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Article: Modeling attention-deficit/hyperactivity disorder: a critical appraisal of the cognitive-energetic model.

Sergeant, Joseph A

2005 Volume 57, Issue 11, Page(s) 1248–1255

Abstract: A number of theoretical models of attention-deficit/hyperactivity disorder (ADHD) have emerged in recent years that may be used as systematic guides for clinical research. The cognitive-energetic model (CEM) proposes that the overall efficiency of ... ...

Abstract	A number of theoretical models of attention-deficit/hyperactivity disorder (ADHD) have emerged in recent years that may be used as systematic guides for clinical research. The cognitive-energetic model (CEM) proposes that the overall efficiency of information processing is determined by the interplay of three levels: computational mechanisms of attention, state factors, and management/executive function (EF). The CEM encompasses both top-down and bottom-up processes and draws attention to the fact that ADHD causes defects at all three levels. These include cognitive mechanisms, such as response output; energetic mechanisms, such as activation and effort; and management/EF deficits. Increasing evidence suggests that inhibition deficits associated with ADHD may, at least in part, be explained in terms of an energetic dysfunction. The activation and effort energetic pools appear most relevant to ADHD, being directly related to response organization; however, further testing of CEM is critically dependent on the development of direct measures of these energetic pools. The CEM is a comprehensive model of ADHD but is not without limitations. In particular, further research is required to define more specifically the relationship between process dysfunction and state dysregulation in ADHD.
MeSH term(s)	Animals ; Attention Deficit Disorder with Hyperactivity/physiopathology ; Cognition/physiology ; Energy Metabolism/physiology ; Humans ; Inhibition (Psychology) ; Memory, Short-Term/physiology ; Models, Neurological ; Motor Activity/physiology ; Problem Solving/physiology ; Sleep/physiology
Language	English
Publishing date	2005-06-01
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Review
ZDB-ID	209434-4
ISSN	1873-2402 ; 0006-3223
ISSN (online)	1873-2402
ISSN	0006-3223
DOI	10.1016/j.biopsych.2004.09.010
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Article ; Online: A behavioral neuroenergetics theory of ADHD.

Killeen, Peter R / Russell, Vivienne A / Sergeant, Joseph A

Neuroscience and biobehavioral reviews

2013 Volume 37, Issue 4, Page(s) 625–657

Abstract: Energetic insufficiency in neurons due to inadequate lactate supply is implicated in several neuropathologies, including attention-deficit/hyperactivity disorder (ADHD). By formalizing the mechanism and implications of such constraints on function, the ... ...

Abstract	Energetic insufficiency in neurons due to inadequate lactate supply is implicated in several neuropathologies, including attention-deficit/hyperactivity disorder (ADHD). By formalizing the mechanism and implications of such constraints on function, the behavioral Neuroenergetics Theory (NeT) predicts the results of many neuropsychological tasks involving individuals with ADHD and kindred dysfunctions, and entails many novel predictions. The associated diffusion model predicts that response times will follow a mixture of Wald distributions from the attentive state, and ex-Wald distributions after attentional lapses. It is inferred from the model that ADHD participants can bring only 75-85% of the neurocognitive energy to bear on tasks, and allocate only about 85% of the cognitive resources of comparison groups. Parameters derived from the model in specific tasks predict performance in other tasks, and in clinical conditions often associated with ADHD. The primary action of therapeutic stimulants is to increase norepinephrine in active regions of the brain. This activates glial adrenoceptors, increasing the release of lactate from astrocytes to fuel depleted neurons. The theory is aligned with other approaches and integrated with more general theories of ADHD. Therapeutic implications are explored.
MeSH term(s)	Attention/physiology ; Attention Deficit Disorder with Hyperactivity/genetics ; Attention Deficit Disorder with Hyperactivity/physiopathology ; Attention Deficit Disorder with Hyperactivity/psychology ; Energy Metabolism/physiology ; Female ; Humans ; Lactic Acid/metabolism ; Male ; Memory, Short-Term/physiology ; Norepinephrine/physiology ; Psychomotor Performance/physiology ; Receptors, Adrenergic/physiology
Chemical Substances	Receptors, Adrenergic ; Lactic Acid (33X04XA5AT) ; Norepinephrine (X4W3ENH1CV)
Language	English
Publishing date	2013-05
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	282464-4
ISSN	1873-7528 ; 0149-7634
ISSN (online)	1873-7528
ISSN	0149-7634
DOI	10.1016/j.neubiorev.2013.02.011
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Article ; Online: Impaired decision making in oppositional defiant disorder related to altered psychophysiological responses to reinforcement.

