Attention-deficit/hyperactivity disorder (ADHD) is associated with functional impairments in different areas of daily life. One such area is social functioning. The purpose of this paper is to ...critically review research on social dysfunctioning in children with ADHD. Children with ADHD often have conflicts with adults and peers, and suffer from unpopularity, rejection by peers, and a lack of friendships, in part as a consequence of their ADHD symptoms. Comorbid oppositional defiant or conduct disorder aggravates these impairments. In some cases the inadequate social behavior of children with ADHD may be phenomenologically and etiologically related to pervasive developmental disorders (PDD). However, the causes and consequences of PDD symptoms in ADHD are understudied. Also, the relative contributions of ADHD, on the one hand, and comorbid disorders, on the other, to the course of social impairments are unknown. Social dysfunctioning in children with ADHD appears to increase their risk of later psychopathology other than ADHD. Thus far effective treatment for social dysfunctioning is lacking. Future research should address the exact nature and long-term consequences of social dysfunctioning in children with ADHD, and focus on development of effective treatment strategies.
Objective: The efficacy of atomoxetine as treatment of symptoms of attention-deficit/hyperactivity disorder (ADHD) in patients with autism spectrum disorder (ASD) has not been established. Method: In ...this study, 97 patients aged 6 to 17 years with ADHD and ASD were randomly assigned to double-blind treatment with 1.2 mg/kg/day atomoxetine or placebo for 8 weeks. The primary endpoint was the ADHD Rating Scale (ADHD-RS) score; secondary endpoints were the Clinical Global Impression of ADHD-Improvement (CGI-I) and the Conners Teacher Rating Scale-Revised: Short Form (CTRS-R:S) score. Results: Baseline mean ADHD-RS scores for atomoxetine versus placebo were 40.7 and 38.6; after 8 weeks, mixed-effect model repeated-measure means were 31.6 (95% confidence interval 29.2-33.9) and 38.3 (36.0-40.6), respectively, with a difference in least square means of -6.7 (-10.0 to -3.4; p less than 0.001). The CTRS-R:S Hyperactivity subscore also improved significantly for atomoxetine compared with placebo, but not the other CTRS-R:S subscores. However, there were not significantly more patients on atomoxetine (20.9%) who improved much, or very much according to the CGI-I, than on placebo (8.7%; p = 0.14). Adverse events (mostly nausea, decrease in appetite, fatigue, and early morning awakening) were reported in 81.3% of atomoxetine patients and 65.3% of placebo patients (p greater than 0.1). There were no serious adverse events. Conclusions: Atomoxetine moderately improved ADHD symptoms in patients with ASD and was generally well tolerated. Adverse events in this study were similar to those in other studies with ADHD patients without ASD. (Contains 4 tables and 1 figure.)
Facial expressions contain both motor and emotional components. The inferior frontal gyrus (IFG) and posterior parietal cortex have been considered to compose a mirror neuron system (MNS) for the ...motor components of facial expressions, while the amygdala and insula may represent an "additional" MNS for emotional states. Together, these systems may contribute to our understanding of facial expressions. Here we further examine this possibility. In three separate event-related fMRI experiment, subjects had to (1) observe (2) discriminate and (3) imitate facial expressions. Stimuli were dynamic neutral, happy, fearful and disgusted facial expressions, and in Experiments 1 and 2, an additional pattern motion condition. Importantly, during each experiment, subjects were unaware of the nature of the next experiments. Results demonstrate that even passive viewing of facial expressions activates a wide network of brain regions that were also involved in the execution of similar expressions, including the IFG/insula and the posterior parietal cortex. Only a subset of these regions responded more during the observation of facial than pattern motion (bilateral ventral IFG, bilateral STS/MTG, bilateral amygdala, SMA). While the viewing of facial expressions recruited similar brain regions in all three experiments, adding an active task (discrimination, imitation) augmented the magnitude of these activations. Brain activations reflected differences in observed facial expressions, with emotional expressions activating relatively more the insula/frontal operculum, and neutral ones (blowing up the cheeks) the somatosensory cortices (SII). Using movies, fear activated the amygdala and disgust the insula, but other emotions activated these structures to a similar degree.
Objective: To evaluate the effectiveness of Emotion Regulation Training (ERT), a 17-session weekly group training for adolescents with borderline personality disorder (BPD) symptoms. Method: One ...hundred nine adolescents with borderline traits (73% meeting the full criteria for BPD) were randomized to treatment as usual only (TAU) or ERT + TAU. Outcome measurements included severity of BPD symptoms, general psychopathology, and quality of life. Multilevel analyses were conducted on an intent-to-treat basis. Clinical significant change was determined by normative comparisons on a primary outcome measurement. Results: Independent of treatment condition, the two groups improved equally on the severity of BPD symptoms, general psychopathology, and quality of life. Nineteen percent of the ERT group was remitted according to the cutoff score after treatment (at 6 months) versus 12% of the control group. Follow-up assessments in the ERT group at 12 months showed some further improvement (33% remittance). With regard to predictors of outcomes, adolescents with higher levels of depression or attention-deficit/hyperactivity disorder or oppositional-defiant disorder at baseline and who reported a history of abuse had worse outcomes, regardless of treatment condition. The attrition rate for the ERT sessions was remarkably low (19%). Conclusions: Early interventions for BPD symptoms in adolescence are feasible and necessary. No additional effect of ERT over TAU could be demonstrated in the present study. There is a clear need for developing effective interventions for adolescents with persistent BPD symptomatology. Clinical trial registration information--Evaluation of Group Training for Adolescents (Emotion Regulation Training) with Emotion Regulation Problems: A Randomized Controlled Clinical Trial; http://trialregister.nl/; ISRCTN97589104. (Contains 6 tables and 2 figures.)
