Distraction and reorientation in children: a behavioral and ERP study

In the context of distraction, involuntary orienting to task-irrelevant deviations and the following reorienting to task-relevant stimulus information were studied in children aged 5-6 years. In an auditory distraction paradigm, reaction times were prolonged by 51 ms in trials including a task-irrelevant stimulus deviancy. Event-related potentials (ERPs) revealed a mismatch response (MMR) at 252 ms and a reorienting negativity (RON) 476 ms post-stimulus in response to deviating sounds. These behavioral and ERP effects resemble those reported for adults. We conclude that kindergarten children are prone to distraction, although they can quite effectively but not fully shield working memory operations from perturbating distracting information, and can recover from distraction in a similar way to adults.     

Effects of sound location on visual task performance and electrophysiological measures of distraction

Novel sounds embedded in a repetitive stream of auditory stimuli impair performance of the visual task at hand. Parmentier et al. suggested that this distraction effect might be because of the shifting cost of moving attention from the task-irrelevant (auditory) to the task-relevant (visual) channel, or from their shifting of spatial locations. Here, the source location of the sounds in an audio-visual distraction paradigm was varied systematically (headphones and 0, -18, -72, 18, and 72 degrees), and the results revealed significant distracting effects of novel sounds occurring in the headphone and the right location conditions. This supports the assumption that in the behavioral cost observed in the audio-visual distraction paradigm a spatial shift of attention is involved.     

Electrical responses reveal the temporal dynamics of brain events during involuntary attention switching

Surviving in the natural environment requires the rapid switching of attention among potentially relevant stimuli. We studied electrophysiologically the involuntary switching time in humans performing a task designed to study brain mechanisms of involuntary attention and distraction (C. Escera et al., 1998, J. Cogn. Neurosci., 10, 590-604). Ten subjects were instructed to discriminate visual stimuli preceded by a task-irrelevant sound, this being either a repetitive tone (P = 0.8) or a distracting sound, i.e. a slightly higher deviant tone (P = 0.1) or an environmental novel sound (P = 0.1). In different conditions, the sounds preceded the visual stimuli by 245 or 355 ms. Deviant tones and novel sounds prolonged reaction times significantly to subsequent visual stimuli by 7.4 (P < 0.02) and 15.2 ms (P < 0.003), respectively. In addition to a mismatch negativity (MMN) and a positive-polarity, 320-ms latency, P3a event-related potential associated, respectively, with detection of the distracting sound and the subsequent orienting of attention to it, a late frontal negative deflection was observed in distracting trials. The peak latency of this brain response from sound onset was 580 ms in the 245-ms condition and 115 ms longer in the 355-ms condition (P < 0.001), peaking consequently at 340 ms from visual stimulus onset, irrespective of the onset of the distracting sound. We suggest that this late frontal negative response may signal over the scalp the process of reallocating attention back to the original task after momentary distraction, and therefore that recovering from distraction may take a similar shifting time as orienting attention involuntarily towards unexpected novelty.     

Dissociation in performance of children with ADHD and high-functioning autism on a task of sustained attention

Attention deficit hyperactivity disorder (ADHD) and autism are two neurodevelopmental disorders associated with prominent executive dysfunction, which may be underpinned by disruption within fronto-striatal and fronto-parietal circuits. We probed executive function in these disorders using a sustained attention task with a validated brain-behaviour basis. Twenty-three children with ADHD, 21 children with high-functioning autism (HFA) and 18 control children were tested on the Sustained Attention to Response Task (SART). In a fixed sequence version of the task, children were required to withhold their response to a predictably occurring no-go target (3) in a 1-9 digit sequence; in the random version the sequence was unpredictable. The ADHD group showed clear deficits in response inhibition and sustained attention, through higher errors of commission and omission on both SART versions. The HFA group showed no sustained attention deficits, through a normal number of omission errors on both SART versions. The HFA group showed dissociation in response inhibition performance, as indexed by commission errors. On the Fixed SART, a normal number of errors was made, however when the stimuli were randomised, the HFA group made as many commission errors as the ADHD group. Greater slow-frequency variability in response time and a slowing in mean response time by the ADHD group suggested impaired arousal processes. The ADHD group showed greater fast-frequency variability in response time, indicative of impaired top-down control, relative to the HFA and control groups. These data imply involvement of fronto-parietal attentional networks and sub-cortical arousal systems in the pathology of ADHD and prefrontal cortex dysfunction in children with HFA.     

