Comparison of change detection performance and visual search patterns among children with/without ADHD: Evidence from eye movements

BackgroundADHD participants showed poorer change detection performance compared to participants without any diagnosis. The difficulty to detect changes in ADHD children might be due to their voluntary eye movement control and attentional deficits.AimsTo evaluate change detection performance and visual search patterns of children with ADHD and compare their performances with typically developing (TD) children.Methods and procedures48 children (n_ADHD = 24, n_TD = 24) participated (M_age = 8 years, 10 months). Flicker paradigm was used to evaluate change detection performance, while eye movements were recorded during the experiment.ResultsChange detection accuracies of TD children were higher compared to ADHD children. TD groups made longer fixations on the changed area and their first fixation duration was also longer than ADHD children which showed that TD children had longer fixation maintenance than ADHD children.ConclusionsThe change detection performance, which is associated with visual attention and memory, was found to be worse in ADHD children than TD children and these children made shorter fixations on the changed area than TD children. The findings were found to be in line with the difficulty to sustain attention in ADHD children that is necessary for encoding the scene properties and goal-oriented behavior.     

Rett syndrome: an eye‐tracking study of attention and recognition memory

Aim

The aim of this study was to examine attention and recognition memory for faces and patterns in Rett syndrome, a severely disabling neurodevelopmental disorder caused by mutations in the X‐linked MECP2 gene.

Method

Because Rett syndrome impairs speech and hand use, precluding most neuropsychological testing, the visual paired‐comparison paradigm (VPC) was used, together with eye tracking. In the VPC, two identical stimuli are presented for familiarization. On test, the familiar stimulus and a new one are paired, and recognition inferred from preferential looking to the novel target. Attention is measured by looking time, gaze dispersion, and number/length of fixations. Twenty‐seven female patients with Rett syndrome (mean age 10y 6mo; SD 6y 8mo, age range 2–22y) from the Rett clinic at a children's hospital were assessed in this study, along with 30 age‐ and sex‐matched typically developing participants (outpatients from the same hospital).

Results

Although patients with Rett syndrome showed recognition of both faces and patterns, with novelty scores greater than chance (50%), their performance was significantly poorer than that of the typically developing comparison group. Their attention to both was less mature and marked by a more narrowly focused gaze, with fewer and longer fixations. When inspecting faces, attention to the eyes was similar in both groups; however, patients with Rett syndrome tended to ignore the nose and mouth.

Interpretation

This is one of the first studies to characterize attention and memory in individuals with Rett syndrome. Visually based techniques, such as the VPC, open a new avenue for quantifying the cognitive phenotype associated with this syndrome.     

Children with down syndrome and sleep disordered breathing display impairments in ventilatory control

ObjectivesTo investigate the role of ventilatory control instability (i.e. loop gain) in children with Down syndrome and sleep disordered breathing.MethodsChildren (3–19 years) with Down syndrome and sleep disordered breathing (n = 14) were compared with typically developing children (n = 14) matched for age, sex and sleep disordered breathing severity. All children underwent overnight polysomnography. Spontaneous sighs were identified and a 180s analysis window (60s pre-sigh to 120s post-sigh) containing flow measurements and oxygen saturation were created. Loop gain, a measure of the sensitivity of the negative feedback loop that controls ventilation, was estimated by fitting a mathematical model of ventilatory control to the post-sigh ventilatory pattern.Results; Loop gain was significantly higher in children with Down syndrome compared to matched typically developing children (median loop gain [interquartile range]: 0.36 [0.33, 0.55] vs 0.32 [0.24, 0.38]; P = 0.0395). While children with Down syndrome also had significantly lower average oxygen saturation associated within each analysis window compared to typically developing children (mean ± standard deviation: 96.9 ± 1.3% vs 98.0 ± 1.0%; P = 0.0155), loop gain was not related to polysomnographic measures of hypoxia.ConclusionsHigher loop gain in children with Down syndrome and sleep disordered breathing indicates that these children have more unstable ventilatory control, compared to age, sex and sleep disordered breathing severity matched typically developing children. This may be due to an inherent impairment in ventilatory control in children with Down syndrome contributing to their increased risk of sleep disordered breathing which may inform alternative treatment options for this population.     

