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1.  A week-long meditation retreat decouples behavioral measures of the alerting and executive attention networks 
Previous studies have examined the influence of meditation on three functionally different components of attention: executive control, alerting, and orienting. These studies have consistently found that meditation training improves both executive attention and alerting, but there has not been a consistent and clear effect of meditation training on orienting. In addition, while previous studies have shown that the functional coupling of the alerting and executive networks increases the processing of task irrelevant stimuli, it is unknown if participating in a meditation retreat can decouple these components of attention and lead to improved performance. The current study investigated the influence of a week-long intensive meditation retreat on three components of attention by randomly assigning participants to either pre- or postretreat testing groups. A modified attention network test (ANT) was used. Executive attention was measured as the difference in response time (RT) between congruent and incongruent task irrelevant flankers (conflict effect). Reflexive and volitional orienting were measured by manipulating cue validity and stimulus onset asynchrony (SOA). The coupling of executive attention and alerting was measured by examining flanker interference as a function of the SOA of an alerting cue. The meditation retreat improved task based indices of executive attention, but not reflexive or volitional orienting. There was clear behavioral evidence of coupling between executive attention and alerting in the preretreat group, as the conflict effect peaked when an alerting cue was presented 300 ms before the target. Importantly, there was no increase in the conflict effect for the postretreat group. This is consistent with the notion that the retreat decoupled the executive and alerting networks. These results suggest that previously reported improvements in the executive and alerting networks after meditation training might be mediated by the same underlying mechanism.
doi:10.3389/fnhum.2014.00069
PMCID: PMC3926190  PMID: 24596550
meditation; attention network test; orienting; alerting; shamatha meditation; visual attention; executive attention
2.  Executive attention impairment in first-episode schizophrenia 
BMC Psychiatry  2012;12:154.
Background
We compared the attention abilities of a group of first-episode schizophrenia (FES) patients and a group of healthy participants using the Attention Network Test (ANT), a standard procedure that estimates the functional state of three neural networks controlling the efficiency of three different attentional behaviors, i.e., alerting (achieving and maintaining a state of high sensitivity to incoming stimuli), orienting (ability to select information from sensory input), and executive attention (mechanisms for resolving conflict among thoughts, feelings, and actions).
Methods
We evaluated 22 FES patients from 17 to 29 years of age with a recent history of a single psychotic episode treated only with atypical neuroleptics, and 20 healthy persons matched with FES patients by sex, age, and educational level as the control group. Attention was estimated using the ANT in which participants indicate whether a central horizontal arrow is pointing to the left or the right. The central arrow may be preceded by spatial or temporal cues denoting where and when the arrow will appear, and may be flanked by other arrows (hereafter, flankers) pointing in the same or the opposite direction.
Results
The efficiency of the alerting, orienting, and executive networks was estimated by measuring how reaction time was influenced by congruency between temporal, spatial, and flanker cues. We found that the control group only demonstrated significantly greater attention efficiency than FES patients in the executive attention network.
Conclusions
FES patients are impaired in executive attention but not in alerting or orienting attention, suggesting that executive attention deficit may be a primary impairment during the progression of the disease.
doi:10.1186/1471-244X-12-154
PMCID: PMC3493330  PMID: 22998680
Schizophrenia; First-episode; Attention; ANT; Executive; Cognitive
3.  Alertness can be improved by an interaction between orienting attention and alerting attention in schizophrenia 
Background
Attention is impaired in schizophrenia. Early attention components include orienting and alerting, as well as executive control networks. Previous studies have shown mainly executive control deficits, while few of them found orienting and alerting abnormalities. Here we explore the different attentive networks, their modulation and interactions in patients with schizophrenia.
Methods
Twenty-one schizophrenic patients (DSMIV), compared to 21 controls, performed a modified version of the Attention Network Task, in which an orienting paradigm (with valid, invalid and no cues) was combined with a flanker task (congruent/incongruent) and an alerting signal (tone/no tone), to assess orienting, executive control and alerting networks independently.
Results
Patients showed an abnormal alerting effect and slower overall reaction time compared to controls. Moreover, there was an interaction between orienting and alerting: patients are helped more than controls by the alerting signal in a valid orientation to solve the incongruent condition.
