Prediction of attention deficit hyperactivity disorder based on explainable artificial intelligence.

Accurate assessment of Attention Deficit Hyperactivity Disorder (ADHD) is crucial for the effective treatment of affected individuals. Traditionally, psychometric tests such as the WISC-IV have been utilized to gather evidence and identify patterns or factors contributing to ADHD diagnosis. However, in recent years, the use of machine learning (ML) models in conjunction with post-hoc eXplainable Artificial Intelligence (XAI) techniques has improved our ability to make precise predictions and provide transparent explanations. The objective of this study is twofold: firstly, to predict the likelihood of an individual receiving an ADHD diagnosis using ML algorithms, and secondly, to offer interpretable insights into the decision-making process of the ML model. The dataset under scrutiny comprises 694 cases collected over the past decade in Spain, including information on age, gender, and WISC-IV test scores. The outcome variable is the professional diagnosis. Diverse ML algorithms representing various learning styles were rigorously evaluated through a stratified 10-fold cross-validation, with performance assessed using key metrics, including accuracy, area under the receiver operating characteristic curve, sensitivity, and specificity. Models were compared using both the full set of initial features and a well-suited wrapper-type feature selection algorithm (Boruta). Following the identification of the most suitable model, Shapley additive values were computed to assign weights to each predictor based on their additive contribution to the outcome and to elucidate the predictions. Strikingly, a reduced set of 8 out of the initial 20 variables produced results comparable to using the full feature set. Among the ML models tested, the Random Forest algorithm outperformed others on most metrics (ACC = 0.90, AUC = 0.94, Sensitivity = 0.91, Specificity = 0.92). Notably, the principal predictors, ranked by importance, included GAI - CPI, WMI, CPI, PSI, VCI, WMI - PSI, PRI, and LN. Individual case examples exhibit variations in predictions depending on unique characteristics, including instances of false positives and negatives. Our ML model adeptly predicted ADHD diagnoses in 90% of cases, with potential for further enhancement by expanding our database. Furthermore, the use of XAI techniques enables the elucidation of salient factors in individual cases, thereby aiding inexperienced professionals in the diagnostic process and facilitating comparison with expert assessments. It is important to note that this tool is designed to support the ADHD diagnostic process, where the medical professional always has the final say in decision-making.

CuentosIE: can a chatbot about "tales with a message" help to teach emotional intelligence?

In this article, we present CuentosIE (TalesEI: chatbot of tales with a message to develop Emotional Intelligence), an educational chatbot on emotions that also provides teachers and psychologists with a tool to monitor their students/patients through indicators and data compiled by CuentosIE. The use of "tales with a message" is justified by their simplicity and easy understanding, thanks to their moral or associated metaphors. The main contributions of CuentosIE are the selection, collection, and classification of a set of highly specialized tales, as well as the provision of tools (searching, reading comprehension, chatting, recommending, and classifying) that are useful for both educating users about emotions and monitoring their emotional development. The preliminary evaluation of the tool has obtained encouraging results, which provides an affirmative answer to the question posed in the title of the article.

The Influence of Emotional Regulation and Cognitive Flexibility on Sleep Habits in Spanish Children and Adolescents through the Lens of Parents.

BACKGROUND: Previous research studies have suggested the importance of studying the relationship between emotional regulation and sleep habits. Some investigations have especially focused on how emotional regulation could impact sleep habits in children and adolescents. Therefore, these researchers have stated there exists a two-way direction in this relationship. OBJECTIVE: This study aimed to analyze the influence of emotional regulation on sleep habits in Spanish children and adolescents and the mediating role of anxiety in this relationship. METHOD: Participants were 953 Spanish parents who completed the assessment protocol according to their children and adolescents' information. RESULTS: The results revealed moderate-strong correlations between emotional regulation problems and sleep habit disturbances (r = 0.375, p < 0.001), trait (r = 0.488, p < 0.001) anxiety, and state (r = 0.589, p < 0.001) anxiety. Additionally, emotional regulation showed a direct impact on sleep habits (ß = 0.011, p = 0.005). Trait and state anxiety demonstrated a significant mediating role in the relationship between emotional regulation and sleep habits. CONCLUSIONS: Emotional regulation may have an impact on sleep habits during childhood and adolescence, suggesting the importance of early intervention focused on the emotions management and the prevention of sleep habit disturbances.