The test of variables of attention (TOVA) is useful in the diagnosis of Japanese male children with attention deficit hyperactivity disorder

The purpose of this study was to evaluate the ability of the test of variables of attention (TOVA) to distinguish between 6- to 12-year-old Japanese male children with attention deficit hyperactivity disorder (ADHD group; n=17) meeting DSM-IV and ICD-10 criteria, and age-matched, normal Japanese male controls (control group; n=19). The TOVA is a computer-administered, visual continuous performance test that provides measures of attention. The ADHD group had significantly higher means than the control group in all variables: omission errors, commission errors, response time, response time variability, anticipatory responses, and multiple response. Control children exhibited age-related changes in two variables: response time and response-time variability, but no age-related changes were observed in any variables in the ADHD group. This preliminary study indicates that the TOVA makes a useful contribution to the diagnosis of Japanese male children with ADHD.     

Musicians show general enhancement of complex sound encoding and better inhibition of irrelevant auditory change in music: an ERP study

Using electrophysiology, we have examined two questions in relation to musical training – namely, whether it enhances sensory encoding of the human voice and whether it improves the ability to ignore irrelevant auditory change. Participants performed an auditory distraction task, in which they identified each sound as either short (350 ms) or long (550 ms) and ignored a change in timbre of the sounds. Sounds consisted of a male and a female voice saying a neutral sound [a], and of a cello and a French Horn playing an F3 note. In some blocks, musical sounds occurred on 80% of trials, while voice sounds on 20% of trials. In other blocks, the reverse was true. Participants heard naturally recorded sounds in half of experimental blocks and their spectrally‐rotated versions in the other half. Regarding voice perception, we found that musicians had a larger N1 event‐related potential component not only to vocal sounds but also to their never before heard spectrally‐rotated versions. We therefore conclude that musical training is associated with a general improvement in the early neural encoding of complex sounds. Regarding the ability to ignore irrelevant auditory change, musicians' accuracy tended to suffer less from the change in timbre of the sounds, especially when deviants were musical notes. This behavioral finding was accompanied by a marginally larger re‐orienting negativity in musicians, suggesting that their advantage may lie in a more efficient disengagement of attention from the distracting auditory dimension.     

A pilot and feasibility study of virtual reality as a distraction for children with cancer

OBJECTIVE: To pilot and test the feasibility of a novel technology to reduce anxiety and pain associated with an invasive medical procedure in children with cancer. METHOD: Children with cancer (ages 7-19) whose treatment protocols required access of their subcutaneous venous port device (port access) were randomly assigned to a virtual reality distraction intervention, a non-virtual reality distraction, or treatment as usual without a distraction. The researchers obtained assessments of the child's pain and anxiety from the parent, child, and unblinded nurses. Pulse rate was monitored throughout the procedure, and behavioral indices of distress were recorded, as observed by the researchers. RESULTS: Reductions in pain and anxiety were found for children who used the virtual reality distraction in comparison with the no distraction condition as evidenced by lower pulse rate and reports of pain by nurses. No significant differences were found for the non-virtual reality condition versus the no distraction condition on pulse rate. CONCLUSIONS: These findings suggest that virtual reality may be a useful tool for distraction during painful medical procedures, but further studies are needed to test potential efficacy and feasibility during other, more distressing medical procedures with larger sample sizes.     