Conclusion
These results suggest that patients with schizophrenia have altered alerting abilities. However, the orienting and alerting cues interact to improve their attention performance in the resolution of conflict, creating possibilities for cognitive remediation strategies.
doi:10.1186/1744-9081-7-24
PMCID: PMC3156722  PMID: 21729299
4.  Alerting, orienting or executive attention networks: differential patters of pupil dilations 
Attention capacities, alerting responses, orienting to sensory stimulation, and executive monitoring of performance are considered independent yet interrelated systems. These operations play integral roles in regulating the behavior of diverse species along the evolutionary ladder. Each of the primary attention constructs—alerting, orienting, and executive monitoring—involves salient autonomic correlates as evidenced by changes in reactive pupil dilation (PD), heart rate, and skin conductance. Recent technological advances that use remote high-resolution recording may allow the discernment of temporo-spatial attributes of autonomic responses that characterize the alerting, orienting, and executive monitoring networks during free viewing, irrespective of voluntary performance. This may deepen the understanding of the roles of autonomic regulation in these mental operations and may deepen our understanding of behavioral changes in verbal as well as in non-verbal species. The aim of this study was to explore differences between psychosensory PD responses in alerting, orienting, and executive conflict monitoring tasks to generate estimates of concurrent locus coeruleus (LC) noradrenergic input trajectories in healthy human adults using the attention networks test (ANT). The analysis revealed a construct-specific pattern of pupil responses: alerting is characterized by an early component (Pa), its acceleration enables covert orienting, and executive control is evidenced by a prominent late component (Pe). PD characteristics seem to be task-sensitive, allowing exploration of mental operations irrespective of conscious voluntary responses. These data may facilitate development of studies designed to assess mental operations in diverse species using autonomic responses.
doi:10.3389/fnbeh.2013.00145
PMCID: PMC3796264  PMID: 24133422
arousal; attention; autonomic response; pupil dilation; Norepinephrine; locus coeruleus
5.  A New Method for Computing Attention Network Scores and Relationships between Attention Networks 
PLoS ONE  2014;9(3):e89733.
The attention network test (ANT) is a reliable tool to detect the efficiency of alerting, orienting, and executive control networks. However, studies using the ANT obtained inconsistent relationships between attention networks due to two reasons: on the one hand, the inter-network relationships of attention subsystems were far from clear; on the other hand, ANT scores in previous studies were disturbed by possible inter-network interactions. Here we proposed a new computing method by dissecting cue-target conditions to estimate ANT scores and relationships between attention networks as pure as possible. The method was tested in 36 participants. Comparing to the original method, the new method showed a larger alerting score and a smaller executive control score, and revealed interactions between alerting and executive control and between orienting and executive control. More interestingly, the new method revealed unidirectional influences from alerting to executive control and from executive control to orienting. These findings provided useful information for better understanding attention networks and their relationships in the ANT. Finally, the relationships of attention networks should be considered with more experimental paradigms and techniques.
doi:10.1371/journal.pone.0089733
PMCID: PMC3940671  PMID: 24594693
6.  Executive Attention in Schizophrenic Males and the Impact of COMT Val108/158Met Genotype on Performance on the Attention Network Test 
Schizophrenia Bulletin  2008;34(6):1231-1239.
Background: Executive control of attention in schizophrenia has recently been assessed by means of the Attention Network Test (ANT). In the past, for tasks assessing executive attention, findings in schizophrenia have been contradictory, among others suggesting a lack of increased stimulus interference effects. Attention and executive functioning are substantially influenced by candidate genes of schizophrenia, including the functional single-nucleotide polymorphism catechol-o-methyltransferase (COMT) Val108/158Met, with task-dependent, specific effects of Met allele load on cognitive function. Therefore, we aimed at investigating executive attention in schizophrenic patients (SZP) as compared with healthy controls (HC), and to assess the specific impact of COMT Val108/158Met on executive attention, using ANT. Methods: We applied ANT to 63 SZP and 40 HC. We calculated a general linear model to investigate the influence of affection status and the COMT Val108/158Met genotype on executive attention as assessed by the ANT. Results: Multivariate analysis of variance revealed a significant effect of group on executive attention. SZP exhibited smaller conflict effects in the ANT. Met allele load significantly modulated executive attention efficiency, with homozygous Met individuals showing low overall reaction time but increased effects conflicting stimulus information in executive attention. Conclusions: Our data suggest a disease-related dissociation of executive attention with reduced conflict effects in SZP. Furthermore, they support the hypothesis of differential tonic-phasic dopamine activation and specific dopamine level effects in different cognitive tasks, which helps interpreting contradictory findings of Met allele load on cognitive performance. Disease status seems to modulate the impact of COMT Val108/158Met on cognitive performance.
