD off Mph. All groups increased blink rates from rest to task, and no group differences were found in blink rate during rest and task, or in the modulation of blink rate from rest to task. Time-on task resulted in a similar increase in blink rates in all three groups. Stimulant medication appeared not to influence blink rate and blink modulation, except that in the ADHD off Mph group the blink rate was enhanced only under conditions with performance feedback. All groups inhibited blinks before stimulus presentation and strategically timed their blinks after the stimulus. Children with ADHD off Mph showed reduced blink inhibition before the stimulus; however, given the low incidence (<1 % of the trials) and long latency this is not likely to impair their visual intake.

Methylphenidate, interstimulus interval, and reaction time performance of children with attention deficit/hyperactivity disorder: a pilot study.

Thirteen children with attention deficit/hyperactivity disorder (ADHD: DSM-IV-TR) participated in the pilot study. They carried out a Go/No-Go test with a short (2 seconds) and long (6 seconds) interstimulus interval (ISI) when on placebo and a therapeutic dose of methylphenidate (MPH). For the long-ISI placebo condition the responses were slow and inaccurate. This pattern of response may be due to underactivation of the readiness-to-respond state that is not fully controlled by effort allocation. Speed of response and accuracy were enhanced during the short-ISI placebo condition and the long-ISI MPH condition. However, the combined effect (short ISI and MPH) resulted in a fast but inaccurate response style. This pattern of response may be due to overactivation of the readiness-to-respond state. The data of the pilot study support the stimulus shift hypothesis: MPH administration result in deterioration on tests on which children had previously done well (short ISI plus placebo versus short ISI plus MPH). In addition, the data support the idea that ADHD is associated with poor state regulation rather than motivational (delay aversion) theories or temporal-processing/time-estimation theories of ADHD. The pilot study defined empirically an issue for further study with the larger controlled sample.

Visual behaviour of ADHD children during an attention test: an almost forgotten variable. Attention-Deficit Hyperactivity Disorder.

The goal of this study was to examine whether looking away behaviour of ADHD children interferes with their test performance. ADHD and normal children carried out two continuous performance tests (CPTs): one with a regular interstimulus interval (ISI), and the other with an irregular ISI. Children were instructed to push a response button when a target stimulus was presented on the monitor. The children's visual behaviour was recorded and scored offline. A micro-analysis of the visual behaviour indicated that ADHD children timed their looking away behaviour in the regular CPT: i.e. they looked away from the monitor and back in the interval between two succeeding stimuli. As a result they did not miss stimuli. Timing of looking away was less possible in the CPT with the irregular ISI. In this condition, looking away interfered with the ADHD children's task accuracy. In sum, looking away behaviour had a negative effect on the accuracy of test performance of ADHD children when stimuli were unpredictable. Looking away behaviour was not associated with the slower reaction times of the ADHD children. Hence, the often reported slowness of ADHD children is not to be explained by their visual behaviour.

Motor control and state regulation in children with ADHD: a cardiac response study.

The goal of the current study was to investigate whether poor motor control in children with Attention-Deficit Hyperactivity Disorder (ADHD) was associated with a state regulation deficit. For this purpose, 28 ADHD and 22 healthy children carried out two Go No-Go tests: one with a fast stimulus presentation rate, and the other with a slow stimulus presentation rate. Groups were compared on RT performance and on specific cardiac measures, reflecting arousal, motor activation/inhibition, and effort allocation. No group difference in the arousal measure (mean heart rate) was found. Further, groups did not differ with respect to response inhibition: in both the fast and slow condition, ADHD children made comparable numbers of errors of commission to the control group, and the groups did not differ with respect to the heart rate deceleration after the onset of the No-Go signal, reflecting motor inhibition. Group differences were found with respect to motor activation and effort allocation in the condition with a slow presentation rate. In this condition: (1) ADHD children reacted more slowly to Go signals than control children, suggesting poor motor activation; (2) the heart rate deceleration before the onset of Go signals, which is believed to reflect motor preparation, was less pronounced in the ADHD children; (3) after Go signals, where a response was given, the cardiac shift from deceleration to acceleration, indicating response initiation, was delayed in ADHD children; and (4) ADHD children had greater heart rate variability (0.10 Hz component) than the control group, indicating that less effort was allocated. No group differences in motor activation and effort allocation were found in the condition with a fast presentation rate of stimuli. We conclude, therefore, that a slow presentation rate of stimuli brings the ADHD child in a non-optimal activation state.

Heart rate variability and sustained attention in ADHD children.

The major goal of the current study was to investigate the association between continuous performance tests (CPTs) and the heart rate variability (HRV) of attention deficit hyperactivity disorder (ADHD) children. The HRV, specifically the 0.10-Hz component, may be considered to be a psychophysiological index of effort allocation (motivation): The less effort the subject allocates, the greater the 0.10-Hz component. Results indicated that, compared to controls, ADHD subjects had a greater 0.10-Hz component, which was associated with poor test performance over time. Thus, using a psychophysiological measure, we were able to confirm the clinical concept of ADHD from a motivational perspective.

Sustained attention, activation and MPH in ADHD: a research note.

Sustained attention was studied in children with attention deficit hyperactivity disorder (ADHD) and normal controls using a continuous performance task with slow presentation of stimuli and carried out with an experimenter-present and absent condition. Children with ADHD were slower than controls, with performance deteriorating over time, particularly in the experimenter-absent condition. Both the slowness and deterioration normalized when the children received MPH. Hence the rate of stimuli presentation and the presence or absence of experimenter are both crucial factors in the performance of children with ADHD. MPH is able to ameliorate the performance decrement seen under these conditions.