Cognitive-motor interference during fine and gross motor tasks in children with Developmental Coordination Disorder (DCD)

BackgroundWhile typically developing children produce relatively automatized postural control processes, children with DCD seem to exhibit an automatization deficit. Dual tasks with various cognitive loads seem to be an effective way to assess the automatic deficit hypothesis.AimsThe aims of the study were: (1) to examine the effect of a concurrent cognitive task on fine and gross motor tasks in children with DCD, and (2) to determine whether the effect varied with different difficulty levels of the concurrent task.Methods and proceduresWe examined dual-task performance (Trail-Making-Test, Trail-Walking-Test) in 20 children with DCD and 39 typically developing children. Based on the idea of the Trail-Making-Test, participants walked along a fixed pathway, following a prescribed path, delineated by target markers of (1) increasing sequential numbers, and (2) increasing sequential numbers and letters. The motor and cognitive dual-task effects (DTE) were calculated for each task.ResultsRegardless of the cognitive task, children with DCD performed equally well in fine and gross motor tasks, and were slower in the dual task conditions than under single task-conditions, compared with children without DCD. Increased cognitive task complexity resulted in slow trail walking as well as slower trail tracing. The motor interference for the gross motor tasks was least for the simplest conditions and greatest for the complex conditions and was more pronounced in children with DCD. Cognitive interference was low irrespective of the motor task.Conclusions and implicationsChildren with DCD show a different approach to allocation of cognitive resources, and have difficulties making motor skills automatic. The latter notion is consistent with impaired cerebellar function and the “automatization deficit hypothesis”, suggesting that any deficit in the automatization process will appear if conscious monitoring of the motor skill is made more difficult by integrating another task requiring attentional resources.     

The effect of emotional intensity on responses to joint attention in preschoolers with an autism spectrum disorder

BackgroundResponding to joint attention (RJA) is reduced in young children with ASD despite being vital to the early development of social communication. For this reason, RJA is a frequent target in early intervention programs. Clinical guidelines suggest that exaggerating facial expressions or gestural pointing may improve RJA in children with autism by clarifying the meaning of the gaze or gesture. In the current study, we investigate the effect of intensity of emotional expression on RJA in preschoolers with ASD.MethodTwenty-five preschoolers with ASD and 21 typically developing peers were administered a specifically designed eye-tracking task in which an actor directs attention to a moving object by looking at it with an expression that was either neutral, mildly surprised or intensely surprised. In a supplementary condition, gestural pointing was accompanied by a neutral gaze shift.ResultsCommensurate with previous studies, children with ASD oriented less to the face of the actor and were less responsive to RJA when compared to their typically developing peers. However, children with autism differed in their response to RJA according to the different task conditions. They demonstrated more frequent responses to RJA when the actor’s facial expression was either intense or supported by gestural pointing.ConclusionsWe report initial evidence for the importance of clarifying content cues in order to help preschoolers with autism adhere to receptive joint attention (RJA) opportunities. Our findings inform knowledge about early treatment and attention to emotional expressions in autism and improve our understanding of how early interventions may work to increase RJA in young children with ASD.     

Contributing to the early detection of Rett syndrome: the potential role of auditory Gestalt perception

To assess whether there are qualitatively deviant characteristics in the early vocalizations of children with Rett syndrome, we had 400 native Austrian-German speakers listen to audio recordings of vocalizations from typically developing girls and girls with Rett syndrome. The audio recordings were rated as (a) inconspicuous, (b) conspicuous or (c) not able to decide between (a) and (b). The results showed that participants were accurate in differentiating the vocalizations of typically developing children compared to children with Rett syndrome. However, the accuracy for rating verbal behaviors was dependent on the type of vocalization with greater accuracy for canonical babbling compared to cooing vocalizations. The results suggest a potential role for the use of rating child vocalizations for early detection of Rett syndrome. This is important because clinical criteria related to speech and language development remain important for early identification of Rett syndrome.     