doi:10.1093/schbul/sbm155
PMCID: PMC2632487  PMID: 18199630
schizophrenia; endophenotype; genetics; attention; dopamine
7.  Alerting, orienting, and executive attention in older adults 
The Attention Network Test (ANT) assesses alerting, orienting, and executive attention. The current study was designed to achieve three main objectives. First, we determined the reliability, effects, and interactions of attention networks in a relatively large cohort of non-demented older adults (n = 184). Second, in the context of this aged cohort, we examined the effect of chronological age on attention networks. Third, the effect of blood pressure on ANT performance was evaluated. Results revealed high-reliability for the ANT as a whole, and for specific cue and flanker types. We found significant main effects for the three attention networks as well as diminished alerting but enhanced orienting effects during conflict resolution trials. Furthermore, increased chronological age and low blood pressure were both associated with significantly worse performance on the executive attention network. These findings are consistent with executive function decline in older adults and the plausible effect of reduced blood flow to the frontal lobes on individual differences in attention demanding tasks.
doi:10.1017/S1355617710000767
PMCID: PMC3134373  PMID: 20663241
Aging; Attention; Executive function; Blood pressure; Processing speed
8.  Revealing the Functional Neuroanatomy of Intrinsic Alertness Using fMRI: Methodological Peculiarities 
PLoS ONE  2011;6(9):e25453.
Clinical observations and neuroimaging data revealed a right-hemisphere fronto-parietal-thalamic-brainstem network for intrinsic alertness, and additional left fronto-parietal activity during phasic alertness. The primary objective of this fMRI study was to map the functional neuroanatomy of intrinsic alertness as precisely as possible in healthy participants, using a novel assessment paradigm already employed in clinical settings. Both the paradigm and the experimental design were optimized to specifically assess intrinsic alertness, while at the same time controlling for sensory-motor processing. The present results suggest that the processing of intrinsic alertness is accompanied by increased activity within the brainstem, thalamus, anterior cingulate gyrus, right insula, and right parietal cortex. Additionally, we found increased activation in the left hemisphere around the middle frontal gyrus (BA 9), the insula, the supplementary motor area, and the cerebellum. Our results further suggest that rather minute aspects of the experimental design may induce aspects of phasic alertness, which in turn might lead to additional brain activation in left-frontal areas not normally involved in intrinsic alertness. Accordingly, left BA 9 activation may be related to co-activation of the phasic alertness network due to the switch between rest and task conditions functioning as an external warning cue triggering the phasic alertness network. Furthermore, activation of the intrinsic alertness network during fixation blocks due to enhanced expectancy shortly before the switch to the task block might, when subtracted from the task block, lead to diminished activation in the typical right hemisphere intrinsic alertness network. Thus, we cautiously suggest that – as a methodological artifact – left frontal activations might show up due to phasic alertness involvement and intrinsic alertness activations might be weakened due to contrasting with fixation blocks, when assessing the functional neuroanatomy of intrinsic alertness with a block design in fMRI studies.
doi:10.1371/journal.pone.0025453
PMCID: PMC3184148  PMID: 21984928
9.  Functional Neural Correlates of Attentional Deficits in Amnestic Mild Cognitive Impairment 
PLoS ONE  2013;8(1):e54035.
Although amnestic mild cognitive impairment (aMCI; often considered a prodromal phase of Alzheimer’s disease, AD) is most recognized by its implications for decline in memory function, research suggests that deficits in attention are present early in aMCI and may be predictive of progression to AD. The present study used functional magnetic resonance imaging to examine differences in the brain during the attention network test between 8 individuals with aMCI and 8 neurologically healthy, demographically matched controls. While there were no significant behavioral differences between groups for the alerting and orienting functions, patients with aMCI showed more activity in neural regions typically associated with the networks subserving these functions (e.g., temporoparietal junction and posterior parietal regions, respectively). More importantly, there were both behavioral (i.e., greater conflict effect) and corresponding neural deficits in executive control (e.g., less activation in the prefrontal and anterior cingulate cortices). Although based on a small number of patients, our findings suggest that deficits of attention, especially the executive control of attention, may significantly contribute to the behavioral and cognitive deficits of aMCI.
doi:10.1371/journal.pone.0054035
PMCID: PMC3543395  PMID: 23326568
10.  Attention Network Test in adults with ADHD - the impact of affective fluctuations 
Background
The Attention Network Test (ANT) generates measures of different aspects of attention/executive function. In the present study we investigated whether adults with ADHD performed different from controls on measures of accuracy, variability and vigilance as well as the control network. Secondly, we studied subgroups of adults with ADHD, expecting impairment on measures of the alerting and control networks in a subgroup with additional symptoms of affective fluctuations.
Methods
A group of 114 adults (ADHD n = 58; controls n = 56) performed the ANT and completed the Adult ADHD Rating Scale (ASRS) and the Mood Disorder Questionnaire (MDQ). The latter was used to define affective fluctuations.