Autism: processing of novel auditory information assessed by event-related brain potentials

Event-related brain potentials (ERPs) of 13-21-year-old autistic subjects and age-matched controls were elicited by auditory stimuli in a variation of orienting response paradigms. Unexpected, novel sounds (bizarre concoctions of human, mechanical and computer sounds) were randomly inserted as probes in a sequence of expected, non-novel sounds (the word 'me'). In order to help ensure that both subject groups were attending to this stream of information, each subject was required to press a button to a specified target sound (the word 'you') also randomly inserted in the sequence of expected non-novel sounds. The ERP results showed that in both groups, unexpected, novel probes and also targets evoked a different neurophysiological response than did expected, non-novel sounds. This suggests that the autistic group did not misperceive novel information as non-novel and were able to make simple classification decisions as accurately as normal controls. However, in the autistic group, there may be less 'processing' of the novel probes and of targets: compared to the control group, the autistic group had smaller amplitudes of two long-latency components to novels and smaller P3b amplitudes to targets. The two components to novels were termed A/Pcz/300 (A = auditory; P = positive; cz = electrode site of maximum amplitude; 300 = latency in msec) and A/Ncz/800. In another sequence of sounds, subjects simply listened to frequently presented 'me' sounds (90%) and infrequently presented 'you' sounds (10%). In this no-task condition, no differences between autistic and normal control subjects were found.     

Response repetition vs. response change modulates behavioral and electrophysiological effects of distraction

If stimulation occasionally contains distracting information, behavioral responses to task-relevant aspects of the stimulation are prolonged and more error prone. Additionally, event-related potentials (ERPs) acquired in an auditory distraction paradigm show that the distracting information elicits the components mismatch negativity (MMN), P3a and reorienting negativity (RON). Here, we assess to what extent sequential dependencies in the stimulation influence such indicators of distraction. Data of four experiments were reanalyzed for response repetition and response change trials separately. Behavioral performance on Deviants suggests markedly smaller distraction effects in change compared to repetition trials. However, the presence of MMN-P3a-RON in both response repetition and response change trials shows that sequential features in stimulation do not dissolve distraction, but might substantially contribute to the (behavioral) effects measured in distraction paradigms and should be controlled for.     

When loading working memory reduces distraction: behavioral and electrophysiological evidence from an auditory-visual distraction paradigm

The sensitivity of involuntary attention to top-down modulation was tested using an auditory-visual distraction task and a working memory (WM) load manipulation in subjects performing a simple visual classification task while ignoring contingent auditory stimulation. The sounds were repetitive standard tones (80%) and environmental novel sounds (20%). Distraction caused by the novel sounds was compared across a 1-back WM condition and a no-memory control condition, both involving the comparison of two digits. Event-related brain potentials (ERPs) to the sounds were recorded, and the N1/MMN (mismatch negativity), novelty-P3, and RON components were identified in the novel minus standard difference waveforms. Distraction was reduced in the WM condition, both behaviorally and as indexed by an attenuation of the late phase of the novelty-P3. The transient/change detection mechanism indexed by MMN was not affected by the WM manipulation. Sustained slow frontal and parietal waveforms related to WM processes were found on the standard ERPs. The present results indicate that distraction caused by irrelevant novel sounds is reduced when a WM component is involved in the task, and that this modulation by WM load takes place at a late state of the orienting response, all in all confirming that involuntary attention is under the control of top-down mechanisms. Moreover, as these results contradict predictions of the load theory of selective attention and cognitive control, it is suggested that the WM load effects on distraction depend on the nature of the distractor-target relationships.     

Reaction time, attention, and impulsivity in epilepsy.

