#5 Abstract The goal of experiment is to determine the extent of the role of the environment in affecting 1)alerting; 2)executive control;

and 3) reorienting in teenagers diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). Twenty teenage ADHD patients whose primary caregiver does not have ADHD are administered a modified version of the Attention Network Task (ANT) while being placed inside of an FMRI machine. A separate test is then administered to measure chaos in the home (environmental influences). The data from the two tests will be closely scrutinized to see if there are trends among the three subsets of scores on the test (listed above in the goal). If a correlation is determined between chaos in the home and one of the three subsets from the ANT task, further research can be done in that one area to determine more efficient ways to avoid the enhancement of ADHD symptoms. It is hypothesized that overall performance on the ANT task will be negatively correlated with amount of chaos in the home. More specifically it is hypothesized that executive control will be the most glaring [negatively] subset of the scores, alerting and reorienting should also be affected. Regions of interest will include the superior parietal cortex, insula, inferior frontal gyrus, superior temporal gyrus, and the superior frontal gyrus (Tamm, 2004, Konrad, 2005). Introduction For quite some time there has been debate as to whether or not the environment actually has an effect on ADHD teenagers, and if it does, in what regard. The most common and logical way to determine this effect is to measure chaos in the home and relate it somehow to behavioral patterns or brain images of ADHD teenagers. While studies in the past have been done to analyze similarly posed questions and ideas, no study has ever specifically tested for 1)analyzing, 2)executive control, and 3) reorienting, and attempted to find a correlation between one of these three specific categories, and chaos in the home. Background and Significance Attention Deficit Hyperactive Disorder is a disease that is diagnosed in up to 7% of American children, ages 6-11 and which continues into adulthood. DSM-IV Criteria for diagnosing a person with ADHD states that six or more of a given list of symptoms indicative of A) inattention, B) hyperactivity-impulsivity, or C) impulsivity must be present for at least six months to a point that is inappropriate for developmental level (Department of Health and Human Services, 2005). This research will be limited to ADHD patients presenting symptoms of inattention to eliminate potential experimental cohorts and to maximize accuracy throughout the administration of the modified ANT task. The table below summarizes the symptoms that are present in ADHD patients who exhibit inattention.

Figure 1-1: DSM-IV Criteria For ADHD- Inattention 1. Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities. 2. 3. Often has trouble keeping attention on tasks or play activities. Often does not seem to listen when spoken to directly.

4. Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions). 5. Often has trouble organizing activities.

6. Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework). 7. Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools). 8. 9. Is often easily distracted. Is often forgetful in daily activities.

Terms to Familiarize With Alerting: achieving and maintaining an alert state (Smothergill, 1989, Konrad, 2005) Executive control: resolving conflict among responses (Konrad, 2005) Reorienting: cognitive task that forces human to adjust when stimuli occur outside the current focus of attention (Konrad, 2005) Chaos: disarray and disorder that occurs in the home (Matheny, 1995) ADHD patients: only focuses on the diagnosis based on the inattention aspect of ADHDnote that hyperactivity or impulsivity symptoms may occur comorbid with inattention symptoms (Pennington, 2005) In previous research performed by Konrad et al. (2005) it was determined that the superior parietal cortex, inferior frontal gyrus, superior temporal gyrus, and the superior frontal gyrus were all activated by during a similar ANT task when measuring for executive control in both children and adults. Though only teenagers are being used in this research study, the proposed ROI are the same as in the previous literature because while it is hypothesized that ADHD patients will show different results from the ANT task than a person without ADHD, the brain activation areas should remain virtually unchanged. The degree of chaos in the home in this experiment will be assessed using a predetermined scale. The scale consists of six items rated on a five-point scale (1=definitely untrue, 5=definitely true) about the levels of chaos in the home. The sample items include You cant hear yourself think in our home and We are usually able to stay on top of things (Matheny, 1995). Chaos measurements are terrific ways to test for environmental influences that could potentially give answers to questions on environmental factors and ADHD (Petrill, 2004). Method of Approach Specific Aim 1 To establish a correlation between amount of chaos in the home and performance on a modified ANT task which measures alerting, executive control, and reorienting. Afterwards, the data will be analyzed and a regression will be plotted which demonstrates chaos vs. BOLD signals of ROI.

A.