Modulation of attention by socio-emotional scenes in children with autism spectrum disorder

BackgroundAbnormal attentional processes to socially relevant information may underlie social impairment in Autism Spectrum Disorder (ASD). To examine how these processes are modulated by the emotional salience of the stimuli, we studied the attentional biases to social scenes (happy, sad, and threatening) in ASD children.MethodAn emotional dot-probe task was applied to children (from 6 to 12 years old) with Autism Spectrum Disorder without additional language and/or intellectual impairments (ASD; n = 25) and age/sex-matched controls (n = 25).ResultsASD children showed an attentional bias toward threatening scenes while typically developing children tended to direct their attention toward sad scenes. There were no differences between groups for happy scenes.ConclusionsThreatening situations captured greater attention in ASD individuals than in the control participants. Thus, abnormal attention to emotionally relevant situations may negatively affect the ability of ASD children to adapt cognitively and emotionally, particularly in threatening situations.     

Differences in autonomic functions as related to induced stress between children with and without cerebral palsy while performing a virtual meal-making task

BackgroundEfforts to improve the participation and performance of children with cerebral palsy (CP) are often related to the adaptation of environmental conditions to meet their cognitive and motor abilities. However, the influence of affective stimuli within the environment on emotion and performance, and their ability to improve or impede the children's participation has not been investigated in any systematic way although the emerging evidence suggests that it affects the individuals in many levels.Objectives(1) To measure autonomic responses to affective stimuli during a simulated Meal-Maker task in children with CP in comparison to children who are typically developing, and (2) to examine the interactions between autonomic functions, subjective reports of stress, and task performance among children with and without CP.MethodsFifteen children with CP and 19 typically developing peers (6 to 12 years) participated. After completing behavioral questionnaires (e.g., State and Trait Anxiety Inventories), children prepared meals within a camera tracking virtual Meal-Maker environment. Either a negative, positive, or neutral visual stimulus was displayed, selected from the International Affective Picture System. Children also passively viewed the same pictures while rating their valence and arousal levels. Heart rate (HR) and skin conductance were recorded synchronously with stimulus onset.ResultsSignificant differences in autonomic functions were found between groups, i.e., a higher “low frequency” to “high frequency” (LF:HF) ratio in the children with CP during the meals associated with a negative stimulus (p = 0.011). Only children with CP had significant positive correlations between trait anxiety and LF:HF ratio during virtual meal-making associated with positive (p = 0.049) and negative stimuli (p = 0.003) but not during neutral stimuli. For children with CP the amplitude of skin conductance response during passive picture viewing was significantly higher for negative than for positive stimuli (p = 0.017) but there were no significant changes in autonomic responses during virtual Meal-Maker task.Significant correlations between trait anxiety, autonomic activity during the calm state and Meal-Maker performance outcomes were found only for children with CP.ConclusionsIn general, the Meal-Maker virtual environment was shown to be a feasible platform for the investigation of the effect of emotionally loaded stimuli on the balance of autonomic functions in children with and without CP. Anxiety level appears to play a significant role in children with CP and should be considered as a potentially important factor during clinical evaluation and intervention. Further studies are needed to develop additional measurements of emotional responses and to refine the types of affective interference.     

Three physiological responses in fathers and non-fathers’ to vocalizations of typically developing infants and infants with Autism Spectrum Disorder

