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BLAST paradigm: A new test to assess brief attentional fluctuations in children with epilepsy, ADHD, and normally
Marine Thieux1, Julien Jung2, Romain Bouet3
1INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, Lyon, France; Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Member of the European Reference Network on Rare and Complex Epilepsies EpiCARE, Hospices Civils de Lyon and University Lyon, Lyon, France.
Insights
Children with epilepsy and/or ADHD show impaired attentional stability. The Bron-Lyon Attention Stability Test (BLAST) effectively identifies these deficits, even in those without full attention-deficit hyperactivity disorder (ADHD) criteria.
Area of Science:
- Neuroscience
- Pediatric Neurology
- Clinical Psychology
Background:
- Pure attentional deficits are underdiagnosed in children with epilepsy.
- Many children with epilepsy and attention issues do not meet full criteria for attention-deficit hyperactivity disorder (ADHD).
- Current clinical tools are inadequate for detecting subtle attentional fluctuations.
Purpose of the Study:
- Evaluate attentional stability in children with epilepsy and/or ADHD using the Bron-Lyon Attention Stability Test (BLAST).
- Assess attentional stability in children with epilepsy (with and without ADHD), ADHD alone, and healthy controls.
- Identify determinants of attentional stability, including epilepsy-related factors.
Main Methods:
- Utilized the Bron-Lyon Attention Stability Test (BLAST) for high temporal precision evaluation of attentional fluctuations.
- Assessed spontaneous fluctuations in response accuracy and timing to measure attentional stability.
- Included 122 children with epilepsy, 52 with ADHD, and 53 healthy controls.
Main Results:
- Children with epilepsy and/or ADHD exhibited lower attentional stability compared to healthy controls.
- In children with epilepsy, earlier seizure onset and antiepileptic drug (AED) polytherapy were linked to lower attentional stability.
- Seizure frequency, duration, or type did not significantly impact BLAST scores.
Conclusions:
- Attentional stability is impaired in children with epilepsy and/or ADHD.
- The BLAST test is a sensitive tool for detecting attentional deficits in children with epilepsy and attention complaints, including those not meeting ADHD criteria.
- BLAST shows potential as a clinical neuropsychological tool for assessing childhood attentional disorders.
Background:
Pure attentional deficits are still underdiagnosed in children with epilepsy. While attention-deficit hyperactivity disorder (ADHD) is historically the most studied cause of attentional disorders, an important number of children with epilepsy and attentional complaints do not fully meet the DSM-V (Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition) criteria for ADHD and may be excluded from specific care. Clinical tools currently available are insufficient to detect more subtle but clinically relevant attentional fluctuations.
Objective/Methods:
The recently developed Bron-Lyon Attention Stability Test (BLAST) was used to evaluate brief attentional fluctuations with a high temporal precision. Drawing on two new attentional indices, we evaluated spontaneous fluctuations of response accuracy and timing, underlying attentional stability. The main objective was to assess attentional stability in children with i) epilepsy with comorbid ADHD, ii) epilepsy without comorbid ADHD, iii) ADHD not medicated and without epilepsy, and iv) normal development. Further objectives were to assess the main determinants of attentional stability in those groups, including the effect of factors related to the epileptic condition.
Results:
In 122 children with epilepsy (67 with comorbid ADHD), 52 children with ADHD, and 53 healthy controls, we demonstrated lower attentional stability in both the groups with epilepsy and ADHD compared with healthy children. In children with epilepsy, BLAST scores were negatively associated with earlier seizure onset and AED (antiepileptic drug) polytherapy, while the seizure frequency, epilepsy duration, or type did not influence BLAST scores.
Conclusions:
This study demonstrates that attentional stability is impaired in children with epilepsy and/or ADHD. Bron-Lyon Attention Stability Test seems to be a sensitive test to detect attentional stability deficit in children with epilepsy and with attentional complaints who did not meet all criteria of ADHD. We propose that BLAST could be a useful clinical neuropsychological tool to assess attentional disorders in children.
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