Anxiety, sleep habits and executive function during the COVID-19 pandemic through parents' perception: a longitudinal study.

The present study therefore aims to examine trait and state anxiety, sleep habits and executive functioning during 1 year and a half of the COVID-19 pandemic in children and adolescents through the lens of parents. Assessments were conducted at three different times: April 2020 (T1), October 2020 (T2) and October 2021 (T3). The main sample included 953 children and adolescents aged 6 to 18 years, and scales were used to assess anxiety (STAIC), sleep habits (BEARS) and executive functioning (BRIEF-2). The results showed that 6 months after the outbreak of the pandemic, state and trait anxiety, sleep disturbances and executive dysfunctions increased significantly. One and a half year later, trait anxiety and sleep disturbances have been maintained, while state anxiety and executive dysfunction have decreased their scores obtaining scores similar to those of April 2020. In conclusion, there has been a further decrease in children and adolescents' mental health since the beginning of the pandemic, and it seems to remain at the present time, such as trait anxiety as a part of the personality.

Anxiety, sleep habits and executive function during the COVID-19 pandemic through parents' perception: a longitudinal study

Abstract The present study therefore aims to examine trait and state anxiety, sleep habits and executive functioning during 1 year and a half of the COVID-19 pandemic in children and adolescents through the lens of parents. Assessments were conducted at three different times: April 2020 (T1), October 2020 (T2) and October 2021 (T3). The main sample included 953 children and adolescents aged 6 to 18 years, and scales were used to assess anxiety (STAIC), sleep habits (BEARS) and executive functioning (BRIEF-2). The results showed that 6 months after the outbreak of the pandemic, state and trait anxiety, sleep disturbances and executive dysfunctions increased significantly. One and a half year later, trait anxiety and sleep disturbances have been maintained, while state anxiety and executive dysfunction have decreased their scores obtaining scores similar to those of April 2020. In conclusion, there has been a further decrease in children and adolescents' mental health since the beginning of the pandemic, and it seems to remain at the present time, such as trait anxiety as a part of the personality.

Implications of the Online Teaching Model Derived from the COVID-19 Lockdown Situation for Anxiety and Executive Functioning in Spanish Children and Adolescents.

Given the seriousness of the existing situation regarding the mental health of children and adolescents relating to the confinement period imposed due to COVID-19, we conducted this study to describe the effects of the confinement on state anxiety and executive functioning dimensions in a period of online educational modality. A sample of 953 children and adolescents was assessed. A sociodemographic questionnaire, the State Anxiety Inventory for Children (STAIC), and the Behavioral Evaluation of Executive Function (BRIEF-2) scale were applied. The analysis of the results indicates that 68.8% of children and adolescents presented medium-high levels of anxiety. Regarding sex, females showed higher levels of anxiety and worse levels of executive functioning. Although the group aged 11 to 18 years showed methodologically higher state anxiety (p = 0.041) than the group aged 6 to 10 years, the difference was not clinically relevant (δ = -0.113). The state anxiety variable was also correlated positively and significantly to the three executive functioning dimensions explored. In conclusion, it seems evident that COVID-19 lockdowns could have psychological and emotional effects on children and adolescents.

ADHD Symptomatology, Executive Function and Cognitive Performance Differences between Family Foster Care and Control Group in ADHD-Diagnosed Children.

Children in foster care have a high prevalence of attention deficit and hyperactivity disorder (ADHD) diagnosis, together with other difficulties in inattentive/hyperactive behaviors, executive and cognitive processes. Early exposure to adversity is a risk factor for developing ADHD via neurodevelopmental pathways. The goal of this research is (a) to study the cognitive and executive performance and inattentive/hyperactive behavior of ADHD-diagnosed children living in foster families in Spain, and (b) to analyze the role of placement variables in their performance. The sample was composed of 102 ADHD-diagnosed children aged 6- to 12-years-old, divided into two groups: 59 children living with non-relative foster families and 43 children not involved with protection services. Children's executive function-inhibition, working memory, flexibility, attention, intellectual capacity, verbal comprehension, perceptive reasoning, working memory and processing speed were assessed using objective testing measures. At the same time, parents and teachers reported on children's inattentive, hyperactive and impulsive behaviors. Children in foster care obtained lower scores in the general ability index than the control group after controlling the age at assessment. However, no differences were found in executive processes. Regarding placement factors, children with shorter exposure to adversities in their birth families and more time in foster care showed better executive performance. Professionals should consider the placement history of children in foster care and its influence on their symptomatology and cognitive capacities.