Results
The sex distribution was similar in the two groups, but the ADHD group was significantly older (p = .005) and their score on a test of intellectual function (WASI) significantly lower than in the control group (p = .007). The two groups were not significantly different on measures of the three attention networks, but the ADHD group was generally less accurate (p = .001) and showed a higher variability through the task (p = .033).
The significance was only retained for the accuracy measure when age and IQ scores were controlled for. Within the ADHD group, individuals reporting affective fluctuations (n = 22) were slower (p = .015) and obtained a lower score on the alerting network (p = .018) and a higher score on the conflict network (p = .023) than those without these symptoms. The significance was retained for the alerting network (p = .011), but not the conflict network (p = .061) when we controlled for the total ASRS and IQ scores.
Discussion
Adults with ADHD were characterized by impairment on accuracy and variability measures calculated from the ANT. Within the ADHD group, adults reporting affective fluctuations seemed to be more alert (i.e., less impacted by alerting cues), but slower and more distracted by conflicting stimuli than the subgroup without such fluctuations. The results suggest that the two ADHD subgroups are characterized by distinct patterns of attentional problems, and that the symptoms assessed by MDQ contribute to the cognitive heterogeneity characterizing groups of individuals with ADHD.
doi:10.1186/1744-9081-7-27
PMCID: PMC3168400  PMID: 21794128
11.  Look Out – It’s Your Off-Peak Time of Day! Time of Day Matters More for Alerting than for Orienting or Executive Attention 
Experimental aging research  2013;39(3):305-321.
Background
Older adults’ peak performance on memory and cognitive inhibition tasks tends to be in the morning while younger adults’ peak performance tends to be in the afternoon. Although these tasks require efficient attentional processes for optimal performance, previous research examining age differences in the effects of time of day has not measured the distinct aspects of attention quantified by the attentional network test (ANT; Fan, McCandliss, Sommer, & Posner, 2002).
Methods
We examined the relationship between time of testing and the efficiency of alerting, orienting and executive attention networks by randomly assigning younger (18–28 years; N = 27, M = 21.37 years, SD = 2.39) and older adults (65–85 years; N = 32, M = 73.34 years, SD = 5.18) to AM or PM testing of alerting, orienting and executive attention. Mean reaction times for each network was analyzed with a univariate ANOVA with age (younger, older) and time of day (AM, PM) as between-subjects factors.
Results
Consistent with our hypotheses, while time of day had little effect on orienting or executive attention, it affected alerting in opposite ways for younger and older adults, with alerting cues benefitting performance most at participants’ off-peak times of day. A larger benefit from alerting cues was observed when participants’ were tested at their off-peak (M = 30.11 ± 15.66) relative to their peak time (M = 2.18 ± 15.97).
Conclusion
Our findings show that age-related circadian patterns influence the alerting component of attention, with both age groups showing the largest benefit from alerting cues when testing occurs at non-optimal times of day. Overall, our findings underscore the importance of controlling for time of day in investigations of attention and add to our understanding of how age differences in circadian patterns impact attention.
doi:10.1080/0361073X.2013.779197
PMCID: PMC4067093  PMID: 23607399
12.  Differential activation of frontoparietal attention networks by social and symbolic spatial cues 
Perception of both gaze-direction and symbolic directional cues (e.g. arrows) orient an observer’s attention toward the indicated location. It is unclear, however, whether these similar behavioral effects are examples of the same attentional phenomenon and, therefore, subserved by the same neural substrate. It has been proposed that gaze, given its evolutionary significance, constitutes a ‘special’ category of spatial cue. As such, it is predicted that the neural systems supporting spatial reorienting will be different for gaze than for non-biological symbols. We tested this prediction using functional magnetic resonance imaging to measure the brain’s response during target localization in which laterally presented targets were preceded by uninformative gaze or arrow cues. Reaction times were faster during valid than invalid trials for both arrow and gaze cues. However, differential patterns of activity were evoked in the brain. Trials including invalid rather than valid arrow cues resulted in a stronger hemodynamic response in the ventral attention network. No such difference was seen during trials including valid and invalid gaze cues. This differential engagement of the ventral reorienting network is consistent with the notion that the facilitation of target detection by gaze cues and arrow cues is subserved by different neural substrates.
doi:10.1093/scan/nsq008
PMCID: PMC2999758  PMID: 20304864
arrow; eyes; fMRI; gaze
13.  Attentional networks in children and adolescents with autism spectrum disorder 
Background
Individuals diagnosed with autism spectrum disorder (ASD) exhibit lifelong abnormalities in the adaptive allocation of visual attention. The ubiquitous nature of attentional impairments in ASD has led some authors to hypothesize that atypical attentional modulation may be a factor in the development of higher-level sociocommunicative deficits.
