Deficits in the covert orienting of attention in children with Developmental Coordination Disorder: Does severity of DCD count?

Children with Developmental Coordination Disorder (DCD) show deficits in the covert orienting of visuospatial attention, suggesting an underlying issue in attentional disengagement and/or inhibitory control. However, an important theoretical issue that remains unclear is whether the pattern of deficits varies with DCD severity. Fifty-one children with moderate DCD (MDCD), 24 children with severe DCD (SDCD), and 38 typically developing (TD) children participated in the study. Their performance was compared on the covert orienting of visuospatial attention task (COVAT), specifically the voluntary control mode. Results showed that the pattern of performance differed between groups. At a short stimulus-response asynchrony (350 ms), the difference in response times for validly and invalidly cued trials was similar for all three groups. However, at the longer SOA (800 ms), both DCD groups continued to show a relative disadvantage for responses that followed invalid cues. This suggests that a deficit in response inhibition and/or attentional disengagement is manifest in children with both moderate and severe DCD. The implications of these findings for theory and treatment are discussed.     

Orienting of spatial attention in Huntington's Disease

To explore the functioning of spatial attention in Huntington's Disease (HD), 14 HD patients and 14 age-matched controls performed a cued response time (RT) task with peripheral cues. In Experiment 1, cues were not informative about the future target location, thus eliciting a purely exogenous orienting of attention. At short stimulus-onset asynchrony (SOA), controls showed an initial facilitation for cued locations, later replaced by a cost (inhibition of return, IOR). Patients had a larger and more persistent validity effect, with delayed IOR, resulting from a larger cost for uncued targets. This suggests an impairment of attentional disengaging from cued locations. In Experiment 2, 80% of the cues were valid, thus inducing an initially exogenous, and later endogenous, attentional shift towards the cued box. The validity effect was larger in patients than in controls, again as a result of a disproportionate cost for uncued targets. In Experiment 3, 80% of the cues were invalid, thus inviting participants to endogenously re-orient attention towards the uncued box. Patients could take advantage of invalid cues to re-orient their attention towards the uncued targets but at a longer SOA than controls, thus suggesting that endogenous orienting is preserved in HD, but slowed down by the disengage deficit. The disengage deficit correlated with several radiological and biological markers of HD, thus suggesting a causal relationship between HD and attentional impairments. Cued RT tasks are promising tools for the clinical monitoring of HD and of its potential treatments.     

Covert orienting to exogenous and endogenous cues in children with spina bifida

Children with spina bifida meningomyelocele and hydrocephalus (SBM) have congenital dysmorphology of the midbrain and thinning of the posterior cortex, brain regions associated with the control of covert orienting. We studied cued covert orienting in 92 children with SBM, and 40 age-matched typically developing controls. Cues were of three types: exogenous (luminance change in a peripheral box either valid or invalid for upcoming target location), endogenous arrow (a central arrow either valid or invalid for upcoming target location), or endogenous word (a central word either valid or invalid for upcoming target location). Compared to controls, children with SBM showed slowed covert orienting to both exogenous and endogenous cues and a higher cost of attentional disengagement (e.g., a greater cue-validity effect) for exogenous although not for endogenous cues. Covert orienting deficits were associated with midbrain dysmorphology in the form of beaking of the tectum, and with right posterior brain volume loss.     

Covert orienting of visuospatial attention in the early stages of aging

Electrophysiological and behavioral responses were recorded in healthy young (19-23 years) and older (56-66 years) subjects during the execution of a visuospatial attention task. The objective was to test whether covert orienting of visuospatial attention (COVAT) is sensitive to the early stages of aging. All subjects responded faster to targets following valid than invalid cues. The amplitude of the P1 component of visual event-related potentials (ERP) was larger to targets following central valid cues at all SOAs. Subtle age-related changes were observed in P1 amplitude under peripheral cueing. Furthermore, older subjects presented longer reaction times (RTs) and lower P1 amplitudes regardless of the attention condition.     

Facilitation and inhibition arising from the exogenous orienting of covert attention depends on the temporal properties of spatial cues and targets.