Luman, Marjolein / Sergeant, Joseph A / Knol, Dirk L / Oosterlaan, Jaap

Biological psychiatry

2010 Volume 68, Issue 4, Page(s) 337–344

Abstract: Background: When making decisions, children with oppositional defiant disorder (ODD) are thought to focus on reward and ignore penalty. This is suggested to be associated with a state of low psychophysiological arousal.: Methods: This study ... ...

Abstract	Background: When making decisions, children with oppositional defiant disorder (ODD) are thought to focus on reward and ignore penalty. This is suggested to be associated with a state of low psychophysiological arousal. Methods: This study investigates decision making in 18 children with oppositional defiant disorder and 24 typically developing control subjects. Children were required to choose between three alternatives that carried either frequent small rewards and occasional small penalties (advantageous), frequent large rewards and increasing penalties (seductive), or frequent small rewards and increasing penalties (disadvantageous). Penalties in the seductive and disadvantageous alternatives increased either in frequency or magnitude in two conditions. Heart rate (HR) and skin conductance responses to reinforcement were obtained. Results: In the magnitude condition, children with ODD showed an increased preference for the seductive alternative (carrying large rewards); this was not observed in the frequency condition. Children with ODD, compared with typically developing children, displayed greater HR reactivity to reward (more HR deceleration) and smaller HR reactivity to penalty. Correlation analyses showed that decreased HR responses to penalty were related to an increased preference for large rewards. No group differences were observed in skin conductance responses to reward or penalty. Conclusions: The findings suggest that an increased preference for large rewards in children with ODD is related to a reduced cardiac reactivity to aversive stimuli. This confirms notions of impaired decision making and altered reinforcement sensitivity in children with ODD and adds to the literature linking altered autonomic control to antisocial behavior.
MeSH term(s)	Analysis of Variance ; Arousal/physiology ; Attention Deficit and Disruptive Behavior Disorders/physiopathology ; Attention Deficit and Disruptive Behavior Disorders/psychology ; Case-Control Studies ; Child ; Choice Behavior ; Decision Making ; Female ; Galvanic Skin Response/physiology ; Gambling/psychology ; Games, Experimental ; Heart Rate/physiology ; Humans ; Logistic Models ; Male ; Psychology, Child ; Punishment/psychology ; Reference Values ; Reward ; Risk-Taking
Language	English
Publishing date	2010-08-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	209434-4
ISSN	1873-2402 ; 0006-3223
ISSN (online)	1873-2402
ISSN	0006-3223
DOI	10.1016/j.biopsych.2009.12.037
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Article: Modulation of response timing in ADHD, effects of reinforcement valence and magnitude.

Luman, Marjolein / Oosterlaan, Jaap / Sergeant, Joseph A

Journal of abnormal child psychology

2007 Volume 36, Issue 3, Page(s) 445–456

Abstract: The present study investigated the impact of reinforcement valence and magnitude on response timing in children with ADHD. Children were required to estimate a 1-s interval, and both the median response time (response tendency) and the intrasubject- ... ...

Abstract	The present study investigated the impact of reinforcement valence and magnitude on response timing in children with ADHD. Children were required to estimate a 1-s interval, and both the median response time (response tendency) and the intrasubject-variability (response stability) were investigated. In addition, heart rate and skin conductance were measured to examine the autonomic responses to reinforcement. Feedback-only trials were compared to low response cost trials (response cost for incorrect responses), low reward trials (reward for correct responses), high response cost and high reward trials. In feedback-only trials, children with ADHD underestimated more severely the interval and responded more variably than controls. Children with ADHD, unlike controls, were unaffected by the reinforcement conditions in terms of time underestimations. The variability of responding, on the other hand, decreased under conditions of reinforcement to a larger extent in children with ADHD than controls. There were no indications that children with ADHD were abnormally affected by the valence or magnitude of reinforcement. Furthermore, skin conductance responses increased when feedback was coupled with reinforcement, an effect which was larger in children with ADHD than controls. This could be interpreted as demonstrating that children with ADHD suffer from a diminished awareness of the significance of feedback in the feedback-only condition. The current study suggests that children with ADHD suffer from motivation problems when reinforcement was not available, at least when variability in responding was measured. Underestimations of time may reflect more stable deficits in ADHD.
MeSH term(s)	Attention Deficit Disorder with Hyperactivity/diagnosis ; Attention Deficit Disorder with Hyperactivity/psychology ; Child ; Diagnostic and Statistical Manual of Mental Disorders ; Female ; Humans ; Male ; Reaction Time ; Reinforcement, Psychology ; Reward ; Severity of Illness Index ; Time Factors
Language	English
Publishing date	2007-11-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	193136-2
ISSN	1573-2835 ; 0091-0627
ISSN (online)	1573-2835
ISSN	0091-0627
DOI	10.1007/s10802-007-9190-8
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Article ; Online: RD, ADHD, and their comorbidity from a dual route perspective.