Reaction time, attention, and impulsivity were studied in 112 children with epilepsy (4.5-13 years) using a computerized test. We measured simple reaction time (response with each hand separately to a single stimulus), forced choice reaction time (two stimuli presented in random order, one designated for each hand), and choice reaction time with distraction (two response stimuli, one for each hand, with two additional distracting stimuli randomly inserted). We also measured variability of speed of response and errors of omission and commission. Controls were unaffected children of similar age, ethnic, and socioeconomic backgrounds. Children with epilepsy were significantly slower, more variable, and made more omission errors than control children, even when analysis was limited to epileptic patients with IQ greater than 90, but they did not make more commission (i.e., impulsive) errors. Reaction times were related to IQ, but in general were not related to seizure severity, duration of seizure disorder, or duration of medication use. Untreated patients (N = 13) did not differ from those with antiepileptic drug levels in the therapeutic range on the day of testing (N = 52), but differed significantly from normal patients. Epileptic patients demonstrated significant slowing of reaction time and inattention, but not significant impulsivity, compared to normal children; however, these deficits do not appear to be related specifically to seizure history or treatment.     

Newborns discriminate novel from harmonic sounds: a study using magnetoencephalography.

OBJECTIVE: We investigated whether newborns respond differently to novel and deviant sounds during quiet sleep. METHODS: Twelve healthy neonates were presented with a three-stimulus oddball paradigm, consisting of frequent standard (76%), infrequent deviant (12%), and infrequent novel stimuli (12%). The standards and deviants were counterbalanced between the newborns and consisted of 500 and 750 Hz tones with two upper harmonics. The novel stimuli contained animal, human, and mechanical sounds. All stimuli had a duration of 300 ms and the stimulus onset asynchrony was 1s. Evoked magnetic responses during quiet sleep were recorded and averaged offline. RESULTS: Two deflections peaking at 345 and 615 ms after stimulus onset were observed in the evoked responses of most of the newborns. The first deflection was larger to novel and deviant stimuli than to the standard and, furthermore, larger to novel than to deviant stimuli. The second deflection was larger to novel and deviant stimuli than to standards, but did not differ between the novels and deviants. CONCLUSIONS: The two deflections found in the present study reflect different mechanisms of auditory change detection and discriminative processes. SIGNIFICANCE: The early brain indicators of novelty detection may be crucial in assessing the normal and abnormal cortical function in newborns. Further, studying evoked magnetic fields to complex auditory stimulation in healthy newborns is needed for studying the newborns at-risk for cognitive or language problems.     

Increased Prefrontal Oxygenation Related to Distractor-Resistant Working Memory in Children with Attention-Deficit/Hyperactivity Disorder (ADHD)

This study aimed at investigating the effect of distraction on working memory and its underlying neural mechanisms in children with attention-deficit/hyperactivity disorder (ADHD). To this end, we studied hemodynamic activity in the prefrontal cortex using near-infrared spectroscopy while 16 children with ADHD and 10 typically developing (TD) children performed a working memory task. This task had two conditions: one involved a distraction during the memory delay interval, whereas the other had no systematic distraction. The ADHD patients showed significantly poorer behavioral performance compared with the TD group, particularly under the distraction. The ADHD group exhibited significantly higher level of prefrontal activation than did TD children. The activity level was positively correlated with the severity of ADHD symptoms. These results suggest that the impairment in the inhibition of distraction is responsible for the working memory deficits observed in ADHD children. Inefficient processing in the prefrontal cortex appears to underlie such deficits.     

Abnormal early stages of task stimulus processing in children with attention-deficit hyperactivity disorder--evidence from event-related gamma oscillations.