Method
Participants were 20 children with ASD and 20 age- and Nonverbal IQ-matched typically developing (TD) children. We used the Attention Network Test (ANT) to investigate the efficiency and independence of three discrete attentional networks: alerting, orienting, and executive control. Additionally, we sought to investigate the relationship between each attentional network and measures of sociocommunicative symptom severity in children with ASD.
Results
Results indicate that the orienting, but not alerting or executive control, networks may be impaired in children with ASD. In contrast to TD children, correlational analyses suggest that the alerting and executive control networks may not function as independently in children with ASD. Additionally, an association was found between the alerting network and social impairment and between the executive control network and IQ in children with ASD.
Conclusions
The results provide further evidence of an impairment in the visuospatial orienting network in ASD and suggest that there may be greater interdependence of alerting and executive control networks in ASD. Furthermore, decreased ability to efficiently modulate levels of alertness was related to increased sociocommunicative deficits, suggesting that domain-general attentional function may be associated with ASD symptomatology.
doi:10.1111/j.1469-7610.2010.02257.x
PMCID: PMC3145814  PMID: 20456535
Autism; reaction time; visual attention; alerting; orienting; executive control
14.  The effect of multisensory cues on attention in aging 
Brain research  2012;1472:63-73.
The attention network test (ANT) assesses the effect of alerting and orienting cues on a visual flanker task measuring executive attention. Previous findings revealed that older adults demonstrate greater reaction times (RT) benefits when provided with visual orienting cues that offer both spatial and temporal information of an ensuing target. Given the overlap of neural substrates and networks involved in multisensory processing and cueing (i.e., alerting and orienting), an investigation of multisensory cueing effects on RT was warranted. The current study was designed to determine whether participants, both old and young, benefited from receiving multisensory alerting and orienting cues. Eighteen young (M = 19.17 years; 45% female) and eighteen old (M = 76.44 years; 61% female) individuals that were determined to be non-demented and without any medical or psychiatric conditions that would affect their performance were included. Results revealed main effects for the executive attention and orienting networks, but not for the alerting network. In terms of orienting, both old and young adults demonstrated significant orienting effects for auditory-somatosensory (AS), auditory-visual (AV), and visual-somatosensory (VS) cues. RT benefits of multisensory compared to unisensory orienting effects differed by cue type and age group; younger adults demonstrated greater RT benefits for AS orienting cues whereas older adults demonstrated greater RT benefits for AV orienting cues. Both groups, however, demonstrated significant RT benefits for multisensory VS orienting cues. These findings provide evidence for the facilitative effect of multisensory orienting cues, and not multisensory alerting cues, in old and young adults.
doi:10.1016/j.brainres.2012.07.014
PMCID: PMC3592377  PMID: 22820295
Multisensory integration; Alerting; Orienting; Executive attention; Aging
15.  Selective Impairment of Attentional Networks of Alerting in Wilson's Disease 
PLoS ONE  2014;9(6):e100454.
Wilson's disease (WD) is typically affected by attention, which is one of the cognitive domains. The Attention Network Test (ANT) was developed to measure the functioning of the following three individual attentional networks: orienting, alerting, and executive control. The ANT has been used in a variety of neuropsychiatric conditions; however, it has not been used in WD. The aim of this study was to investigate the attentional function of WD patients, and 35 patients with early and moderate neurological WD, as well as 35 gender-, age-, and education-matched healthy controls performed the ANT. Remarkable differences between the patients and healthy controls were observed in the alerting network (p = 0.007) in contrast the differences in the orienting (p = 0.729) and executive control (p = 0.888) networks of visual attention. The mean reaction time in the ANT was significantly longer in the WD patients than in the controls (p<0.001, 0.001). In the WD patients, there was an effect specifically on the alerting domain of the attention network, whereas the orienting and executive control domains were not affected.
doi:10.1371/journal.pone.0100454
PMCID: PMC4065050  PMID: 24949936
16.  Which aspects of visual attention are changed by deafness? The case of the Attentional Network Test 
Neuropsychologia  2007;45(8):1801-1811.