de Jong, Christien G W / Licht, Robert / Sergeant, Joseph A / Oosterlaan, Jaap

Child neuropsychology : a journal on normal and abnormal development in childhood and adolescence

2012 Volume 18, Issue 5, Page(s) 467–486

Abstract: In order to achieve further insight into the comorbidity of reading disorder (RD) and attention deficit/hyperactivity disorder (ADHD), lexical processing and rapid naming were studied in RD and ADHD. The Dual Route Cascaded model postulates that lexical ... ...

Abstract	In order to achieve further insight into the comorbidity of reading disorder (RD) and attention deficit/hyperactivity disorder (ADHD), lexical processing and rapid naming were studied in RD and ADHD. The Dual Route Cascaded model postulates that lexical processing contains two parallel processes: lexical route processing and sublexical route processing. An orthographic decision task and a phonological decision task were used to measure lexical and sublexical route processing, respectively. In addition, a rapid naming task was used to compare 27 children with RD, 18 children with ADHD, 20 children with ADHD+RD, and 29 controls. RD and ADHD shared impairments in accuracy of orthographic and phonological decision making as well as in rapid naming, which suggest that RD and ADHD may be overlapping disorders that share deficits in both lexical route and sublexical route processing. RD was dissociated from ADHD by being slower in both orthographical and phonological decision making that indicates unique deficits in RD on lexical and sublexical speed.
MeSH term(s)	Adolescent ; Attention Deficit Disorder with Hyperactivity/complications ; Attention Deficit Disorder with Hyperactivity/physiopathology ; Case-Control Studies ; Child ; Decision Making ; Dyslexia/complications ; Dyslexia/physiopathology ; Female ; Humans ; Intelligence Tests ; Male ; Neuropsychological Tests ; Phonetics ; Reaction Time
Language	English
Publishing date	2012
Publishing country	England
Document type	Journal Article
ZDB-ID	1483041-3
ISSN	1744-4136 ; 0929-7049
ISSN (online)	1744-4136
ISSN	0929-7049
DOI	10.1080/09297049.2011.625354
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Article ; Online: Developmental trajectories of neural mechanisms supporting conflict and error processing in middle childhood.

van Meel, Catharina S / Heslenfeld, Dirk J / Rommelse, Nanda N / Oosterlaan, Jaap / Sergeant, Joseph A

Developmental neuropsychology

2012 Volume 37, Issue 4, Page(s) 358–378

Abstract: To study age-related changes in cognitive control, event-related potentials (ERPs) of children aged 6-9 years, 10-12 years, and young adults were recorded during a Flanker task. Younger children were more susceptible to conflict than older ones and ... ...

Abstract	To study age-related changes in cognitive control, event-related potentials (ERPs) of children aged 6-9 years, 10-12 years, and young adults were recorded during a Flanker task. Younger children were more susceptible to conflict than older ones and adults. The N2 in incongruent trials was smaller in younger than older children, who did not differ from adults. The error-related negativity (ERN) following errors, however, was larger in adults than in children, but did not differ between younger and older children. Delayed development of neural responses to error processing relative to conflict monitoring may indicate dissociable maturational time tables of subdivisions of the anterior cingulate cortex.
MeSH term(s)	Adolescent ; Adult ; Child ; Child Development/physiology ; Cognition/physiology ; Conflict (Psychology) ; Electroencephalography/methods ; Evoked Potentials/physiology ; Female ; Gyrus Cinguli/physiology ; Humans ; Male ; Neuropsychological Tests ; Young Adult
Language	English
Publishing date	2012
Publishing country	England
Document type	Comparative Study ; Journal Article
ZDB-ID	632665-1
ISSN	1532-6942 ; 8756-5641
ISSN (online)	1532-6942
ISSN	8756-5641
DOI	10.1080/87565641.2011.653062
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Article: ADHD and DCD: a relationship in need of research.

Sergeant, Joseph A / Piek, Jan P / Oosterlaan, Jaap

Human movement science

2006 Volume 25, Issue 1, Page(s) 76–89

Abstract: Although the connection between attention deficit hyperactivity disorder (ADHD) and developmental coordination disorder (DCD) has been recognized for several decades, little research has examined the relationship between these two disorders. This paper ... ...

