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TRANSCRIPT
Van der Meere, BVan der Meere, Böörger, & Wiersema (submitted)rger, & Wiersema (submitted)
Gemiddelde frequentie lipspart
Periode
654321
Aa
nta
l
30
20
10
0
groepscode
Controle
ADHD
Mean frequency facial movements
jjjjjjjjjjjj
group
Time on task
Brain/HR/Facial movementsBrain/HR/Facial movements
Lateral hypothalamic area
Anterior cingulate cortex
Nts(Control Center)
RVLM IML
NA(Parasympathetic)
Venous Volume
Systemic Resistance
Maximum Elastance
Heart Rate
Heart&
Circulation
Baroreceptors
Sympathetic
PA
conclusionconclusion
ADHD associated with poor state ADHD associated with poor state regulation (underactivation) : in common regulation (underactivation) : in common parlance “poor motivation.parlance “poor motivation.
More research needed on factors that More research needed on factors that regulate energy metabolism in ADHD regulate energy metabolism in ADHD
Genetics and state regulationGenetics and state regulation
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
S F I BL F-I S+BL
Other
child-specificenvironment
shared environment
additive genes
Go/No-Go Task Fast Task Combined
Minor disabilitiesMinor disabilities
Lower IQ level but in the normal rangeLower IQ level but in the normal range Mild motor impairmentMild motor impairment Poor memory language skillsPoor memory language skills 30 to 50 of the children with VLBW follow 30 to 50 of the children with VLBW follow
special educationspecial education
Longitudinal study of Longitudinal study of the effects of maternal the effects of maternal
anxiety and stress during anxiety and stress during pregnancy : pregnancy :
Neuropsychological Neuropsychological examination of attention examination of attention and inhibition functions in and inhibition functions in
adolescentsadolescents
Mechanisms Mechanisms
On the basis of animal research in rats and non-human On the basis of animal research in rats and non-human primates, and of epidemiological research in humans, primates, and of epidemiological research in humans, suggested potential mechanisms aresuggested potential mechanisms are::
Placental transfer of maternal stress-related hormones: Placental transfer of maternal stress-related hormones: does maternal cortisol influence the development of does maternal cortisol influence the development of
the fetal brain?(fetal programming hypothesis) the fetal brain?(fetal programming hypothesis) are the fetal extrahypothalamic CRH, glucocorticoid are the fetal extrahypothalamic CRH, glucocorticoid
system (limbic system and HPA-axis)and brainstem system (limbic system and HPA-axis)and brainstem particularly sensitive to these early influences?particularly sensitive to these early influences?) )
Anxiety of the mother.Anxiety of the mother.
Measure: Measure: -state anxiety (situational momentory anxiety), -state anxiety (situational momentory anxiety), -trait anxiety (personality)-trait anxiety (personality)
result: the more anxiety the mother shows, the result: the more anxiety the mother shows, the more movements made by the unborn child.more movements made by the unborn child.
Relation featal behavior - Relation featal behavior - neonatal behaviorneonatal behavior
Correlations were between .34 to .67Correlations were between .34 to .67 measured five days after delivery.measured five days after delivery.
Results of follow-up,wave 1Results of follow-up,wave 1 (0 - 7 months after birth) (0 - 7 months after birth)
Maternal anxiety during pregnancyMaternal anxiety during pregnancy : : explains 10-25% of the variance in:explains 10-25% of the variance in:
fetal and neonatal behavioural state organization fetal and neonatal behavioural state organization (time ‘awake’) and state-dependent activity (time ‘awake’) and state-dependent activity
in irritability, excessive crying, irregularity in in irritability, excessive crying, irregularity in biological functions, difficult temperament during biological functions, difficult temperament during the first seven months after birth (the first seven months after birth (temperament was temperament was measured with ITQ (Carey et al.) IC Q (Bates et al.) measured with ITQ (Carey et al.) IC Q (Bates et al.)
has no effect on neonatal neurological state, infant has no effect on neonatal neurological state, infant feeding behaviour, mental and motor development feeding behaviour, mental and motor development (Bayley scales) (Bayley scales) (Van den Bergh,1990, 1992; Van den Bergh et al., 1989) (Van den Bergh,1990, 1992; Van den Bergh et al., 1989)
Results of follow-up, wave 2Results of follow-up, wave 2 (8-9 years)(8-9 years)
After controlling for covariates (birth weigth, cigarette After controlling for covariates (birth weigth, cigarette smoking of mother during pregnancy, postnatal maternal smoking of mother during pregnancy, postnatal maternal anxiety were entered as first step in hierarchical MR) anxiety were entered as first step in hierarchical MR) prenatal maternal anxiety measures explainedprenatal maternal anxiety measures explained: :
In boys: 11 to 42 % of the variance in self-regulation measures In boys: 11 to 42 % of the variance in self-regulation measures (effortful control, attention, inhibitory control, hyperactivity) (effortful control, attention, inhibitory control, hyperactivity)
In girls 11 to 19 % of the variance in self-regulation measures In girls 11 to 19 % of the variance in self-regulation measures
(extraversion, impulsivity, activity, acting-out)(extraversion, impulsivity, activity, acting-out) (measured with CBQ (Children’s Behavior Questionnaire; Rothbart), CARTS (measured with CBQ (Children’s Behavior Questionnaire; Rothbart), CARTS
Conners ’ Abbreviated Teacher Rating Scale), GBO (Groninger Behavior Conners ’ Abbreviated Teacher Rating Scale), GBO (Groninger Behavior Observation Scale; Kalverboer)).Observation Scale; Kalverboer)).
