Altered Cervical Vestibular-Evoked Myogenic Potential in Children with Attention Deficit and Hyperactivity Disorder

Abstract

ObjectiveEmerging evidence suggests that children with attention deficit and hyperactivity disorder (ADHD) present more difficulties in standing and walking balance than typically developing children. Most of previous studies have assessed these functions using postural and sensory organization tests showing differences in balance performance between control and ADHD children. However, to date, it is unknown whether these balance alterations are accompanied with vestibular dysfunction. The principal aim of this study is to evaluate vestibular otolith function in ADHD and matched control children.MethodsWe assessed vestibular otolith function in children with ADHD and controls using the subjective visual vertical (SVV) bucket test and cervical vestibular-evoked myogenic potentials (cVEMPs). In addition, gait and balance were evaluated using the dynamic gait index (DGI) and computerized posturography.ResultsNon-significant differences between groups were obtained in SVV evaluation. DGI results show lower scores for overall test performance in children with ADHD (p < 0.001), while computerized postural recordings showed significant differences for the limit of stability between groups (p = 0.02). cVEMPs in response to 500 Hz tone bursts presented at 100 dB were absent or reduced in children with ADHD, as revealed by differences in P1 and N1 peak-to-peak amplitudes between groups (p < 0.01).ConclusionThese findings suggest that vestibular brainstem reflexes are altered in a subset of children with ADHD. We propose to include cVEMP reflexes in the clinical evaluation of ADHD patients.

Neural Foundations of Ayres Sensory Integration®

“…Further, prevalence rates are growing for diagnoses that characteristically involve sensory integration and praxis difficulties. For example, diagnoses of attention deficit disorders with and without hyperactivity are on the rise [109], and at least one study indicates that vestibular processing challenges, previously unidentified in this population, may affect some children with this diagnosis [110]. Sensory integration and praxis concerns, including atypical reactivity, are prevalent among children with autism [45,54].…”

Weak Vestibular Response in Persistent Developmental Stuttering

“…A difference from controls in VEMP testing can additionally be used to support diagnoses which perhaps have no obvious relation to balance and dizziness, or to each other. These include brainstem lesions ( Oh et al, 2013 ), multiple scleroris ( Escorihuela García et al, 2013 ; Gabelić et al, 2013 ; Ivanković et al, 2013 ; Güven et al, 2014 ), dementia ( Harun et al, 2016 ), Parkinson’s disease ( Shalash et al, 2017 ) and attention deficit and hyperactivity disorder ( Isaac et al, 2017 ). See Oh et al (2016) or Deriu et al (2019) for further review and discussion.…”

Vestibular Functioning in Children with Neurodevelopmental Disorders Using the Functional Head Impulse Test

“…Note also that Deroualle and Lopez [ 32 ] reported several behavioral and neuroimaging studies suggesting the vestibular contribution to emotional and social cognition. Furthermore, Isaac et al [ 33 ] reported reduced cVEMPs (cervical vestibular evoked myogenic potentials) amplitudes or a total lack of responses in children with ADHD, suggesting the presence of peripheral and central vestibular impairments in these children. Note that, even if cervical and ocular VEMPs have mostly been related to peripheral vestibular disorders, the characteristics and the diagnostic values of VEMPs have been used to assess the function of the central otolithic pathways; indeed, the cervical VEMPs are mediated by vestibular nuclei and uncrossed medial vestibulospinal tract descending in the lower brainstem and spinal cord [ 34 ].…”