The loss of one sensory modality can lead to a reorganization of the other intact sensory modalities. In the case of individuals who are born profoundly deaf, there is growing evidence of changes in visual functions. Specifically, deaf individuals demonstrate enhanced visual processing in the periphery, and in particular enhanced peripheral visual attention. To further characterize those aspects of visual attention that may be modified by deafness, deaf and hearing individuals were compared on the Attentional Network Test (ANT). The ANT was selected as it provides a measure of the efficiency of three neurally distinct subsystems of visual attention: alerting, orienting and executive control. The alerting measure refers to the efficiency with which a temporal cue is used to direct attention towards a target event, and the orienting measure is an indicator of the efficiency with which a spatial cue focuses attention upon that target’s spatial location. The executive control measure, on the other hand, is an indicator of the amount of interference from peripheral flankers on processing that central target. In two separate experiments, deaf and hearing individuals displayed similar alerting and orienting abilities indicating comparable attention across populations. As predicted by enhanced peripheral attention, deaf subjects were found to have larger flanker interference effects than hearing subjects. These results indicate that not all aspects of visual attention are modified by early deafness, suggesting rather specific effects of cross-modal plasticity.
doi:10.1016/j.neuropsychologia.2006.12.019
PMCID: PMC2885017  PMID: 17291549
Attention; Deafness; Peripheral vision; Flanker; Orienting; Attentional Network Test
17.  The effects of a DTNBP1 gene variant on attention networks: an fMRI study 
Background
Attention deficits belong to the main cognitive symptoms of schizophrenia and come along with altered neural activity in previously described cerebral networks. Given the high heritability of schizophrenia the question arises if impaired function of these networks is modulated by susceptibility genes and detectable in healthy risk allele carriers.
Methods
The present event-related fMRI study investigated the effect of the single nucleotide polymorphism (SNP) rs1018381 of the DTNBP1 (dystrobrevin-binding protein 1) gene on brain activity in 80 subjects while performing the attention network test (ANT). In this reaction time task three domains of attention are probed simultaneously: alerting, orienting and executive control of attention.
Results
Risk allele carriers showed impaired performance in the executive control condition associated with reduced neural activity in the left superior frontal gyrus [Brodmann area (BA) 9]. Risk allele carriers did not show alterations in the alerting and orienting networks.
Conclusions
BA 9 is a key region of schizophrenia pathology and belongs to a network that has been shown previously to be involved in impaired executive control mechanisms in schizophrenia. Our results identified the impact of DTNBP1 on the development of a specific attention deficit via modulation of a left prefrontal network.
doi:10.1186/1744-9081-6-54
PMCID: PMC2949706  PMID: 20846375
18.  Atypical development of the executive attention network in children with chromosome 22q11.2 deletion syndrome 
Impairment in the executive control of attention has been found in youth with chromosome 22q11.2 deletion syndrome (22q11.2DS). However, how this impairment is modified by other factors, particularly age, is unknown. Forty-six typically developing and 53 children with 22q11.2DS were tested with the attention networks task (ANT) in this cross-sectional study. We used logarithmic transform and linear modeling to assess age effects on the executive index of the ANT. Mixed modeling accounted for between subject variability, age, handedness, catecholamine-O-transferase (COMT; codon 158) genotype, and gender on performance for all experimental conditions (cue × flanker) and their two-level interactions. Children with 22q11.2DS showed a relative, age-dependent executive index impairment but not orienting or alerting network index impairments. In factorial analysis, age was a major predictor of overall performance. There was a significant effect of the 22q11.2DS on overall performance. Of note, children with 22q11.2DS are specifically vulnerable to incongruent flanker interference, especially at younger ages. We did not find an overall effect of COMT genotype or handedness. Children with 22q11.2DS demonstrated age-related impairment in the executive control of attention. Future investigation will likely reveal that there are different developmental trajectories of executive attentional function likely related to the development of schizophrenia in 22q11.2DS.
doi:10.1007/s11689-010-9070-3
PMCID: PMC3056994  PMID: 21475729
Chromosome 22q11.2 deletion syndrome; Cognitive control; Attention networks task
19.  Atypical development of the executive attention network in children with chromosome 22q11.2 deletion syndrome 
Impairment in the executive control of attention has been found in youth with chromosome 22q11.2 deletion syndrome (22q11.2DS). However, how this impairment is modified by other factors, particularly age, is unknown. Forty-six typically developing and 53 children with 22q11.2DS were tested with the attention networks task (ANT) in this cross-sectional study. We used logarithmic transform and linear modeling to assess age effects on the executive index of the ANT. Mixed modeling accounted for between subject variability, age, handedness, catecholamine-O-transferase (COMT; codon 158) genotype, and gender on performance for all experimental conditions (cue × flanker) and their two-level interactions. Children with 22q11.2DS showed a relative, age-dependent executive index impairment but not orienting or alerting network index impairments. In factorial analysis, age was a major predictor of overall performance. There was a significant effect of the 22q11.2DS on overall performance. Of note, children with 22q11.2DS are specifically vulnerable to incongruent flanker interference, especially at younger ages. We did not find an overall effect of COMT genotype or handedness. Children with 22q11.2DS demonstrated age-related impairment in the executive control of attention. Future investigation will likely reveal that there are different developmental trajectories of executive attentional function likely related to the development of schizophrenia in 22q11.2DS.
doi:10.1007/s11689-010-9070-3
PMCID: PMC3056994  PMID: 21475729
Chromosome 22q11.2 deletion syndrome; Cognitive control; Attention networks task
20.  Triple dissociation of attention networks in stroke according to lesion location 
Neurology  2013;81(9):812-820.