On the covert orienting of visual attention task (COVAT), responses to targets appearing at the location indicated by a non-predictive spatial cue are faster than responses to targets appearing at uncued locations when stimulus onset asynchrony (SOA) is less than approximately 200 ms. For longer SOAs, this pattern reverses and RTs to targets appearing at uncued locations become faster than RTs to targets appearing at the cued location. This facilitation followed by inhibition has been termed the biphasic effect of non-predictive peripheral spatial cues. Currently, there is debate about whether these two processes are independent. This issue was addressed in a series of experiments where the temporal overlap between the peripheral cue and target was manipulated at both short and long SOAs. Results showed that facilitation was present only when the SOA was short and there was temporal overlap between cue and target. Conversely, inhibition occurred only when the SOA was long and there was no temporal overlap between cue and target. The biphasic effect, with an early facilitation followed by a later inhibition, occurred only when the cue duration was fixed such that there was temporal overlap between the cue and target at short but not long SOAs. In a final experiment, the duration of targets the temporal overlap between cue and target and the SOA were manipulated factorially. The results showed that facilitation occurred only when the SOA was short, there was temporal overlap between cue and target and the target remained visible until the subject responded. These results suggest that the facilitation and inhibition found on COVATs which use non-informative peripheral cues are independent processes and their presence and magnitude is related to the temporal properties of cues and targets.     

Covert orienting and focusing of attention in children with attention deficit hyperactivity disorder

Performance on the covert visuo-spatial attentional functions of orienting and focusing by a group of ADHD children (n = 20) was compared to that of age and sex-matched control children. In Experiment 1, responses were given to cued targets at valid and invalid locations. In Experiment 2, responses were given to targets presented in small, medium-sized or large visual field locations. For both experiments, the hypotheses that reaction times of ADHD children would be greater than those of control children and that performance would be asymmetrical, were supported. For Experiment 1, ADHD children showed bilaterally greater 'benefits' from having directed attention to the cued location and greater 'costs' in having to relocate the attentional focus than controls. In Experiment 2, the hypothesis that the function of focusing attention by ADHD children may show breakdown in the usual pattern of an increase in reaction time with focus area was partly supported by the finding of similar reaction times to targets presented in medium-sized and large regions of the left visual hemifield. These results have been interpreted as reflecting a stronger anchorage of attention by ADHD children upon a cued location and an inability to shift covert attention easily to an alternative location. The breakdown of the focusing function suggests adoption of similar time response sets across focus area size by the more compromised right hemisphere.     

Deficit of endogenous spatial orienting of attention in children with benign epilepsy with centrotemporal spikes (BECTS)

Attention difficulties have been reported in children with benign epilepsy with centrotemporal spikes (BECTS) but have not yet been fully specified. The aim of this study was to evaluate the functions of exogenous and endogenous spatial orienting of attention and alerting in these children. Two versions of the spatial cueing paradigm and an alerting task, including trials with and without warning signal, were performed by 25 children with BECTS aged 6–12 years and 25 controls matched for age, gender and IQ. In these three tasks, patients were slower and made more omissions than controls. The alert effect amplitude was comparable in both groups at the longer SOAs (450 ms and 800 ms) while, at the shortest SOA (100 ms), it was greater in controls than in the BECTS group. In the first version of the spatial cueing task (peripheral cues and no probability information), the validity effect amplitude, measured by longer response times (RTs) in invalid trials compared to valid trials, was comparable in both groups. In the second version (central cues and a 75% probability that the target would appear at the cued location), the validity effect was larger in the BECTS group compared to controls because of a higher cost of invalid trials compared to neutral trials. These results suggest the existence of impairments in the endogenous orienting of attention in children with BECTS, in particular an attention disengagement deficit, while exogenous orienting of attention appears to be preserved.     

Deficits of visuospatial attention with reflexive orienting induced by eye-gazed cues in children with developmental coordination disorder in the lower extremities: An event-related potential study

The present study aims to investigate and compare the behavioral performance and event-related potentials (ERPs) measures in children with developmental coordination disorder (DCD) and typically developing (TD) children when performing the visuospatial attention task with reflexive orienting. Thirty children with DCD and 30 TD children were recruited and presented with central eye-gazed cues. The children needed to detect and respond to laterally presented reaction signals preceded by centrally presented non-predictive directional and non-directional eye-gazed cues, which directed them to attend covertly to the right or left field location, or straight ahead, via stepping on pedals with their bilateral lower limbs, while brain ERPs were concurrently recorded. The behavioral data showed that children with DCD responded slowly and exhibited a deficit in inhibitory control capacity as compared to TD children. In terms of electrophysiological characteristics, children with DCD showed distinct modulatory effects upon longer N2 and P3 latencies, smaller P3 amplitude, an elongated interval between N2 and the motor response (N2 latency-RT), and small areas on Contingent Negative Variation (CNV). The behavioral and ERP data suggest that children with DCD could have deficits in the ventral attention network and the mechanisms on the inhibitory control difficulty, when performing such a task, could be a slower response inhibitory process and stimulus classification speed, less ability in interhemispheric and cognitive-to-motor transfer speed, and less mature abilities with regard to anticipatorily executive and motor preparatory processes.     

