The behavioral science of ADHD: from diagnostics to interventions

Transcription

1 The behavioral science of ADHD: from diagnostics to interventions Detailed Information about the lecture(r)s: Lecture 1: Nanda Lambregts-Rommelse Title: Cognitive Test Application (COTAPP) It has consistently been shown that there is not one cognitive deficit underlying DSM-based developmental disorders, of which ADHD is the most often diagnosed and most well-known disorder (Fair et al, 2012; Rommelse et al, 2011; Sun & Bays, 2012; the Zeeuw et al., 2012). As in the general population, children with for example ADHD show relative weaknesses in one or more cognitive functions, in combination with normal to strong cognitive functions in other domains. These weaknesses differ from child to child. In clinical practice, this means that only a part of the children with suspected ADHD or another developmental disorder will have a poor score on many tested cognitive domains such as sustained attention, inhibition, planning and working memory (Nigg et al., 2005). For a test that contributes to the diagnostic process it is therefore essential to - within a limited time - measure as many cognitive processes as possible. By examining performance on all of these measures together, a cognitive profile of the patient including his/her relative strengths and weaknesses can be made. It is generally assumed that children with entirely different cognitive profiles differ from each other in predisposition, prognosis, and treatment needs. Cognitive weaknesses may contribute to the clinical severity and may be a target for treatment (think for example of working memory training). Cognitive strengths, on the other hand, can be used to compensate for cognitive weaknesses, and may give rise to educational adjustments for the child. As such, cognitive profiling is an important addition to clinical diagnostics. A test like the COTAPP (Cognitive Task Application) is thus an important addition to currently existing diagnostics. COTAPP is a short (+/- 30 minutes) computerized test that measures many cognitive functions in a playful manner, and, as such, can identify a profile of cognitive strengths and weaknesses. Nanda Rommelse is Associate Professor and junior Principal Investigator at the department of psychiatry (Radboud University Medical Center), research coordinator and healthcare psychologist in training at the outpatient university clinic Karakter and aspiring Principal Investigator at the Donders Institute. Her research focus is on improving diagnostic and treatment procedures of ADHD, by investigating the following key topics: - heritability of cognitive deficits in ADHD - stability of cognitive deficits in ADHD - development of innovative cognitive instruments for ADHD diagnosis - differential diagnoses of ADHD and autism - diagnosis of ADHD in combination with a very low or very high (gifted) IQ - treatment of ADHD with a restricted elimination diet Several of Nanda s accomplishments (Bachelor, two Master degrees, PhD) have been honored with the predicate cum laude and both her Master and PhD thesis were chosen as best thesis written in 2004 and 2009, respectively, by the Dutch Association for Neuropsychology. She has received a Venigrant, supervises/supervised 20 PhD candidates, has published over 100 articles in peer-reviewed, international journals and is editor of the journal European Child and Adolescent Psychiatry. In 2013