Autism Diagnostic Observation Schedule (ADOS) module 4 was investigated in an independent sample of high-functioning adult males with an autism spectrum disorder (ASD) compared to three specific ...diagnostic groups: schizophrenia, psychopathy, and typical development. ADOS module 4 proves to be a reliable instrument with good predictive value. It can adequately discriminate ASD from psychopathy and typical development, but is less specific with respect to schizophrenia due to behavioral overlap between autistic and negative symptoms. However, these groups differ on some core items and explorative analyses indicate that a revision of the algorithm in line with Gotham et al. (J Autism Dev Disord 37: 613–627,
2007
) could be beneficial for discriminating ASD from schizophrenia.
This study investigated the effect of social relevance in affective pictures on two orienting responses, i.e. the evoked cardiac response (ECR), and a long latency cortical evoked potential (LPP) and ...whether this effect would differ between males and females. Assuming that orienting to affective social information is fundamental to experiencing affective empathy, associations between self-report measures of empathy and the two orienting responses were investigated.
ECRs were obtained from 34 female and 30 male students, and LPPs from 25 female and 27 male students viewing 414 pictures from the International Affective Picture System. Pictures portrayed pleasant, unpleasant and neutral scenes with and without humans.
Both the ECR and LPP showed the largest response to pictures with humans in unpleasant situations. For both measures, the responses to pictures with humans correlated with self-report measures of empathy. While we found a greater male than female responsiveness to the pictures without humans in the ECR, a greater female than male responsiveness was observed in the LPP response to pictures with humans.
The sensitivity of these orienting responses to social relevance and their differential contribution to the prediction of individual differences underline the validity of their combined use in clinical studies investigating individuals with social disabilities.
▶ Electrophysiological index of inhibition diminished in dyslexic, ADHD and comorbid adults. ▶ Externalising behaviour does not explain inhibitory control deficits in ADHD. ▶ ADHD adults more ...problems with inhibitory control than adults with ADHD+dyslexia.
Twenty male adults with ADHD, 16 dyslexic adults, 15 comorbid adults, and 16 normal controls were compared on performance and underlying brain responses, during a cued Continuous Performance Test (O-X CPT), with the aim of discovering features of information processing differentiating between the groups. The study evaluated both cue- and target-related processes by analysing performance measures (errors, reaction time, and variability of reaction time), and event-related potentials (ERPs). Cue-related ERP components included the Cue-N2, Cue-P3, contingent negative variation (CNV) consisting of the CNV1, related to cue orienting, and the CNV2, related to response preparation. For targets, a distinction was made between response-related (Go), and inhibitory (Nogo) processing. Target-related components included the Go-P3, Nogo-N2, and Nogo-P3.
Performance deficits were found only for the ADHD group, who demonstrated a faster decline in response speed with time-on-task and greater overall within-subject variability. No group differences were found for cue-related ERP components. Yet, controlling for group differences in internalising problems, inhibitory control was reduced in all clinical groups compared to controls, as demonstrated by an absence of frontal amplification of P3 in the Nogo condition, relative to the Go condition. For the ADHD group, in contrast to the comorbid and the dyslexic group, this effect remained after controlling for externalising symptoms, indicating that only for the ADHD group deficiencies in inhibitory control were not explained by externalising behaviour.
Background Hypoactivation of the inferior frontal gyrus during the perception of facial expressions has been interpreted as evidence for a deficit of the mirror neuron system in children with autism. ...We examined whether this dysfunction persists in adulthood, and how brain activity in the mirror neuron system relates to social functioning outside the laboratory. Methods Twenty-one adult males with autism spectrum disorders and 21 typically developing subjects matched for age, sex, and IQ were scanned in three conditions: observing short movies showing facial expressions, performing a facial movement, and experiencing a disgusting taste. Symptom severity and level of social adjustment were measured with the Autism Diagnostic Observation Schedule and the Social Functioning Scale. Results Inferior frontal gyrus activity during the observation of facial expressions increased with age in subjects with autism, but not in control subjects. The age-related increase in activity was associated with changes in gaze behavior and improvements in social functioning. These age-related neurocognitive improvements were not found in a group of individuals with schizophrenia, who had comparable levels of social functioning. Conclusions The results of this cross-sectional study suggest that mirror neuron system activity augments with age in autism and that this is accompanied by changes in gaze behavior and improved social functioning. It is the first demonstration of an age-related neurocognitive improvement in autism. Increased motor simulation may contribute to the amelioration in social functioning documented in adolescence and adulthood. This finding should encourage the development of new therapeutic interventions directed at emotion simulation.
Abstract Objective Performance monitoring was investigated in typically developing (TD) children, children with Autistic Spectrum Disorder (ASD), and Methylphenidate (Mph)-treated and medication-free ...children with Attention Deficit Hyperactivity Disorder (ADHD). Methods Subjects performed a feedback-based learning task. Event-related Potentials (ERPs) time locked to responses and feedback were derived from the EEG. Results Compared to the TD and ASD groups, the medication-free ADHD group showed a decreased response-locked Error Related Negativity (ERN) and error Positivity (Pe), particularly as learning progressed throughout the task. Compared to the medication-free ADHD group, the Methylphenidate-treated group showed a normalised Pe. All clinical groups showed or tended to show a decreased feedback-locked late positive potential to negative feedback. Conclusions The ERPs suggest that medication-free children with ADHD, but not with ASD, have a diminished capacity to monitor their error responses when they are learning by performance feedback. This capacity partially ‘normalises’ in Mph-treated children with ADHD. Both children with ADHD and children with ASD are suggested being compromised in affective feedback processing. Significance This study shows that measuring ERPs of error and feedback processing is a useful method for (1) dissociating ADHD from ASD and (2) elucidating medication effects in ADHD on component processes of performance monitoring.
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