Effects of Equine-Assisted Activities and Therapies on the Affective Network of Adolescents with Internet Gaming Disorder.

OBJECTIVES: Internet gaming disorder (IGD) has been suggested to be a mental health disorder. Attachment and emotional status in IGD patients are important for understanding the etiology and progression of IGD because both parameters are considered to be associated with the affective network. Equine-assisted activities and therapies (EAAT) have been reported to improve emotional status and attachment in subjects. We hypothesized that EAAT would improve attachment in IGD adolescents with insecure attachment issues and increase functional connectivity (FC) within the affective network. DESIGN: Subjects completed a demographic questionnaire, the Korean Experiences in Close Relationships Scale Revised version (K-ECRS), the Child Depression Inventory, Young's Internet Addiction Scale, the Korean Attention-Deficit Hyperactivity Disorder Rating Scale, and resting-state functional magnetic resonance imaging at baseline at the end of EAAT. SUBJECTS: Fifteen IGD adolescents with insecure attachment issues and 15 healthy comparison adolescents with secure attachment agreed to participate in this study. RESULTS: After 7 days of EAAT, K-ECRS avoidance and anxiety scores improved in all adolescents. K-ECRS avoidance scores of the IGD group showed marked improvement compared with those of the healthy group. In all participants, FC from the left amygdala to the left parahippocampal gyrus, left medial frontal gyrus, and left inferior frontal gyrus, as well as from the right amygdala to the left caudate, right claustrum, and left inferior frontal gyrus increased. In IGD adolescents, FC from the left amygdala to the left frontal orbital gyrus, as well as from the right amygdala to the right corpus callosum also increased. CONCLUSION: These findings suggested that EAAT improves attachment, which could lead to a decrease in the severity of IGD symptoms in IGD patients with insecure attachment issues. In addition, EAAT increases FC within the affective network, which was associated with attachment not only in healthy adolescents but also in adolescents with IGD.

Balance Deficit and Brain Connectivity in Children with Attention-Deficit/Hyperactivity Disorder.

OBJECTIVE: We aimed to assess disturbances in postural and gait balance and functional connectivity within the brain regions controlling balance in children with attention-deficit/hyperactivity disorder (ADHD). METHODS: Thirteen children with ADHD and 13 age- and sex-matched controls were recruited. Gait balance was assessed by the difference in the center of pressure (COP) between the left and right foot, as well as the difference in plantar pressure between the left and right foot during gait. Neuroimaging data were acquired using a 3.0 Tesla MRI scanner. Functional connectivity between the vermis of the cerebellum and all other brain regionswas assessed. RESULTS: The difference in plantar pressure between the left foot and right foot in the ADHD group was greater than that observed in the control group. The average COP jerk score of the right foot in the ADHD group was higher than that observed in the control group. A higher functional connectivity between the cerebellum and the right middle frontal gyrus (premotor cortex) and medial frontal gyrus (cingulate gyrus) was observed in the control group relative to the ADHD group. In the ADHD group, the difference in plantar pressure between the left and right foot was also negatively correlated with the beta-value within the middle frontal gyrus. CONCLUSION: Children with ADHD had disturbance of balance as assessed by plantar pressure. Decreased brain connectivity from the cerebellum to the premotor cortex and anterior cingulate was associated with disturbances of posture and balance in children with ADHD.

Changes in Gait Balance and Brain Connectivity in Response to Equine-Assisted Activity and Training in Children with Attention Deficit Hyperactivity Disorder.

OBJECTIVES: Equine-assisted activity and training (EAAT) is thought to improve body balance and clinical symptoms in children with attention deficit hyperactivity disorder (ADHD). The study hypostheses were that EAAT would improve the clinical symptoms and gait balance in children with ADHD and that these improvements would be associated with increased brain connectivity within the balance circuit. METHODS: A total of 12 children with ADHD and 12 age- and sex-matched healthy control children were recruited. EAAT consisted of three training sessions, each 70 minutes long, once a week for 4 weeks. Brain functional connectivity was assessed by using functional magnetic resonance imaging. RESULTS: After 4 weeks of EAAT, children with ADHD showed improved scores on the Korean ADHD scale (K-ARS), while the K-ARS scores of healthy children did not change. During the 4 weeks, the plantar pressure difference between the left foot and right foot decreased in both the healthy control group and the ADHD group. After 4 weeks of EAAT, healthy controls showed increased brain connectivity from the cerebellum to the left occipital lingual gyrus, fusiform gyrus, right and left thalami, right caudate, right precentral gyrus, and right superior frontal gyrus. However, children with ADHD showed increased brain connectivity from the cerebellum to the right insular cortex, right middle temporal gyrus, left superior temporal gyrus, and right precentral gyrus. In contrast, children with ADHD exhibited decreased brain connectivity from the cerebellum to the left inferior frontal gyrus. CONCLUSION: EAAT may improve clinical symptoms, gait balance, and brain connectivity, the last of which controls gait balance, in children with ADHD. However, children with ADHD who have deficits in the fronto-cerebellar tract did not exhibit changes in brain connectivity as extensive as those in healthy children in response to EAAT.