Children with ASD, even before receiving a formal diagnosis, express atypical patterns of distress vocalizations (namely, episodes of crying). Their cries have higher fundamental frequencies, shorter inter-bout pauses, and fewer utterances. Cries of children with ASD are also perceived differently from other cries, and these perceptual differences may alter parent–infant interaction. This study assessed multiple physiological responses in fathers and non-fathers to atypical distress vocalizations (cries of children with ASD), acoustically matched typical distress vocalizations (cries of typically developing children), and positive vocalizations (laughter of typically developing children). The experimental procedures were designed to measure how components of the autonomic nervous system respond to typical and atypical infant vocalizations. Three convergent methodologies (Galvanic Skin Response—GSR; cardiac dynamics via Inter-Beat Interval—IBI; right hand temperature change—RHTC) were performed on two groups with contrasting caregiving experience: fathers of typically developing children (n = 10) and non-fathers (n = 10). Inferential statistical analysis compared the two groups (fathers, non-fathers) and three stimulus types (ASD cry, typical cry, laughter) for the three measures (GSR, IBI, RHTC). Both fathers and non-fathers showed greater negative responses (increased GSR) to ASD cries compared to typical cries and laughter. Fathers showed higher IBI and greater temperature increases (RHTC) than non-fathers while listening to typical and atypical cries. Fathers and non-fathers showed more emotional arousal mediated by sympathetic activation while listening to cries of children with ASD. Fathers were calmer and acted more promptly than non-fathers while listening to typical cries, perhaps because the fathers had more experience in caring for crying infants. These findings point to similarities and differences in fathers’ and non-fathers’ physiological responsiveness to cries of children with ASD and might guide specific intervention programs for parents of children at risk of ASD.     

Patterns of gaze behavior during an eye-tracking measure of joint attention in typically developing children and children with autism spectrum disorder

This study evaluated whether diagnostic classifications or features of ASD were associated with individual differences in children's gaze pattern during an eye-tracking measure of joint attention. The sample included 21 children with ASD (mean age, 7.3 ± 1.5 years) and 24 typically developing children (mean age, 6.8 ± 1.6 years), matched on receptive language abilities. Results revealed no significant group differences on global measures of gaze allocation (total gaze time allocation). However, significant group differences emerged using a measure evaluating a microstructure of children's gaze (duration of first fixation). In addition, individual differences in children's gaze pattern were reliably predicted by parent report measures of children's social abilities. The majority of children in this sample (including all typically developing children and those children with ASD who scored lowest on the SRS Social Awareness subscale) showed significant modulation in eye-gaze between the two experimental conditions. In contrast, children with ASD who also scored the highest on the SRS Social Awareness subscale consistently failed to modulate their eye gaze in accordance with the experimental condition. This failure to flexibly modulate gaze in the context of a joint attention eye-tracking paradigm may reveal children's limited awareness of social cues that may further limit social learning.     

Atención sostenida en niños con hipotiroidismo congénito en edad escolar. Influencia de los episodios de sobretratamiento en los primeros 3 años de vida

IntroductionChildren with congenital hypothyroidism (CH) are at risk of developing mild cognitive impairment despite normal overall intellectual performance. These deficits may be caused by disease-related and treatment-related factors. This study explores the impact of abnormal thyroid function during the first 3 years of life on attention performance at school age.MethodsWe included 49 children diagnosed with CH and receiving treatment for the condition: 14 boys (mean age 9.5 ± 2.8 years) and 35 girls (9.6 ± 2.6 years). The number of episodes of normal, under-, and overtreatment were estimated based on TSH levels during their first 3 years of life (at 12, 18, 24, 30, and 36 months). Children were assessed using a computerised version of a Sustained attention test. General linear models were calculated with the attention index as the dependent variable and sex, aetiology, and number of episodes of normal, under-, and overtreatment as independent variables.ResultsHigher numbers of episodes of overtreatment (low TSH level) were associated with poorer attention performance at school age (P = .005, r = –0.45).ConclusionsChildren with CH should be monitored closely during the first 3 years of life in order to prevent not only hypothyroidism but also any adverse effects of overtreatment that may affect attentional function at school age.     

Refixation saccades and attention in schizophrenia

Saccadic refixation eye movements of 20 schizophrenic, 20 hospitalized nonpsychotic, and 20 normal subjects were compared in two repetitive fixation tasks with high and low target information. Although no differences emerged among groups in the overall frequency or size of saccades, the average and peak velocity of saccades was slower for schizophrenics than for normals. The velocity of saccades for the hospitalized nonpsychotic group was between that of schizophrenics and normals. To evaluate this finding further, saccades in the first two stimulus cycles were examined. The average and peak velocity of saccades was found to be significantly slower for schizophrenics than for normals. Again, the velocity of saccades for hospitalized nonpsychotic subjects was between that of schizophrenics and normals. Moreover, the size of saccades during the first two cycles was smaller for the schizophrenic than for other subject groups. Embedded alphanumeric information in the fixation target generally resulted in increased velocity of saccades for all subjects. The results were interpreted as evidence for an attentional deficit in schizophrenia. Specifically, schizophrenic subjects appeared to be less able to utilize peripheral visual information than hospitalized or normal subjects.     