2 she was elected by the Dutch Network of Woman Professors as most talented young female researcher working in gamma sciences at the Radboud UMC/University. Lecture 2: Dagmar van Liefferinge Title: A rating measure of ADHD-related neuropsychological impairment in children and adolescents: Data from the Cognition And Motivation in Everyday Life (CAMEL) Scale from population and clinical samples A new parent questionnaire, the Cognition And Motivation of Everyday Life (CAMEL) scale, was developed to provide a comprehensive assessment of ADHD-related impairment across diverse cognitive, motivational and energetic domains in children. Its psychometric properties were investigated. Sixty items were generated to cover a wide range of putative ADHD-related neuropsychological processes. The questionnaire was applied in a mixed community and clinical sample of 952 of children (6 to 16 years old). Data on ADHD symptoms were also collected using a parent rating scale. Factor analysis identified six factors which we labelled (i) Cognition, (ii) Self- Direction and Organization, (iii) Effort Engagement, (iv) Arousal Regulation, (v) Motivational Responsiveness, and (vi) Cautiousness. Self-Direction and Organization and Arousal regulation were the strongest predictors for ADHD symptomatology. Self-Direction and Organization was strongly associated with inattention and Arousal Regulation with hyperactivity-impulsivity symptoms. Parents were able to reliably distinguish different domains of neuropsychological functioning. However, their views did not map directly on to contemporary models of ADHD neuropsychological impairment derived from empirical study using laboratory tests. Dagmar Van Liefferinge received her master s degree Clinical Psychology in She is a research assistant at the Faculty of Psychology and Educational Sciences of the KU Leuven. She is a staff member of the research group Clinical Psychology. Her main research interests are in the field of psychopathology in children and adolescents. Her PhD project focuses on the emotional and neuropsychological functioning of children and adolescents with ADHD. Her research is supervised by Prof. Nady Van Broeck, Prof. Marina Danckaerts and Prof. Saskia Van der Oord. Lecture 3: Hasse De Meyer Title: Associative learning processes in children with ADHD Until now little research has assessed if ADHD symptoms might be caused or mediated by a deficit in associative learning processes, although both motivational processing and working memory are important for this elementary learning and prevailing in the theoretical frameworks of ADHD. Conditional discrimination learning or learning which choice between two behavioral options is appropriate given a certain context is a type of associative learning that can be related to the problems that children with ADHD experience in adjusting their behavior to environmental demands and situational changes. The aim of the study is, therefore, to explore whether ADHD is accompanied by deficits in condition discrimination learning and what the relation is with working memory and motivational functioning. Condition Discrimination Learning is investigated through an adapted Delayed Matching To Sample Task in approximately 28 children (age: 8-12, 14 with ADHD and 14 normally developing children) together with tasks for working memory and motivational processes. The data collection is currently running and preliminary results will be presented in the

3 symposium. This research should yield a better understanding of the interplay between reward processing, working memory and elementary learning deficits in normally developing children. Hasse De Meyer is a clinical psychologist and doctoral researcher at the department of Clinical Psychology/Centre of Learning and Experimental Psychopathology of the Faculty of Psychology and Educational Sciences and a member of the interdisciplinary research group ADHDynamisch [see ADHDynamisch.be] of the KU Leuven. Her research focuses on associative learning processes and remediation of these processes in children with ADHD. Her supervisor is Prof. dr. Saskia van der Oord and co-supervisor is Prof. dr. Tom Beckers. She obtained her Bachelor s degree in psychology in 2011 and her Master s degree in clinical psychology in 2013, both at KU Leuven. In 2014 she started her doctoral research. Lecture 4: Saskia van der Oord Title: Behavioral parent training and operant learning in ADHD Behavioral parent training consists of a package of different techniques, in which operant learning (acquisition of adaptive behavior through reinforcement, and extinction of non-adaptive behavior through extinction) is considered a core element. Within samples of children with ADHD as a package behavioral parent training is moderately effective, although long-term effects are limited and ADHD behavior is often not changed. To enhance effectiveness of BPT, knowledge of effectiveness of individual elements of treatments within target populations is needed. This lecture gives an overview of issues which may be related to the limited effectiveness of behavioral parent training for ADHD and describes preliminary results of a study of operant learning (acquisition/extinction) in children with ADHD. Potential implications of these results for adaptation of common behavioral parent training programs for children with ADHD are discussed. Saskia van der Oord s research is focused on childhood psychopathology. Her main research focus is related to translating recent knowledge of underlying mechanisms of behavioral disorders (mainly ADHD) into treatment modalities, and experimentally testing these treatments on their effectiveness. She is a licensed Behavior Therapist, and has a lot of clinical experience with (cognitive) behavioral treatment for children and adolescents with psychopathology such as ADHD. She works as a clinical child psychologist/behavior therapist and supervises postmaster psychology students in the Faculty s assessment and intervention facility Praxis P ( Further she is affiliated staff of Developmental Psychology of the University of Amsterdam. She is (co)promotor of several Grants both in the Netherlands (ZONmw/ Kinderpostzegels) and in Belgium (FWO/ Internal funds of the KU Leuven), and is and has been (co)promotor of several Phd students both in the Netherlands and Belgium. Lecture 5: Joanneke Weerdmeester Title: Adventurous Dreaming Highflying Dragon - A Feasibility Study on the Effectiveness of a Full- Body Videogame Intervention in Decreasing ADHD Symptoms In my talk I will share the results of a study that assessed the feasibility and effectiveness of a fullbody driven intervention videogame targeted at decreasing ADHD-symptoms, specifically:

4 inattention, hyperactivity, impulsivity and motor deficiency. The game was tested in a Dutch sample (N=73) of school-aged children with elevated ADHD-symptoms. Children assigned to the intervention condition played a full-body driven videogame (using the Xbox 360 Kinect camera) called Adventurous Dreaming Highflying Dragon and those in the control condition played a comparable full-body driven game without ADHD-focused training components. Games were played during six 15-minute sessions. Outcomes were teacher-rated ADHD-symptoms and scores on neuropsychological tasks assessing motor skills, impulsivity and sustained attention. The results indicate that Dragon seems promising as a game-based intervention tool for children with ADHD. Children that played the game improved in several areas with only a short amount of game play (1.5 hrs in total) and their satisfaction with the game was high. Joanneke Weerdmeester is currently working as a PhD-candidate as part of the Developmental Psychopathology research programme at the Behavioural Science Institute in Nijmegen. Her research is focused on the development and validation of game-based interventions for children. Prior to this appointment she obtained both a clinical psychology master degree as well as a behavioural science research master degree at the Radboud University, Nijmegen. Lecture 6: Ili Ma Title: Quantifying response inhibition and its modulation by affect in children and adolescents with ADHD Attention-deficit/hyperactivity disorder (ADHD) has been increasingly recognized as a multi-systemic developmental disorder, with altered cognitive (inhibitory) control and affective processing. Response inhibition is typically defined as the ability to withhold a pre-potent or ongoing response. However, previous ADHD studies have not directly quantified responses as a continuous measure, therefore lacking a direct measure of ongoing responses. This study aimed to assess the conjunction between response inhibition and affect in ADHD patients (n=34) compared to healthy controls (n=36) during childhood and adolescence (9-17 years) using such a continuous measure. An emotional go/nogo paradigm consisting of fearful, neutral, and happy facial expressions was administered. Participants responses were recorded on a device which also measured the strength of the pressure change, allowing a continuous quantification of responses and response strength. The results demonstrate that response inhibition is modulated by valence. Moreover, the applied method provides detailed insight into response inhibition in children and adolescents with and without ADHD. Ili Ma obtained her master's degree in Psychology & Neuroscience at Maastricht University. Her PhD at the Radboud University focused on cognitive control and reinforcement interactions in children and adolescents with ADHD using both behavioral and fmri measurements. She is currently a postdoc in a collaboration project between the Radboud University and VU Amsterdam on the neural correlates of social decision making in chronically peer-rejected children. Lecture 7: Sarah Morsink Title: What motivates children and adolescents with ADHD: a qualitative study