Objective:
To determine whether behavioral dissociations and interactions occur between the attentional functions—alerting, orienting, and conflict resolution—depending upon stroke location and to determine the approximate proportion of patients who can be classified into 1 of these 3 anatomical networks.
Methods:
We recruited 110 anatomically unselected acute stroke patients and 62 age-matched controls. Subjects underwent the attention network test (ANT), which provides a measure of each attention type. Their performance was related to lesion anatomy on MRI using a voxel-lesion mapping approach.
Results:
Patients as a whole performed poorer than controls, but there were no group differences in the size of attentional effects. Specific deficits in 1 of the 3 ANT-tested functions were found in the following lesion locations: alerting deficiency with bilateral anteromedial thalamus and upper brainstem (17% of patients); orienting impairment with right pulvinar and right temporoparietal cortex (15%); conflict resolution with bilateral prefrontal and premotor areas (23%). Lesions to right frontoparietal regions also modified interactions among the 3 types of attention.
Conclusions:
More than half of all stroke patients can be expected to have a lesion location classifiable into 1 of the 3 principal attention networks. Our results have potential implications for therapy personalization in focal brain diseases including stroke.
doi:10.1212/WNL.0b013e3182a2ca34
PMCID: PMC3908461  PMID: 23902704
21.  Attention Network Performance and Psychopathic Symptoms in Early Adolescence: An ERP Study 
Journal of abnormal child psychology  2011;39(7):1001-1012.
Reaction time (RT) and event-related potential (ERP) measures were used to examine the relationships between psychopathic symptoms and three major attention networks (alerting, orienting, and executive attention) among a community sample of youth. Antisocial Process Screening Device (APSD; Frick and Hare 2001) total and subscale scores were negatively correlated with ERP measures of attentional alerting, indicating that youth with psychopathic symptoms had difficulty using warning cues to prepare for upcoming targets. APSD total scores were not related to performance on measures of orienting or executive attention, although weaker executive attention was found among youth with higher scores on the Impulsivity subscale. These findings support attention-based models of psychopathy and provide evidence of specific deficits in attentional alerting among youth with psychopathic traits. Deficiencies in attentional alerting may be related to noradrenergic functioning and may have cascading effects on higher order cognitive and affective processing.
doi:10.1007/s10802-011-9522-6
PMCID: PMC3501980  PMID: 21607659
Attention; Psychopathy; Antisocial personality; ANT; Evoked potential
22.  Nicotine enhances visuospatial attention by deactivating areas of the resting brain default network 
Nicotine-induced attentional enhancement is of potential therapeutic value. To investigate the precise attentional function(s) affected and their neuronal mechanisms, the current fMRI study employed an attention task where subjects responded to stimuli of high or low intensity (INThigh, INTlow) presented randomly in one of four peripheral locations. Central cues of varying precision predicted the target location. In some trials, the cue was not followed by a target, allowing separate analysis of BOLD responses to cue. Minimally deprived smokers underwent fast event-related fMRI twice: once with a nicotine patch (21mg), once with a placebo patch. Matched non-smokers were scanned twice without patch. Behaviorally, nicotine reduced omission errors, reaction time (RT) of valid and invalid cue trials and intra-individual variability of RT, and did so preferentially in trials with INThigh. The BOLD signal related to cue-only trials, irrespective of cue precision, demonstrated nicotine-induced deactivation in anterior and posterior cingulate, angular gyrus, middle frontal gyrus and cuneus. These regions overlapped with the so-called “default network” that activates during rest and deactivates with attention-demanding activities. Partial correlations controlling for nicotine plasma levels indicated associations of deactivation by nicotine in posterior cingulate and angular gyrus with performance improvements under INThigh. Performance and regional activity in the absence of nicotine never differed between smokers and non-smokers, ruling out a simple reversal of a deprivation-induced state. These findings suggest that nicotine improved attentional performance by down-regulating resting brain function in response to task-related cues. Together with the selectivity of effects for INThigh, this suggests a nicotine-induced potentiation of the alerting properties of external stimuli.