Results were found with questionnaires completed by Results were found with questionnaires completed by mother, (blind) teacher and (blind) observer mother, (blind) teacher and (blind) observer
(Van den Bergh, 2001, summitted; Van den Bergh et al., 1999)(Van den Bergh, 2001, summitted; Van den Bergh et al., 1999)
Prediction of self-regulation at 8/9 years from maternal Prediction of self-regulation at 8/9 years from maternal anxiety during pregnancy and covariates (in %). Boysanxiety during pregnancy and covariates (in %). Boys
01020304050607080
Variance explained by covariates during and after pregnancy
Variance explained by measures of anxiety during pregnancy
Mother: CBQ Mother:
CATRS
Teacher: CATRS
Observer: GBO
Prediction of self-regulation at 8/9 years from maternal Prediction of self-regulation at 8/9 years from maternal anxiety during pregnancy and covariates (in %). Girlsanxiety during pregnancy and covariates (in %). Girls
01020304050607080
Eff
ortf
ul c
ontr
olIn
hibi
tory
con
trol
Att
entio
nal f
ocus
sing
Ext
rave
rsio
n/su
rgen
cyIm
puls
ivit
yA
ctiv
ity le
vel
Mot
or a
ctiv
atio
n
Hyp
erac
tivi
tyA
ctin
g-O
ut
Hyp
erac
tivi
tyA
ctin
g-O
ut
Act
vity
Stat
e
Variance explained by covariates during and after pregnancy
Variance explained by measures of anxiety during pregnancy
Mother: CBQ
Mother: CATRS
Teacher: CATRS Observer:
GBO
Child:STAIC
Prediction of self-regulation at 14/15 years from maternal Prediction of self-regulation at 14/15 years from maternal anxiety during pregnancy and covariates (in %). Boysanxiety during pregnancy and covariates (in %). Boys
0
10
20
30
40
50
60
70
80
Variance explained by covariates during and after pregnancy
Variance explained by measures of anxiety during pregnancy
Teacher:
CATRSChild:
STAIC
Mother:
EATQ- R
Prediction of self-regulation at 14/15Prediction of self-regulation at 14/15 years from maternal anxiety during pregnancy and years from maternal anxiety during pregnancy and
covariates (in %). Girlscovariates (in %). Girls
0
10
20
30
40
50
60
70
80A
ctiv
atio
n C
ontr
ol
Inhi
bito
ry C
ontr
ol
Att
entio
n
Shyn
ess
Agg
ress
ion
Dep
ress
ive
moo
d
Hyp
erac
tivi
ty
Act
ing
Out
Fear
Variance explained by covariates during and after pregnancy
Variance explained by measures of anxiety during pregnancy
Mother:
EATQ-RTeacher: CATRS
Discussion Discussion
After controlling for confounding variables, After controlling for confounding variables, there is still a significant effect of maternal there is still a significant effect of maternal prenatal and postnatal anxiety on measures prenatal and postnatal anxiety on measures of temperament, behaviour and emotion in 14 of temperament, behaviour and emotion in 14 and 15 year olds. and 15 year olds.
The gender effect found in waves 1 and 2 of The gender effect found in waves 1 and 2 of the longitudinal study was replicated in these the longitudinal study was replicated in these results. results. For boys prenatal maternal anxiety measures For boys prenatal maternal anxiety measures
seem to influence temperamental dispostions and seem to influence temperamental dispostions and postnatal behaviour which imply self regulatory postnatal behaviour which imply self regulatory mechanisms at the age of 14 and 15.mechanisms at the age of 14 and 15.
ConclusionConclusion
Prenatal environmental factors - such Prenatal environmental factors - such as maternal anxiety - have an as maternal anxiety - have an influence on the phenotypic variation influence on the phenotypic variation in neurobehavioral functioning in neurobehavioral functioning
Study of “early programming” of the brain Study of “early programming” of the brain has the potential of gaining more insight has the potential of gaining more insight in normal and abnormal in normal and abnormal neurodevelopmental processesneurodevelopmental processes
BoysBoys: Anxiety groups, SD,: Anxiety groups, SD, CPT CPT
150
200
250
300
350
400
450
Period 1 Period 6
low Anxmedium Anxhigh Anx
GirlsGirls: Anxiety groups, SD,: Anxiety groups, SD, CPT CPT
100
150
200
250
300
350
400
450
Period 1 Period 6
low Anxmedium Anxhigh Anx
ConclusionsConclusions
Boys have in general more problems with Boys have in general more problems with state regulation and sustained attention state regulation and sustained attention than girls (note: the ratio ADHD boys and than girls (note: the ratio ADHD boys and girls is 6 :1). girls is 6 :1).
Genetics and state regulationGenetics and state regulation
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
S F I BL F-I S+BL
Other
child-specificenvironment
shared environment
additive genes
Go/No-Go Task Fast Task Combined