5 It has been suggested that individuals with ADHD have quantitative motivational differences as compared to their typically developing peers however, to date few studies have assessed potential qualitative differences. I will illustrate a qualitative study aimed to identify the broad variety of potentially motivating factors in children and adolescents with and without ADHD, using a semistructured interview on factors that drive behavior in everyday life. Sarah Morsink obtained a Master s degree in Clinical and in Experimental psychology. Currently, she is a PhD-student at the department of Child and Adolescent Psychiatry of the KU Leuven. Her research is focussed on ADHD and motivation, and is under supervision of prof. Danckaerts, prof. Van der Oord, and dr. Lemiere. Lecture 8: Gabry Mies Title: Mental effort in adolescents with ADHD Mental effort plays an important factor in theoretical models of ADHD; it is central to both motivational and cognitive energetic theories, but it has been underspecified and under-examined empirically. It could, however, provide the missing link between task performance of difficult and challenging tasks requiring cognitive control, and the effects of extrinsic rewards on performance. One theoretical model that might help us explain this is the state regulation model proposed by van der Meere and Sergeant. This model postulates that children with ADHD have a dysfunction in their activation system, and so may require greater levels of effort to regulate their energetic state during response preparation. Because of this, it is possible that children with ADHD become effort averse as they try to avoid the negative emotionality associated with effortful tasks, analogous to the idea that children with ADHD develop an aversion to delay due to negative experiences with delay. In this talk I will present preliminary data of an exploratory study that examined two putative effort-related deficits in ADHD; First, impairments in the ability to apply effort and second, alterations in effortrelated decision making due to an altered cost-benefit analysis relating to the application of effort. For this purpose, both pupil measurements and subjective rating scales were included in order to objectively and subjectively measure mental effort. Gabry Mies is a postdoctoral researcher at the Behavioural Science Institute in the lab of Dr. Anouk Scheres (Developmental Cognitive Affective Neuroscience (DCAN) lab). Her research focuses on behavioral and neural correlates of delay and (physical) effort discounting in ADHD. In she spent 10 months at the department of Child and Adolescent Psychiatry of the University hospital Leuven (KU Leuven), Belgium, where she conducted a study on mental effort in adolescents with ADHD. Gabry obtained her PhD at the Department of Psychiatry of the Erasmus MC, Rotterdam in 2011, and her master s degree in Biology at Wageningen University in Lecture 9: Dieter Baeyens Title: Accommodations for students with ADHD in higher education: a perfect match with functional and participation problems? The phenomenology of ADHD changes across the lifespan but remains associated with impairment in various domains such as education (Schmitt & Petermann, 2008). Students with ADHD are more likely to repeat years and are less likely to graduate in higher education (Weyandt & DuPaul, 2008).

6 Although reasonable accommodations potentially neutralize functional impairments, they fail to do so when they do not take into account age-specific manifestations of ADHD and the wide range of teaching and evaluation methods. Also, implementation parameters of accommodations are currently set on an intuitive basis (e.g., how much additional time is needed in extended examination duration?). Therefore, we aim to extend current knowledge on the selection and implementation of accommodations in students with ADHD in higher education. Firstly, we examined which problems students with ADHD experience in a variety of teaching and evaluation methods through a systematic literature review and a survey study. A set of 16 problems was reported to be more prevalent in 86 students with ADHD compared to 250 controls. However, impairment fluctuated across teaching and evaluation methods. For most problems, a set of effective accommodations could be determined. Secondly, in an experimental design, we investigated optimal implementation parameters of extended examination duration (+0%, +33%, +50%) in 30 students with and 70 students without ADHD during a closed-book exam. Findings will be presented at the meeting and should provide insight on the optimal dose at which functional impairment is neutralized, be it without giving (unfair) advantage to students with ADHD. Dieter Baeyens studied clinical psychology at Ghent University ( ). In 2005 he obtained his PhD in psychological sciences at the same university, focusing on the longitudinal and neural association between ADHD and enuresis. Between 2005 and 2008 he continued this line of research at Ghent University, while also being a visiting fellow at the research abs of Sarah Durston (University of Utrecht) and of Rita Goldstein and Nora Volkow (Brookhaven National Laboratory). As of 2008, Dieter Baeyens was the coordinator of the expertise unit Behavioural and Developmental disorders at Thomas More University College, Antwerp. This multidisciplinary expertise unit combined both clinical activities and applied research on the topic of ADHD and ASD in emerging adults. In 2013, Dieter Baeyens became associate professor at the research unit Parenting and Special Education, KU Leuven. Here, he continues his work on transitional care in education and health care for emerging adults with ADHD and ASD. Currently, he is also coordinator of the special interest group Special Educational Needs of the European Association of Research on Learning and Instruction (EARLI).