Movement Patterns in Students Diagnosed with ADHD, Objective Measurement in a Natural Learning Environment.

Attention deficit hyperactivity disorder is the most common neuropsychological disorder in childhood and adolescence, affecting the basic psychological processes involved in learning, social adaptation and affective adjustment. From previous research, the disorder is linked to problems in different areas of development, with deficiencies in psychological processes leading to the development of the most common characteristics of the disorder such as inattention, excess of activity and lack of inhibitory control. As for the diagnosis, in spite of being a very frequent disorder, there are multiple controversies about which tools are the most suitable for evaluation. One of the most widespread tools in the professional field is behavior inventories such as the Strengths and Difficulties Questionnaires for Parents and Teachers or the ADHD Rating Scale-V. The main disadvantage of these assessment tools is that they do not provide an objective observation. For this reason, there are different studies focused on recording objective measures of the subjects' movement, since hyperkinesia is one of the most characteristic symptoms of this disorder. In this sense, we have developed an application that, using a Kinect device, is capable of measuring the movement of the different parts of the body of up to six subjects in the classroom, being a natural context for the student. The main objective of this work is twofold, on the one hand, to investigate whether there are correlations between excessive movement and high scores in the inventories for the diagnosis of ADHD, Rating Scale-V and Strengths and Difficulties Questionnaire (SDQ) and, on the other hand, to determine which sections of the body present the most significant mobility in subjects diagnosed with ADHD. Results show that the control group, composed of neurotypical subjects, presents less kinaesthetic activity than the clinical group diagnosed with ADHD. This indicates that the experimental group presents one of the main characteristics of the disorder. In addition, results also show that practically all the measured body parts present significant differences, being higher in the clinical group, highlighting the head as the joint with the highest effect size.

Consequences of COVID-19 Confinement on Anxiety, Sleep and Executive Functions of Children and Adolescents in Spain.

Children and adolescents are not indifferent to the dramatic impact of the COVID-19 pandemic, and the need to be forced to live in confinement. The change in life to which they have been abruptly subjected forces us to understand the state of their mental health in order to adequately address both their present and future needs. The present study was carried out with the intention of studying the consequences of confinement on anxiety, sleep routines and executive functioning of 1,028 children and adolescents, aged from 6 to 18 years, residing in Spain to; assess if there are differences regarding these consequences in terms of sex and age; how anxiety affects executive functioning in males and females; and to examine the possible correlations between the measured variables. For this purpose, an online questionnaire containing five sections was designed: the first section gathers information on sociodemographic and health data, while the following sections gather information from different standardized scales which measure anxiety, sleep and executive functions, whose items were adapted in order to be completed by parents, and/or legal guardians. The statistical analyzes carried out highlights significant differences in executive functioning between males and females. In turn, in regards to age, greater difficulties were detected in anxiety in the 9 to 12 age group and greater sleep disturbances between 13 and 18 year olds. On the other hand, significant differences were found in intra-sexual executive functioning depending on whether they presented greater or lesser anxiety, with executive functioning being more tendentiously maladjusted in males than in females, revealing a significantly relevant effect size (p = 0.001; ω2 = 0.27 BRIEF-2; ω2 = 0.19 BDEFS-CA; 95%). Positive correlations are obtained between state anxiety and sleep and executive functioning alterations. Finally, through Path Analysis, it is verified that state anxiety is the variable with the greatest weight within the model that would explain the alteration in the executive functioning of the present sample.

Detection of Executive Performance Profiles Using the ENFEN Battery in Children Diagnosed With Attention-Deficit Hyperactivity Disorder.