Hypothesis

High levels of chaos in the home will lead teenagers diagnosed with ADHD to perform worse on a modified ANT task than ADHD-teenage patients who live with a low level of chaos in the home (Matheny, 2005). Superior parietal cortex, insula, inferior frontal gyrus, superior temporal gyrus, and superior frontal gyrus activation will all occur throughout the experiment (Konrad, 2005). All three subsets of scores will be dramatically lower for ADHD teenagers as compared to standard scores of teenagers in previous studies. However, out of the three neural mechanisms associated with alerting, executive control, and reorienting, scores for executive control will be the lowest due to largely due to the fact that DSM-IV criteria state that inattention-diagnosed ADHD patients have tremendous trouble with organization and taking the time to complete tasks that require a significant amount of mental effort (Konrad, 2005). Since resolving conflict among responses is the key to executive control, it would make the most sense that this category would be most affected by the condition of ADHD as well as being even more negatively associated with high levels of chaos in the home. Scores for alerting and reorienting should also be negatively correlated with amount of chaos in the home, but not to the same to degree as executive control (Brown, 2005, Lajoie, 2003). B. Experiments Participants. Forty right-handed teenagers aged 13-17 (20 women) will be recruited for this study. Participants will be recruited by asking those students who meet the criteria and attend public schools in the Long Island/NYC area for permission. Participants will receive an undetermined monetary stipend for their time and effort with this research. Participants will not be allowed to take part in the study if they have any other diagnosed health disorders in addition to ADHD, nor will they be allowed into the study if they were not diagnosed with ADHD based on the DSM-IV criteria of inattention. Participants will also be notified of the risks and hazards that go along with being placed into an fmri machine so that they are fully aware of how the machine works and are aware of the claustrophobic conditions (Rubia, 1999). Measures. The degree of chaos in the home will be administered once in questionnaire format prior to the fMRI and modified ANT task. The questionnaire will ask participants to use the CHAOS scale given on the questionnaire and assign a number between 1 and 4 that correspond to the following: 1 = Very much like your own home; 2 = Somewhat like your own home; 3 = A little bit like your own home; 4 = Not at all like your own home (Matheny, 1995). The questionnaire consists of 15 statements to which the teenager must use the scale to answer the question. This information will then be used to determine the level of chaos in the home environment of the ADHD teenager. The questionnaire will be administered by a researcher in the study who will be present to answer any questions the participant may have about the questionnaire, and ensure that the participants are focused. When analyzing the data on the questionnaires, a higher score is correlated with increased chaos in the home since the questions will be phrased in such a way that a rating of 4 induces thoughts of their own hypothetical chaotic environment. fMRI procedure An event related fmri study is performed as the subjects are administered a modified version of the Attention Network Task (ANT) (Fan, 2002) which measure alerting, reorienting, and executive control. The ANT is a blend of the cued reaction time task (Posner and Petersen, 1990) and the flanker task (Konrad, 2005). The task requires the participants to attempt to determine if the third arrow out of five vertically arranged arrows points to the left or