doi:10.1523/JNEUROSCI.5129-06.2007
PMCID: PMC2707841  PMID: 17392464
nicotine; attention; fMRI; default network; alerting; ASL
23.  Common and specific impairments in attention functioning in girls with chromosome 22q11.2 deletion, fragile X or Turner syndromes 
Background
Chromosome 22q11.2 deletion syndrome (22q11.2DS), fragile X syndrome (FXS), and Turner syndrome (TS) are complex and variable developmental syndromes caused by different genetic abnormalities; yet, they share similar cognitive impairments in the domains of numbers, space, and time. The atypical development of foundational neural networks that underpin the attentional system is thought to result in further impairments in higher-order cognitive functions. The current study investigates whether children with similar higher-order cognitive impairments but different genetic disorders also show similar impairments in alerting, orienting, and executive control of attention.
Methods
Girls with 22q11.2DS, FXS, or TS and typically developing (TD) girls, aged 7 to 15 years, completed an attention network test, a flanker task with alerting and orienting cues. Exploration of reaction times and accuracy allowed us to test for potential commonalities in attentional functioning in alerting, orienting, and executive control. Linear regression models were used to test whether the predictors of group and chronological age were able to predict differences in attention indices.
Results
Girls with 22q11.2DS, FXS, or TS demonstrated unimpaired function of the alerting system and impaired function of the executive control system. Diagnosis-specific impairments were found such that girls with FXS made more errors and had a reduced orienting index, while girls with 22q11.2DS showed specific age-related deficits in the executive control system.
Conclusions
These results suggest that the control but not the implementation of attention is selectively impaired in girls with 22q11.2DS, TS or FXS. Additionally, the age effect on executive control in girls with 22q11.2DS implies a possible altered developmental trajectory.
doi:10.1186/1866-1955-6-5
PMCID: PMC3995552  PMID: 24628892
Attention networks test; Visuospatial cognition; Cognitive development; Developmental disorder; Chromosome 22q11.2 deletion syndrome; Velocardiofacial syndrome; DiGeorge syndrome; Fragile X syndrome; Turner syndrome
24.  Functional deficits of the attentional networks in autism 
Brain and Behavior  2012;2(5):647-660.
Attentional dysfunction is among the most consistent observations of autism spectrum disorders (ASD). However, the neural nature of this deficit in ASD is still unclear. In this study, we aimed to identify the neurobehavioral correlates of attentional dysfunction in ASD. We used the Attention Network Test-Revised and functional magnetic resonance imaging to examine alerting, orienting, and executive control functions, as well as the neural substrates underlying these attentional functions in unmedicated, high-functioning adults with ASD (n = 12) and matched healthy controls (HC, n = 12). Compared with HC, individuals with ASD showed increased error rates in alerting and executive control, accompanied by lower activity in the mid-frontal gyrus and the caudate nucleus for alerting, and by the absence of significant functional activation in the anterior cingulate cortex (ACC) for executive control. In addition, greater behavioral deficiency in executive control in ASD was correlated with less functional activation of the ACC. These findings of behavioral and neural abnormalities in alerting and executive control of attention in ASD may suggest core attentional deficits, which require further investigation.
doi:10.1002/brb3.90
PMCID: PMC3489817  PMID: 23139910
Alerting; anterior cingulate cortex; attentional networks; autism; executive control
25.  Attentional networks in developmental dyscalculia 
Background
Very little is known about attention deficits in developmental dyscalculia, hence, this study was designed to provide the missing information. We examined attention abilities of participants suffering from developmental dyscalculia using the attention networks test - interactions. This test was designed to examine three different attention networks--executive function, orienting and alerting--and the interactions between them.
Methods
Fourteen university students that were diagnosed as suffering from developmental dyscalculia--intelligence and reading abilities in the normal range and no indication of attention-deficit hyperactivity disorder--and 14 matched controls were tested using the attention networks test - interactions. All participants were given preliminary tests to measure mathematical abilities, reading, attention and intelligence.
Results
The results revealed deficits in the alerting network--a larger alerting effect--and in the executive function networks--a larger congruity effect in developmental dyscalculia participants. The interaction between the alerting and executive function networks was also modulated by group. In addition, developmental dyscalculia participants were slower to respond in the non-cued conditions.
Conclusions
These results imply specific attentional deficits in pure developmental dyscalculia. Namely, those with developmental dyscalculia seem to be deficient in the executive function and alertness networks. They suffer from difficulty in recruiting attention, in addition to the deficits in numerical processing.
doi:10.1186/1744-9081-6-2
PMCID: PMC2821357  PMID: 20157427

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