Abstract	Although the connection between attention deficit hyperactivity disorder (ADHD) and developmental coordination disorder (DCD) has been recognized for several decades, little research has examined the relationship between these two disorders. This paper draws attention to the contribution the cognitive-energetic model (CEM) can make in determining the specific nature of these two disorders. An information processing approach such as the CEM is a useful model to identify specific and overlapping mechanisms that are disrupted in these two disorders. This paper describes the CEM and reviews the research so-far in relation to the model. The CEM has several advantages over other models: First, it predicts which task variables will be independent or may interact, thus enabling the investigator to determine the success/failure of the task manipulation(s) and identify spurious findings. Second, the CEM links energetic factors to task variables and predicts both additive and interactive effects. Third, the CEM enables executive processes such as selective attention, working memory and inhibition to be related to both energetic and lower level processes. Fourth, by employing the CEM in clinical research, taxonomy of deficits can be derived enabling further insight into the nature of the disorders and their specific neuropsychological dysfunction. Suggestions are made for future research into the neuropsychological deficits associated with ADHD and DCD.
MeSH term(s)	Attention Deficit Disorder with Hyperactivity/epidemiology ; Child ; Cognition Disorders/diagnosis ; Cognition Disorders/epidemiology ; Health Services Needs and Demand ; Humans ; Motor Skills Disorders/epidemiology ; Research
Language	English
Publishing date	2006-02
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	601851-8
ISSN	1872-7646 ; 0167-9457
ISSN (online)	1872-7646
ISSN	0167-9457
DOI	10.1016/j.humov.2005.10.007
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Article ; Online: A review on eye movement studies in childhood and adolescent psychiatry.

Rommelse, Nanda N J / Van der Stigchel, Stefan / Sergeant, Joseph A

Brain and cognition

2008 Volume 68, Issue 3, Page(s) 391–414

Abstract: The neural substrates of eye movement measures are largely known. Therefore, measurement of eye movements in psychiatric disorders may provide insight into the underlying neuropathology of these disorders. Visually guided saccades, antisaccades, memory ... ...

Abstract	The neural substrates of eye movement measures are largely known. Therefore, measurement of eye movements in psychiatric disorders may provide insight into the underlying neuropathology of these disorders. Visually guided saccades, antisaccades, memory guided saccades, and smooth pursuit eye movements will be reviewed in various childhood psychiatric disorders. The four aims of this review are (1) to give a thorough overview of eye movement studies in a wide array of psychiatric disorders occurring during childhood and adolescence (attention-deficit/hyperactivity disorder, oppositional deviant disorder and conduct disorder, autism spectrum disorders, reading disorder, childhood-onset schizophrenia, Tourette's syndrome, obsessive compulsive disorder, and anxiety and depression), (2) to discuss the specificity and overlap of eye movement findings across disorders and paradigms, (3) to discuss the developmental aspects of eye movement abnormalities in childhood and adolescence psychiatric disorders, and (4) to present suggestions for future research. In order to make this review of interest to a broad audience, attention will be given to the clinical manifestation of the disorders and the theoretical background of the eye movement paradigms.
MeSH term(s)	Adolescent ; Attention Deficit Disorder with Hyperactivity/diagnosis ; Attention Deficit Disorder with Hyperactivity/physiopathology ; Attention Deficit Disorder with Hyperactivity/psychology ; Child ; Eye Movements/physiology ; Humans ; Memory/physiology ; Mental Disorders/diagnosis ; Mental Disorders/physiopathology ; Mental Disorders/psychology ; Psychiatric Status Rating Scales ; Saccades/physiology ; Visual Perception/physiology
Language	English
Publishing date	2008-12
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	603163-8
ISSN	1090-2147 ; 0278-2626
ISSN (online)	1090-2147
ISSN	0278-2626
DOI	10.1016/j.bandc.2008.08.025
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Article ; Online: Decision-making in ADHD: sensitive to frequency but blind to the magnitude of penalty?

Luman, Marjolein / Oosterlaan, Jaap / Knol, Dirk L / Sergeant, Joseph A

Journal of child psychology and psychiatry, and allied disciplines

2008 Volume 49, Issue 7, Page(s) 712–722

Abstract: Background: Decision-making and reinforcement sensitivity were investigated in 23 children with ADHD and 20 healthy controls using a gambling paradigm.: Methods: Children were required to choose between three alternatives that carried (A) small ... ...