OBJECTIVES: Attention-related differences in early stages of stimulus processing were assessed in healthy controls and children with attention-deficit hyperactivity disorder (ADHD) by analyzing phase-locked gamma band (31-63 Hz) responses to auditory stimuli in a selective-attention task. METHODS: A total of 28 children aged 9-12 years (ADHD and matched healthy controls) pressed a button in response to each target stimulus presented at the attended side (right or left). Auditory gamma band responses (GBRs) within 0-120 ms were analyzed at 8 electrodes with wavelet transform. Effects of attended channel, stimulus type, and group were evaluated for GBR power and phase-locking. RESULTS: For both groups, GBRs had a frontal-central distribution, were significantly larger and more strongly phase-locked to target than to non-target stimuli, and did not differentiate the attended from the unattended channel. ADHD children produced larger and more strongly phase-locked GBRs than controls only to right-side stimuli, irrespective of whether these were the attended or the ignored stimuli. CONCLUSIONS: The association between auditory GBR and motor task stimulus in children suggests that phase-locked gamma oscillations may reflect processes of sensory-motor integration. ADHD-related deviations of GBRs indicate that early mechanisms of auditory stimulus processing are altered in ADHD, presumably as a result of impaired motor inhibition.     

Response switching process in children with attention-deficit–hyperactivity disorder on the novel continuous performance test

We examined the effects of previous trials on subsequent trials on performance in the continuous performance test (CPT) in children with attention-deficit–hyperactivity disorder (ADHD). Thirty-five non-medicated children with ADHD (31 males, four females; mean age 9y 10mo [SD 2y 4mo]) and 33 comparison children (20 males, 13 females; mean age 10y [SD 2y 7mo]) were tested using a novel CPT, in which stimuli were presented with 50% target probability. Reaction time, reaction time variability, omission, and commission error rate were analyzed for two different types of trials in which different responses (switched trials) or the same responses (repeated trials) were required for two consecutive trials. Compared with the comparison group, children with ADHD showed a greater increase in commission error rate from repeated to switched trials, i.e. increased switch cost for commission error rate. On the other hand, omission error rate was not influenced by the previous trial in both ADHD and comparison groups. These results suggest that children with ADHD have trouble in response switching when an inhibitory process is involved.     

Auditory event-related potentials and cognitive function of preterm children at five years of age.

OBJECTIVE: In our previous study, auditory event-related potentials (AERPs) in preterm 1-year-old children had a positive deflection at 150-350 ms that correlated positively with their 2-year neurodevelopmental outcome. In a study of the same subjects at age 5, our aim was to assess AERPs and their relationship to neuropsychological test results. METHODS: Preterm small (SGA, n=13), appropriate for gestational age (AGA, n=15), and control (n=13) children were assessed with an Easy paradigm presenting a large frequency change accompanied with occasional novel sounds, and a Challenging paradigm presenting small frequency and duration changes with a rapid rate. The preterm children underwent neurocognitive tests. RESULTS: Easy paradigm. The P1 response to frequency deviant was smaller and MMN larger in the preterm than in the control children. Challenging paradigm. The P1 response to standard, frequency, and duration deviants was smaller in the preterm than in the control children. The N2 response to frequency deviant was larger in the preterm than in the control children. AGA and SGA children had similar AERPs. The P1, N2, and MMN amplitudes correlated with verbal IQ and NEPSY language subtests. CONCLUSIONS: Small P1 response(s) appears to be typical for preterm children. SIGNIFICANCE: Small P1 response in preterm children may suggest altered primary auditory processing.     

Effect of distraction on communication failures in schizophrenic patients

Manic, schizophrenic, and normal subjects were interviewed in the presence and absence of distracting information, and their speech performance was evaluated. Normal and manic subjects were unaffected by irrelevant information. Schizophrenic subjects manifested more reference failures during distraction than during nondistraction periods.     

Response switching process in children with attention-deficit-hyperactivity disorder on the novel continuous performance test.

We examined the effects of previous trials on subsequent trials on performance in the continuous performance test (CPT) in children with attention-deficit-hyperactivity disorder (ADHD). Thirty-five non-medicated children with ADHD (31 males, four females; mean age 9y 10mo [SD 2y 4mo]) and 33 comparison children (20 males, 13 females; mean age 10y [SD 2y 7mo]) were tested using a novel CPT, in which stimuli were presented with 50% target probability. Reaction time, reaction time variability, omission, and commission error rate were analyzed for two different types of trials in which different responses (switched trials) or the same responses (repeated trials) were required for two consecutive trials. Compared with the comparison group, children with ADHD showed a greater increase in commission error rate from repeated to switched trials, i.e. increased switch cost for commission error rate. On the other hand, omission error rate was not influenced by the previous trial in both ADHD and comparison groups. These results suggest that children with ADHD have trouble in response switching when an inhibitory process is involved.     