Social and Non-Social Cueing of Visuospatial Attention in Autism and Typical Development

Three experiments explored attention to eye gaze, which is incompletely understood in typical development and is hypothesized to be disrupted in autism. Experiment 1 (n = 26 typical adults) involved covert orienting to box, arrow, and gaze cues at two probabilities and cue-target times to test whether reorienting for gaze is endogenous, exogenous, or unique; experiment 2 (total n = 80: male and female children and adults) studied age and sex effects on gaze cueing. Gaze cueing appears endogenous and may strengthen in typical development. Experiment 3 tested exogenous, endogenous, and gaze-based orienting in 25 typical and 27 Autistic Spectrum Disorder (ASD) children. ASD children made more saccades, slowing their reaction times; however, exogenous and endogenous orienting, including gaze cueing, appear intact in ASD.     

Volitional covert orienting to a peripheral cue does not suppress cue-induced inhibition of return

Detection reaction time (RT) at an extrafoveal location can be increased by noninformative precues presented at that location or ipsilaterally to it. This cue-induced inhibition is called inhibition of return or ipsilateral inhibition. We measured detection RT to simple light targets at extrafoveal locations that could be designated for covert orienting by local or distant cues. We found that cue-induced inhibition cooccurred in an additive fashion with the direct effects of covert orienting, i.e., it detracted from facilitation at attended locations and increased the disadvantage for unattended locations. Thus, cue-induced inhibition cannot be suppressed by a volitional covert orienting to the cued location; the co-occurrence of different facilitatory and inhibitory effects confirms the simultaneous operation of multiple independent attentional mechanisms during covert orienting.     

Orienting auditory spatial attention engages frontal eye fields and medial occipital cortex in congenitally blind humans

What happens in vision-related cortical areas when congenitally blind (CB) individuals orient attention to spatial locations? Previous neuroimaging of sighted individuals has found overlapping activation in a network of frontoparietal areas including frontal eye fields (FEF), during both overt (with eye movement) and covert (without eye movement) shifts of spatial attention. Since voluntary eye movement planning seems irrelevant in CB, their FEF neurons should be recruited for alternative functions if their attentional role in sighted individuals is only due to eye movement planning. Recent neuroimaging of the blind has also reported activation in medial occipital areas, normally associated with visual processing, during a diverse set of non-visual tasks, but their response to attentional shifts remains poorly understood. Here, we used event-related fMRI to explore FEF and medial occipital areas in CB individuals and sighted controls with eyes closed (SC) performing a covert attention orienting task with endogenous verbal cues and spatialized auditory targets. We found robust stimulus-locked FEF activation of all CB subjects, similar to and stronger than in SC, suggesting that FEF plays a role in endogenous orienting of covert spatial attention even in individuals in whom voluntary eye movements are irrelevant. We also found robust activation in bilateral medial occipital cortex in CB but not in SC subjects. The response decreased below baseline following endogenous verbal cues but increased following auditory targets, suggesting that the medial occipital area in CB does not directly engage during cued orienting of attention but may be recruited for processing of spatialized auditory targets.     

Neural systems for visual orienting and their relationships to spatial working memory

We investigated neural correlates of human visual orienting using event-related functional magnetic resonance imaging (fMRI). When subjects voluntarily directed attention to a peripheral location, we recorded robust and sustained signals uniquely from the intraparietal sulcus (IPs) and superior frontal cortex (near the frontal eye field, FEF). In the ventral IPs and FEF only, the blood oxygen level dependent signal was modulated by the direction of attention. The IPs and FEF also maintained the most sustained level of activation during a 7-sec delay, when subjects maintained attention at the peripheral cued location (working memory). Therefore, the IPs and FEF form a dorsal network that controls the endogenous allocation and maintenance of visuospatial attention. A separate right hemisphere network was activated by the detection of targets at unattended locations. Activation was largely independent of the target's location (visual field). This network included among other regions the right temporo-parietal junction and the inferior frontal gyrus. We propose that this cortical network is important for reorienting to sensory events.     