Abstract	Background: Decision-making and reinforcement sensitivity were investigated in 23 children with ADHD and 20 healthy controls using a gambling paradigm. Methods: Children were required to choose between three alternatives that carried (A) small rewards and small penalties (advantageous), (B) large rewards and increasing penalties and (C) small rewards and increasing penalties (both disadvantageous). Penalties increased either in frequency or magnitude in two independent conditions. Heart rate (HR) and skin conductance (SC) were measured to examine whether impaired decision-making was accompanied by autonomic abnormalities. Results: Children with ADHD showed a maladaptive response style compared to controls by demonstrating a smaller preference for the advantageous alternative, when penalties increased in magnitude. When penalties increased in frequency, children with ADHD performed like controls. Group differences in decision-making attenuated after the task was administered twice. Compared to controls, performance of children with ADHD in the magnitude condition was accompanied by increased HR acceleration following reward. In this condition, the post-selection SC of children with ADHD was larger for advantageous than for disadvantageous alternatives, in contrast to controls who showed an opposite SC pattern. Conclusions: The current findings suggest that during decision-making, children with ADHD may be sensitive to the frequency but blind to the magnitude of penalty.
MeSH term(s)	Arousal/physiology ; Attention Deficit Disorder with Hyperactivity/diagnosis ; Attention Deficit Disorder with Hyperactivity/physiopathology ; Attention Deficit Disorder with Hyperactivity/psychology ; Autonomic Nervous System/physiopathology ; Child ; Choice Behavior/physiology ; Decision Making/physiology ; Female ; Galvanic Skin Response/physiology ; Gambling/psychology ; Heart Rate/physiology ; Humans ; Male ; Motivation ; Punishment ; Reinforcement Schedule ; Reward
Language	English
Publishing date	2008-07
Publishing country	England
Document type	Journal Article
ZDB-ID	218136-8
ISSN	1469-7610 ; 0021-9630 ; 0373-8086
ISSN (online)	1469-7610
ISSN	0021-9630 ; 0373-8086
DOI	10.1111/j.1469-7610.2008.01910.x
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Article ; Online: ERPs associated with monitoring and evaluation of monetary reward and punishment in children with ADHD.

van Meel, Catharina S / Heslenfeld, Dirk J / Oosterlaan, Jaap / Luman, Marjolein / Sergeant, Joseph A

Journal of child psychology and psychiatry, and allied disciplines

2011 Volume 52, Issue 9, Page(s) 942–953

Abstract: Background: Several models of attention-deficit hyperactivity disorder (ADHD) propose abnormalities in the response to behavioural contingencies. Using event-related potentials (ERPs), the present study investigated the monitoring and subsequent ... ...

Abstract	Background: Several models of attention-deficit hyperactivity disorder (ADHD) propose abnormalities in the response to behavioural contingencies. Using event-related potentials (ERPs), the present study investigated the monitoring and subsequent evaluation of performance feedback resulting in either reward or punishment in children with ADHD (N = 18) and normal controls (N = 18) aged 8 to 12 years. Methods: Children performed a time production task, in which visual performance feedback was given after each response. To manipulate its motivational salience, feedback was coupled with monetary gains, losses or no incentives. Results: Performance feedback signalling omitted gains as well as omitted losses evoked a feedback-related negativity (FRN) in control children. The FRN, however, was entirely absent in children with ADHD in all conditions. Moreover, while losses elicited enhanced amplitudes of the late positive potential (LPP) in controls, omitted rewards had this effect in ADHD. Conclusions: The lack of modulation of the FRN by contingencies in ADHD suggests deficient detection of environmental cues as a function of their motivational significance. LPP findings suggest diminished response to punishment, but oversensitivity to the loss of desired rewards. These findings suggest that children with ADHD have problems assigning relative motivational significance to outcomes of their actions.
MeSH term(s)	Attention Deficit Disorder with Hyperactivity/physiopathology ; Attention Deficit Disorder with Hyperactivity/psychology ; Case-Control Studies ; Child ; Electroencephalography ; Evoked Potentials/physiology ; Feedback, Psychological/physiology ; Female ; Humans ; Male ; Motivation ; Punishment/psychology ; Reinforcement (Psychology) ; Reward
Language	English
Publishing date	2011-09
Publishing country	England
Document type	Journal Article
ZDB-ID	218136-8
ISSN	1469-7610 ; 0021-9630 ; 0373-8086
ISSN (online)	1469-7610
ISSN	0021-9630 ; 0373-8086
DOI	10.1111/j.1469-7610.2010.02352.x
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