Attention-deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in children and adolescents. People who have this disorder are characterized by presenting difficulties in the processes of sustained attention, being very active, and having poor control of their impulses. Despite the high prevalence of this disorder and the existence of various tests used for its diagnosis, few data are available regarding the usefulness and diagnostic validity of these tools. Given the difficulties that these subjects present in executive functions, the aim of this study was to evaluate whether the Neuropsychological Assessment of Executive Functions battery for Children (ENFEN, for its acronym in Spanish, Portellano et al., 2009) allows to establish specific profiles of executive performance for people with attention-deficit hyperactivity disorder (ADHD). The sample was made up of 197 participants of both sexes, aged between 6 and 12 years age (134 with a clinical diagnosis and 63 without pathology). A nonexperimental design was followed, using a comparative descriptive study method. The results indicated that the scales of phonological fluency, color path, rings, and interference are the most associated with the diagnosis of ADHD, providing data on inhibition, mental flexibility, sustained and selective attention, planning, verbal fluency, and working memory, among others. The practical implication of these results is in line with providing support in the clinical diagnosis that is carried out in children's mental health units. In addition, the ENFEN tool can be valued as a suitable psychometric instrument in the psychoeducational field, helping professionals in a school environment to be more aware of the areas of cognitive development in which a student diagnosed with ADHD will have more difficulties and, in doing so, providing more adjusted and effective psychopedagogical measures when it comes to supporting students in their adaptation to the school environment.

Early detection of learning difficulties using the BADyG-E2r Battery during primary education.

The aim of the present study was to assess the predictive capacity of several of the most relevant cognitive skills in the academic field that were evaluated using Differential and General Skills Battery(BADyG-E2r). Particular attention was focused on the variables that need to be overcome regarding the curricular objectives related to pass/fail grading as evaluated by the teachers in the instrumental disciplines of Mathematics and Language. The psychometric battery was applied to the 3rd year students in primary education (a total of 512 students) at 4 public schools that were randomly selected in the province of Alicante (Spain). A follow-up of their academic evolution was under taken until the end of primary education. The obtained results show that high scores in Verbal Reasoning, Numerical Reasoning, and Verbal Syllogisms positively and significantly predict academic success at the end of primary education in the subjects of Language and Mathematics.

Memoria de trabajo y velocidad de procesamiento evaluado mediante WISC-IV como claves en la evaluación del TDAH / Work memory and processing speed evaluated through WISC-IV as keys in the evaluation of ADHD

Los procesos cognitivos medidos mediante la prueba WISC-IV que con más frecuencia se han relacionado con el TDAH son la memoria de trabajo y la velocidad de procesamiento. Sin embargo, existe controversia sobre la existencia de un perfil cognitivo para el TDAH según su presentación sea inatenta o combinada. El primer objetivo fue corroborar si existen para nuestra muestra correlaciones entre el perfil cognitivo obtenido a través del WISC-IV. El segundo, discernir entre las diferentes presentaciones clínicas. Para ello se seleccionó un grupo control compuesto por 31 sujetos y otro clínico compuesto por 95 sujetos diagnosticados de TDAH. En comparación con el grupo control, el grupo clínico presentó resultados significativamente más bajos en los índices coeficiente intelectual total, memoria de trabajo y velocidad de procesamiento. Por otra parte, el grupo clínico presentó puntuaciones en el índice de capacidad general significativamente superior a las del índice de competencia cognitiva

The cognitive processes that are measured by the scale WISC-IV, which has most often been related to ADHD, Working Memory and Processing Speed. However, there is some controversy concerning the existence of a cognitive profile for ADHD that is related to whether its presentation is of the inattentive type or the combined type. The primary aim of this study was to corroborate whether there are correlations between the cognitive profile obtained through WISC-IV for our sample. The secondary aim of this study was to determine whether that profile allows to discern between the different clinical presentations by using a control group composed of 31 subjects and a clinical group consisting of 95 subjects diagnosed with ADHD. Compared to the control group, the clinical group presented significantly lower results in Intelligence Quotient, Working Memory Index and Processing speed Index. Finally, the clinical group presented scores for the General Capacity Index that were significantly higher than for the Cognitive Competency Index

Early Detection of Academic Performance During Primary Education Using the Spanish Primary School Aptitude Test (AEI) Battery.