Novel strategy for the analysis of CPT data provides new insight into the effects of methylphenidate on attentional states in children with ADHD

Continuous performance tasks (CPTs) provide a method for studying some components of attention, but do not take into account that attention fluctuates from moment to moment. To address this issue, CPT performance was classified into one of four states (on-task, impulsive, distracted, or randomly responding) every 30 seconds, based on commission and omission error rates. We evaluated this method on 60 boys (10.6 +/- 1.1 years) with attention-deficit hyperactivity disorder (ADHD)-Combined subtype, tested before and after a dose of methylphenidate (MPH, 0.4 mg/kg), and 8 unmedicated healthy control boys (11.3 +/- 2.0 years of age). Healthy controls were on-task during 82.4% of the 30-second epochs, and made an average of 5.4 attention shifts. In contrast, children with ADHD were only on-task during 42.6% of the epochs (p = 0.0006), and they made an average of 12.8 attention shifts (p = 0.00004). These state measures provided more robust indicators of the difference between children with ADHD and controls than did traditional CPT measures of error rates, latency, and variability. The new state measures were also more significantly affected by MPH. MPH produced a 77% increase in the percent of time children with ADHD spent on-task (p < 10(12)). Conversely, MPH reduced time spent in the distracted, impulsive, and random response states by 79%, 44.5%, and 69.2%, respectively (all p values < 0.0002). Unlike errors of omission and commission, which are highly correlated (r = 0.722, n = 60, p < 10(-11)), the percent of epochs spent in impulsive, distracted, and random response states were uncorrelated, and loaded onto discrete independent factors on principal component analysis. The level of activity during the CPT correlated with the degree of distraction, but not with the degree of impulsivity. Children with ADHD could be subtyped according to the nature of their attention performance problems, and these subtypes differed in levels of hyperactivity and degrees of response to MPH.     

Electrophysiological activity underlying inhibitory control processes in normal adults

In a recent ERP study of inhibitory control using the Stop-Signal Task [Pliszka, S., Liotti, M., Woldorff, M. (2000). Inhibitory control in children with attention-deficit/hyperactivity disorder: Event-related potentials identify the processing component and timing of an impaired right-frontal response-inhibition mechanism. Biological Psychiatry, 48, 238-246], we showed that in normal children (age 10-12 years) the Stop Signals elicited a robust, right-frontal-maximal N200 (latency approximately 200 ms) that was strongly reduced in children with ADHD. To further investigate the mechanisms of response inhibition, this paradigm was applied to 11 healthy young adults. To better distinguish response-inhibition-related activity from early attentional effects, a "Stop-Signal-Irrelevant" condition was added, in which subjects performed the task while ignoring the Stop Signals. In the Stop-Signal-Relevant condition, the right frontal N200 to the Stop Signals was larger for Successful inhibition (SI) than for Failed inhibition (FI) trials. The timing and distribution of this effect was strikingly similar to that of the right-frontal ADHD deficit reported in Pliszka et al. (2000), supporting this activity being related to successful normal inhibitory control processes. In contrast, a posterior N200 was larger for Stop-Relevant than for Stop-Irrelevant trials, likely reflecting enhanced early sensory attention to the Stop Signals when relevant. Two longer-latency failure-specific ERP effects were also observed: a greater frontopolar negative wave (370-450 ms) to Failed than Successful inhibitions, and a greater parietal positive slow wave (450-650 ms) for Failed inhibitions than ignore-stop trials, likely reflecting differential recruitment of error detection and correction mechanisms following Failed attempts to inhibit a response.