Abnormal alpha modulation in response to human eye gaze predicts inattention severity in children with ADHD

Attention-deficit/hyperactivity disorder (ADHD) is characterized by problems in directing and sustaining attention. Recent behavioral studies indicated that children with ADHD are more likely to fail to show the orienting effect in response to human eye gaze. The present study aimed to identify the neurophysiological bases of attention deficits directed by social human eye gaze in children with ADHD, focusing on the relationship between alpha modulations and ADHD symptoms. The electroencephalography data were recorded from 8–13-year-old children (typically developing (TD): n = 24; ADHD: n = 21) while they performed a cued visuospatial covert attention task. The cues were designed as human eyes that might gaze to the left or right visual field. The results revealed that TD children showed a significant alpha lateralization in response to the gaze of human eyes, whereas children with ADHD showed an inverse pattern of alpha modulation in the left parieto-occipital area. Importantly, the abnormal alpha modulation in the left hemisphere predicted inattentive symptom severity and behavioral accuracy in children with ADHD. These results suggest that the dysfunction of alpha modulation in the left hemisphere in response to social cues might be a potential neurophysiologic marker of attention deficit in children with ADHD.     

The dynamics of shifting visuospatial attention revealed by event-related potentials

We developed a behavioral task for spatial orienting of attention in which the same physical stimulus cued covert peripheral shifts of attention to either the left or the right visual fields in different conditions. The design enabled us to record the brain activity engaged during spatial shifts of covert attention that was independent from the physical characteristics of the cueing stimulus using event-related potentials (ERPs). ERPs elicited by foveal cues differed according to the predicted target location starting ca. 160 ms, and differences persisted until the occurrence of the target stimuli. Multiple processes were linked to shifting spatial attention during the cue-target interval. The earliest effects consisted of enhanced negative potentials over the posterior scalp contralateral to the cued location. Later effects were concentrated over the right anterior scalp sites, where activity associated with shifts to the right visual field elicited larger positive potentials. The results extend our understanding of the neural system that orients spatial attention by providing valuable information about the temporal dynamics and hemispheric asymmetries of activity within its posterior and anterior regions.     

The role of visuospatial attention in developmental dyslexia: evidence from a rehabilitation study

Shifting of visual attention induced by peripheral cues was studied in 24 children with specific reading disorder (SRD) or dyslexia and was compared with that of 19 normal readers by means of a covert orienting paradigm. This paradigm presents participants with valid, neutral and invalid spatial cues preceding the presentation of a target stimulus. As compared to normal readers, in SRD children the inhibition effect (i.e. the difference between neutral and invalid cues) was absent. The 24 SRD children were divided into two groups matched for age, IQ and reading ability to study the efficacy of two different rehabilitation procedures. We assessed the effects on reading accuracy and speed over a 4-month treatment with visual hemisphere specific stimulation (VHSS; J. Learn Disabil. 25 (1992) 102) vs. traditional speech training. The VHSS program trains participants to perform rapid endogenous attentional orienting by presenting briefly flashed words in the peripheral visual field. We found that children treated with VHSS showed significant changes in their attentional inhibition process, as indicated by increased costs for 'reorienting' the attentional focus. As this treatment program also proved to be highly efficient in improving the children's reading abilities, the possible causal relationship between reading and inhibition mechanisms of visuospatial attention was discussed.     

Blunted inhibition of return in schizophrenia-evidence from a longitudinal study

Previous cross-sectional studies on covert orienting of visual attention in schizophrenia have been inconsistent. In the present longitudinal study, we examined 40 medicated acutely ill inpatients with a covert orienting of attention task (COVAT) shortly after admission, and again 12-16 weeks after the initial examination, while most patients were in (partial) remission. We administered a COVAT with nonpredictive peripheral cues and two stimulus-onset asynchronies (SOA; 100 and 800 ms). In addition, we examined 34 healthy control subjects twice (2 weeks apart). The most important finding was a lack of inhibition of return (IOR) in patients with schizophrenia, both at the first examination in an acute psychotic state and at the follow-up examination after considerable clinical improvement. The IOR deficit was unrelated to psychopathology, length of illness, number of previous psychotic episodes, and type of neuroleptic (NL) medication. Deficient IOR in patients with schizophrenia appears to be state-independent and might be viewed as a trait or vulnerability marker of the disorder. Subsequent studies with never-medicated populations and with schizotypal or high-risk subjects are needed in order to further analyze the possible role of NL medications and to clarify whether blunted IOR might represent a vulnerability marker of schizophrenia.     