points to the right. Efficiency of different attentional networks previously discussed is assessed by calculating response times and determining how these times are influenced by cues (alerting, spatial valid, or spatial invalid) and also congruent or incongruent flankers (Konrad, 2005). A set of stimuli is made available on a screen in front of the ADHD patient in the scanner. There are two buttons that the subject can press with their right hand using a keyboard that the subject has easy access to. Every stimulus contained a vertical row of five arrows (usually black), that were visually presented. These arrows pointed either to the left of to the right. The target arrow is the third arrow (middle arrow) which was flanked by two different arrows both above and below which pointed in the same direction (Konrad, 2005). When the arrows pointed in the same direction this was known as the congruent condition and when they pointed in the opposite direction, this is called the incongruent condition (Konrad, 2005). Subjects should use the keyboard given to them and push the one button to represent that the middle arrow points to the left, and a different button if the middle arrow points to the right. Each individual trial consists of four discrete parts. Initially, there is a 300-ms fixation period. Secondly, a warning cue was shown for 100-ms (Murphy, 2004). This warning cue was either a non-spatially informative double cue, a valid or invalid spatial cue, or no cue at all. Thirdly, another 300-ms fixation period is administered (Konrad, 2005). Finally, the target and flankers are presented for 1300-ms (Konrad, 2005). The order of trial types and flankers is randomized so that there would no set pattern and subjects would have to rely on visual acuity and concentration for success. Prior to this test actually being administered, all participants are made knowledgeable about the different trial types that were about to be presented to them (Konrad, 2005). For each of the three attentional networks previously discussed (alerting, reorienting, and executive control), there are formulas to come up with subscores for each section of the ANT. The alerting network is calculated by subtracting the average reaction time of the double cue trials from the mean reaction time of the no cue trials. The reorienting effect is calculated by determining the average reaction time of validly cued trials and subtracting that from the average reaction time of invalidly cued trials. Executive control is calculated by subtracting the mean reaction time of all the congruent flanker trials from the mean reaction time of incongruent flanker trials (Konrad., 2005). fmri Analysis and CHAOS analysis For each of the participants in the study, data was analyzed with Statistical Parametric Mapping software (Konrad, 2005). Region of interest (ROI) data and analysis will be used with ANOVA and will be performed by identifying brain activation or lack of brain activation in each of the hypothesized areas: superior parietal cortex, insula, inferior frontal gyrus, superior temporal gyrus, and the superior frontal gyrus. (Yantis, 2002). Results from the CHAOS questionnaire will then be entered into an excel spreadsheet along with raw scores obtained for the three networks (alerting, reorienting, executive control.) A regression will be plotted for any correlation between chaos and attentional networks. Possible Results Participant CHAOS Questionnaire Score Alerting Score(low, medium, high); Reorienting # (out of 60)[15 questions, max Score(low, medium, high); Executive Control rating of 4/question] Score(low,medium,high) 1. 50 medium;medium;low 2. 26 Medium;high;high

3. 4. 5. 6. 7. 8. 9.

58 43 22 16 18 51 33

low;low;low Medium;medium;low High;high;medium High;high;high High;high;high Low;medium;low Medium;low;medium

Possible interpretations of above results. 1. This subject scored fairly high on the chaos test, indicating that chaos is indeed prevalent in his/her home. The subject scored medium on the alerting and reorienting task, and low on the executive control task, which supports the hypothesis that executive control will be the most glaring subscore when chaos is prevalent. 2. This subject scored fairly low on the chaos test indicating that chaos is not extremely prevalent in his/her home. The subject scored medium on the alerting task, and high on both the reorienting and executive control task which once again supports the hypothesis that all three networking systems will be affected [or unaffected] by level of chaos in the home.4-6. 3. This subject scored extremely high on the chaos test indicating that chaos is extremely prevalent in his/her home. The subject scored low on all three tasks which once again supports the hypothesis that all three networking systems will be affected [or unaffected] by level of chaos in the home. 4. This subject scored middle-level on the chaos test indicating that chaos somewhat prevalent in his/her home. The subject scored medium on the alerting task, and medium on the reorienting task. Subject scored low on the executive control task which once again supports the hypothesis that all three networking systems will be affected [or unaffected] by level of chaos in the home and that executive control is the most glaring subscore that is affected by chaos in the home. 5-9. Subjects results are consistent with the first four in terms of performance on CHAOS test correlating with performance on the attention tasks. Hypothesis appears to be valid with each additional trial. Brain imaging will confirm that initial regions of interest were indeed activated throughout the experiment. D. Problems and Pitfalls The main potential problem in this experiment is the lack of focus given to the CHAOS questionnaire. If the sample of participants is comprised of ADHD patients who have trouble focusing, staying organized, and paying attention, it may be difficult to ensure that they are rating each statement on the questionnaire with full competency or capabilities. This self-report method of obtaining data is very risky for several reasons in general, but more specifically in this

scenario it is risky because it could lead to faulty results which may not accurately state the level of chaos in the participants homes. If the questionnaire is faulty, the subject should not be used in the data collection. However, there is no clear-cut way to determine if the questionnaire is faulty unless someone else who lives in their household fills out a theoretical questionnaire for the participant. This method, however, is unrealistic, and has limitations within itself. Future Directions In the future, if a correlation is indeed found between executive control in ADHD patients and chaos in the environment, researchers, behaviorists, and psychologists alike can find ways to specifically limit or reduce chaos in the house with regard to executive control thinking and reasoning pathways. Further research can be done and go into depth on different daily activities that these participants do that actually utilize the executive control networking system, and even more data can be obtained to assist in the reduction of chaos in the homes of these ADHD teenagers.