Attentional network deficits in children with autism spectrum disorder

Statement of purpose: Individuals with autism spectrum disorder (ASD) often demonstrate deficient attentional ability, but the specific nature of the deficit is unclear. The Attention Networks model provides a useful approach to deconstruct this attentional deficit into its component parts. Method: Fifty-two neurotypical (NT) children and 14 children with ASD performed the child version of the Attention Network Test (ANT). The latter requires participants to indicate the direction of a centre target stimulus, which is presented above/below fixation and sometimes flanked by either congruent or incongruent distractor stimuli. Results: Relative to NT children, those with ASD were: (1) slower to react to spatially cued trials and (2) more error prone on executive (conflict) attention trials. Conclusions: Young children with ASD have intact alerting attention, but less-efficient orienting and executive attention.     

Utilitarian Attention by Children with Autism Spectrum Disorder on a Filtering Task

The findings are evidence that persons with ASD benefit more than typically developing (TD) persons from spatial framing cues in focusing their attention on a visual target. Participants were administered a forced-choice task to assess visual filtering. A target stimulus was presented on a screen and flanker stimuli were presented simultaneously with or after the target, with varying stimuli onset asynchronies (SOAs). Regardless of SOA, TD children showed the expected distracting effects with slower reaction times (RTs) when flankers were at closer distances from the target. However, children with ASD displayed shorter RTs in the conditions in which the stimuli were presented simultaneously or with a short SOA. These findings are interpreted as reflecting utilitarian attention among children with ASD.     

Brief report: Attention patterns to non-social stimuli and associations with sensory features in autistic children

BackgroundAberrant attention patterns have been commonly reported in autistic children. However, few studies have examined attention to non-social stimuli varying in salience and complexity using eye-tracking technology, as well as their links to clinical sensory features.MethodForty-one children [16 with autism spectrum disorder (ASD), 10 with developmental delay (DD), and 15 neurotypical (NT)] ages 4 to 13 years were included in this cross-sectional study. Children completed a passive-viewing eye-tracking task designed to measure visual attention (e.g., fixation duration and count) to non-social stimuli with sensory qualities involving motion (spinning or non-spinning) and sound. Parents completed a clinical questionnaire about their child’s sensory behaviors. Eye-tracking metrics were compared across stimulus conditions and diagnostic groups, and their associations with parent-report sensory features were examined.ResultsOverall children showed longer fixation durations and fewer fixation counts to more complex stimuli (e.g., moving or spinning objects), but such facilitatory effects of stimulus properties tended to be less evident in DD versus ASD or NT groups. More clinical sensory features, especially hyperresponsiveness, were moderately to highly associated with quicker initial fixations and longer fixation durations across stimulus conditions in ASD, but not in DD and NT groups.ConclusionThe overall attention and initial orientation to non-social stimuli were comparable across autistic children and their non-autistic peers, with some sensory properties such as dynamic motion producing a facilitatory effect (i.e., fewer fixations of longer durations) on attention. However, sensory differences, particularly hyperresponsiveness, might underlie attention patterns as impacted by stimulus properties specifically in autism.     