The aim of this study was to assess the predictive capacity of some of the most relevant cognitive skills pertaining to the academic field as measured by the Spanish Primary School Aptitude Test Battery. This psychometric tool was applied to all students who were enrolled in the final year of Early Childhood Education (631 students) in the public schools of the province of Alicante (in the South-East of Spain) and a follow-up of their academic progress was carried out when they completed Primary Education (6 school years). The results obtained show that medium-high and high scores in Verbal Aptitude and Numerical Aptitude tests in Early Childhood Education (5 years of age), can predict academic success at the end of Primary Education (12 years of age) in instrumental subjects such as: (1) Language (Verbal Aptitude Odds Ratio = 1.39 and Numerical Aptitude Odds Ratio = 1.39) and (2) Mathematics (Verbal Aptitude Odds Ratio = 1.47 and Numerical Aptitude Odds Ratio = 1.52). We have determined the importance of developing pedagogical programs that stimulate the development of these skills during Early Childhood Education, while implementing support strategies during Primary Education, for those students who present underdeveloped aptitudes in these areas. In this way, school difficulties would be prevented in the instrumental subjects that provide access to other academic areas.

Predictive capacity of the Spanish Neuropsychological Assessment of Executive Functions Battery when diagnosing child ADHD / Capacidad predictiva de la Batería ENFEN en el diagnóstico del Trastorno por Déficit de Atención e Hiperactividad

Abstract Attention deficit hyperactivity disorder (ADHD) is considered to be one of the most common disorders during children and adolescents' neurodevelopment. Given how much the individuals executive functions are affected, the objective of the present study was to verify the validity of the Neuropsychological Assessment of Executive Functions battery for Children (ENFEN for its acronym in Spanish) as a predictor in the diagnosis of ADHD. The sample consisted of 175 participants from southeast Spain of both sexes aged between 6 and 12 (clinical M=8.39, SD=1.87, and control M=8.78, SD=1.91). The clinical group was composed of 89 (79.50%) males and 23 (20.50%) females, and the control group consisted of 37 (58.70%) males and 26 (41.30%) females. ENFEN is an individual applications battery that allows the executive functions to be globally evaluated using a wide range of elements. We followed a non-experimental research design for this comparative descriptive study. The results indicate that the phonological fluency, colour naming path, and interference scales are closely associated with the diagnosis of ADHD as they provide data on elements including inhibition, mental flexibility, sustained and selective attention, verbal fluency, and working memory. In general, this study supports the usefulness and validity of the ENFEN battery as a tool to clinically diagnose ADHD.

Resumen El trastorno por déficit de atención en hiperactividad (TDAH) es uno de los trastornos más frecuentes en el neurodesarrollo de niños y adolescentes. Las personas que lo padecen se caracterizan por presentar dificultades en los procesos de atención sostenida, ser muy activos y tener un deficiente control de sus impulsos. Pese a su elevada prevalencia y la existencia de diversas pruebas utilizadas para su diagnóstico, se conocen pocos datos sobre la utilidad y validez diagnóstica de estas herramientas. Dada la gran afectación que estos sujetos presentan en las funciones ejecutivas, el objetivo de este estudio es comprobar la utilidad y validez de la batería de Evaluación Neuropsicológica de las Funciones Ejecutivas en Niños (ENFEN), como predictora herramienta de apoyo al diagnóstico de TDAH. La muestra de estudio estuvo compuesta por 175 participantes de ambos sexos, con edades comprendidas entre los 6 y 12 años (grupo clínico M=8.39, SD=1.87 y grupo control M=8.78, SD=1.91). El grupo clínico estaba compuesto por 89 (79.50%) hombres y 23 (20,50%) mujeres, y el grupo de control por 37 (58,70%) hombres y 26 (41,30%) mujeres. ENFEN es una batería de aplicación individual, compuesta por varias subpruebas que requieren el empleo de funciones ejecutivas para resolver los elementos que las componen. Se siguió un diseño no-experimental para llevar a cabo un estudio descriptivo comparativo. Los resultados señalaron que las escalas Fluidez Fonológica, Sendero Color e Interferencia que requieren en mayor medida inhibición, flexibilidad mental, atención sostenida y selectiva, fluidez verbal y memoria de trabajo, entre otras aptitudes cognitivas, son las que mejor se asocian al diagnóstico de TDAH. En general, este estudio apoya la utilidad y validez de la prueba ENFEN como herramienta para el diagnóstico clínico del TDAH.