Event-related potentials associated with covert orientation of visual attention in Parkinson''s disease

Event-related potentials (ERPs) were measured in a group of patients with idiopathic Parkinson's disease and compared with a matched control group during a task involving covert orientation of visual attention. Central warning cues directed attention to the probable location of a lateralized signal that required a button-press response. Parkinson patients had enhanced post-cue P1 (at Oz) and P2 (at Cz) amplitudes, delayed N1 (at Oz) latencies, and diminished CNV amplitudes. Post-target amplitudes were similar to controls, except for an enhancedP1 to invalidly cued targets, and delayed N1 and P3 target latencies. These results indicate that Parkinson patients, in addition to their motor deficits, process spatial cues more effortfully and slowly, have impaired response preparation, and process imperative stimuli more slowly.     

ERP correlates of shared control mechanisms involved in saccade preparation and in covert attention

We investigated whether attention shifts and eye movement preparation are mediated by shared control mechanisms, as claimed by the premotor theory of attention. ERPs were recorded in three tasks where directional cues presented at the beginning of each trial instructed participants to direct their attention to the cued side without eye movements (Covert task), to prepare an eye movement in the cued direction without attention shifts (Saccade task) or both (Combined task). A peripheral visual Go/Nogo stimulus that was presented 800 ms after cue onset signalled whether responses had to be executed or withheld. Lateralised ERP components triggered during the cue-target interval, which are assumed to reflect preparatory control mechanisms that mediate attentional orienting, were very similar across tasks. They were also present in the Saccade task, which was designed to discourage any concomitant covert attention shifts. These results support the hypothesis that saccade preparation and attentional orienting are implemented by common control structures. There were however systematic differences in the impact of eye movement programming and covert attention on ERPs triggered in response to visual stimuli at cued versus uncued locations. It is concluded that, although the preparatory processes underlying saccade programming and covert attentional orienting may be based on common mechanisms, they nevertheless differ in their spatially specific effects on visual information processing.     

Involuntary but not voluntary orienting contributes to a disengage deficit in visual neglect

Patients with left neglect are particularly slow to respond to visual targets on their left when attention is first engaged to their right. This deficit is known as the disengage deficit (DD). Studies investigating the DD typically employ nonpredictive peripheral onset cues to measure involuntary orienting and predictive central arrow cues to measure voluntary orienting. A DD has been observed with both cues, suggesting that a DD occurs for involuntary and for voluntary orienting. Recent evidence questions this conclusion because nonpredictive central arrow cues trigger involuntary orienting. This implies that predictive central arrows also involve involuntary orienting and do not measure only voluntary attention. This new knowledge suggests a new conceptualization of the DD. While it is undisputed that a DD occurs when attention is shifted involuntarily, it is uncertain whether a DD is produced by voluntary orienting because most previous cuing studies of the DD have involved shifts of involuntary attention. To address this critical question, we tested neglect and control patients with nonpredictive and predictive peripheral onset cues (Experiment 1), nonpredictive and predictive central arrow cues (Experiment 2), and predictive central number cues (Experiment 3). The experiments provide three lines of converging evidence that voluntary orienting does not contribute to a DD. First, the DD was the same whether attention was engaged involuntarily by nonpredictive peripheral cues or engaged involuntarily and voluntarily by predictive peripheral cues (Experiment 1), indicating that voluntary orienting does not modulate the DD. Second, the DD was the same whether attention was engaged involuntarily by nonpredictive central arrow cues or engaged involuntarily and voluntarily by predictive central arrow cues (Experiment 2), replicating the finding of Experiment 1 with very different cues. Third, the DD was not present when attention was only engaged voluntarily by central predictive number cues (Experiment 3).     

Visual-spatial attention in developmental dyslexia

Orienting and focusing of visual attention are two processes strictly involved in reading. They were studied in a group of dyslexic children and normal readers. Shifting of attention by both peripheral and central visual cues was studied by means of the covert orienting paradigm. Focusing, consisting in the ability to control the size of the attentional focus, was investigated using simple reaction times in central vision. Results showed that dyslexics had a specific disability in the shifting of attention caused by a peripheral cue at short SOAs, and were also able to maintain attention focused for short periods of time only, presumably not long enough for efficient visual processing. Our results support the suggestion that visual selective attention deficits in disabled readers may be due to a specific difficulty in orienting and focusing.