Attention Deficit Hyperactivity Disorder in Adolescents With Epilepsy

BackgroundWe examined attention-deficit hyperactivity disorder in adolescents with epilepsy and the association with seizure-related and sociodemographic variables.MethodsStrengths and Weakness of Attention-Deficit Hyperactivity Disorder Symptoms and Normal Behaviors rating scale was administered to 122 children with epilepsy and 50 children with asthma, aged 10 to 18 years attending mainstream schools.ResultsTwenty-nine (23.7%) adolescents with epilepsy compared with five (10%) with asthma had attention deficit hyperactivity disorder (P = 0.037). Adolescents with epilepsy had a significantly higher score in the inattention subscale when compared with those with asthma (−0.25 ± 1.2 vs −0.64 ± 1.07, P = 0.049). Combined subtype was most frequent in the epilepsy group. Oppositional defiant disorders were more prevalent in those having attention deficit hyperactivity disorder. Psychiatric assistance had only been provided to one third of our patients with epilepsy and attention deficit hyperactivity disorder at the time of study. There was a negative correlation between attention deficit hyperactivity disorder scores and age of seizure onset. A positive correlation was observed between the number of antiepileptic drugs and the inattentive subscale score. The impact of various correlates on individual subtypes was not identical. Independent risk factors associated with attention deficit hyperactivity disorder were medical comorbidities (odds ratio = 12.82, 95% confidence interval 4.44, 37.03, P < 0.0001) and age at seizure onset (odds ratio = 0.73, 95% confidence interval 0.56, 0.94, P = 0.016).ConclusionsAttention deficit hyperactivity disorder is overrepresented in adolescents with epilepsy; screening for its symptoms should be an integral part of management in adolescents with epilepsy.     

Pubertal Development in Rett Syndrome Deviates From Typical Females

BackgroundRett syndrome is a unique neurodevelopmental disorder, affecting approximately one in 10,000 live female births, most experiencing reduced growth. We characterized pubertal trajectories in females with Rett syndrome. We hypothesized that pubertal trajectory deviates from the general female population with early pubertal onset and delayed menarche.MethodsParticipants were individuals enrolled in the Rett Syndrome Natural History Study with clinical diagnosis of Rett syndrome or mutations in MECP2. Intervals to thelarche, adrenarche, and menarche were assessed by survival analysis; body mass index, mutation type, clinical severity, and pubertal milestone relationships were assessed by log-likelihood test; pathway synchrony (relationship between thelarche, adrenarche, and menarche) was assessed by chi-squared analysis.ResultsCompared with the general female population, more than 25% initiated puberty early, yet entered menarche later (median age 13.0 years). A total of 19% experienced delayed menarche. Median length of puberty, from thelarche to menarche, was 3.9 years. Higher body mass index correlated with earlier thelarche and adrenarche but not menarche; milder mutations correlated with earlier menarche; and milder clinical presentation correlated with earlier thelarche and menarche. Fifty-two percent entered puberty in synchrony, but different from the general population, 15% led with thelarche and 32% with adrenarche.ConclusionsPubertal trajectories in Rett syndrome differ from general population, entering puberty early and reaching menarche later. Body mass index affects pubertal timing, but the relationship between specific mutations, clinical presentation, and underlying neuroendocrine pathology is less clear.     

Facial emotion recognition in children with or without Attention Deficit/Hyperactivity Disorder: Impact of comorbidity

ObjectivesThis study sought to assess facial emotion recognition deficit in children with Attention Deficit/Hyperactivity Disorder (ADHD) and to test the hypothesis that it is increased by comorbid features.MethodForty children diagnosed with ADHD were compared with 40 typically developing children, all aged from 7 to 11 years old, on a computerized facial emotion recognition task (based on the Pictures of Facial Affect). Data from parents’ ratings of ADHD and comorbid symptoms (on the Conners’ Revised Parent Rating Scale) were also collected.ResultsChildren with ADHD had significantly fewer correct answer scores than typically developing controls on the emotional task while they performed similarly on the control task. Recognition of sadness was especially impaired in children with ADHD. While ADHD symptoms were slightly related to facial emotion recognition deficit, oppositional symptoms were related to a decrease in the number of correct answers on sadness and surprise recognition.ConclusionFacial emotion recognition deficit in children with ADHD might be related to an impaired emotional process during childhood. Moreover, Oppositional Defiant Disorder seems to be a risk factor for difficulties in emotion recognition especially in children with ADHD.