Methylphenidate improves response inhibition in adults with attention-deficit/hyperactivity disorder

Evidence for subtle verbal fluency deficits in occasional stimulant users: quick to play loose with verbal rules

Psychostimulants like cocaine and amphetamine are commonly abused by young adults who often state that they take these drugs to increase social or cognitive performance. The current study tested the hypothesis that individuals at early stages of occasional stimulant use show subtle executive dysfunctions such as verbal fluency deficits. 155 young (age 18-25), non-dependent occasional users of stimulants and 49 stimulant naïve comparison subjects performed the Delis-Kaplan Verbal Fluency test. Correlation and median split analyses were conducted to account for stimulant history and co-drug use. Compared to stimulant naïve subjects, occasional stimulant users generated significantly more responses on an over-learned verbal fluency task (Category Fluency), but at the expense of increased error rates (Set Loss and Repetition Errors). These performance differences were not related to lifetime uses of stimulants or marijuana. Taken together, these results support the hypothesis that individuals who are using stimulants occasionally exhibit subtle executive dysfunctions when required to generate verbal sets under time pressure. In particular, occasional stimulant users apply quickly but inaccurately verbal rules, which may represent a mix of diminished cognitive flexibility along with increased rigidity and impulsivity. This specific executive dysfunction may help to identify individuals at risk for stimulant use or dependence.

Differential effects of methylphenidate on problem solving in adults with ADHD

OBJECTIVE

Two studies were performed to assess both divergent and convergent thinking in adults with ADHD.

METHOD

The first study compared the problem-solving abilities of healthy participants (N = 144) and unmedicated adults with ADHD (N = 144). In the second study, problem-solving abilities of adults with diagnosed ADHD (N = 22) were examined twice, that is, on and off methylphenidate (MPH), and compared with the performance of a healthy control group (N = 22). Convergent thinking was measured using a Tower of London task, whereas divergent thinking was assessed using verbal fluency tasks.

RESULTS

Adults with ADHD off MPH displayed marked deficits of both divergent and convergent thinking. MPH treatment resulted in a marked improvement of convergent thinking, while no effect of medication was found regarding divergent thinking.

CONCLUSION

Pharmacological treatment of adults with ADHD revealed a differential effect of MPH on problem solving abilities.

Clinically relevant doses of methylphenidate significantly occupy norepinephrine transporters in humans in vivo

BACKGROUND

Attention-deficit/hyperactivity disorder is a psychiatric disorder that starts in childhood. The mechanism of action of methylphenidate, the most common treatment for attention deficit hyperactivity disorder, is unclear. In vitro, the affinity of methylphenidate for the norepinephrine transporter (NET) is higher than that for the dopamine transporter (DAT). The goal of this study was to use positron emission tomography to measure the occupancy of brain norepinephrine transporter by methylphenidate in vivo in humans.

METHODS

We used (S,S)-[¹¹C] methylreboxetine ([¹¹C]MRB) to determine the effective dose 50 (ED₅₀) of methylphenidate for NET. In a within-subject design, healthy subjects (n = 11) received oral, single-blind placebo and 2.5, 10, and 40 mg of methylphenidate 75 min before [¹¹C]MRB injection. Dynamic positron emission tomography imaging was performed for 2 hours with the High Resolution Research Tomograph. The multilinear reference tissue model with occipital cortex as the reference region was used to estimate binding potential non-displaceable (BP(ND)) in the thalamus and other NET-rich regions.

RESULTS

BP(ND) was reduced by methylphenidate in a dose-dependent manner in thalamus and other NET-rich regions. The global ED₅₀ was estimated to be .14 mg/kg; therefore, the average clinical maintenance dose of methylphenidate (.35-.55 mg/kg) produces 70% to 80% occupancy of NET.

CONCLUSIONS

For the first time in humans, we demonstrate that oral methylphenidate significantly occupies NET at clinically relevant doses. The ED₅₀ is lower than that for DAT (.25 mg/kg), suggesting the potential relevance of NET inhibition in the therapeutic effects of methylphenidate in attention-deficit/hyperactivity disorder.

Inhibitory control and psychopathology: a meta-analysis of studies using the stop signal task

The Stop Signal Task (SST) is a measure that has been used widely to assess response inhibition. We conducted a meta-analysis of studies that examined SST performance in patients with various psychiatric disorders to determine the magnitude and generality of deficient inhibition. A five-item instrument was used to assess the methodological quality of studies. We found medium deficits in stop signal reaction time (SSRT), reflecting the speed of the inhibitory process, for attention-deficit hyperactivity disorder (ADHD) (g = 0.62), obsessive compulsive disorder (OCD) (g = 0.77) and schizophrenia (SCZ) (g = 0.69). SSRT was less impaired or normal for anxiety disorder (ANX), autism, major depressive disorder (MDD), oppositional defiant disorder/conduct disorder (ODD/CD), pathological gambling, reading disability (RD), substance dependence, and Tourette syndrome. We observed a large SSRT deficit for comorbid ADHD + RD (g = 0.82). SSRT was less than moderately impaired for ADHD + ANX and ADHD + ODD/CD. Study quality did not significantly affect SSRT across ADHD studies. This confirms an inhibition deficit in ADHD, and suggests that comorbid ADHD has different effects on inhibition in patients with ANX, ODD/CD, and RD. Further studies are needed to firmly establish an inhibition deficit in OCD and SCZ.

Methylphenidate and atomoxetine enhance prefrontal function through α2-adrenergic and dopamine D1 receptors

OBJECTIVE

This study examined the effects of the attention-deficit/hyperactivity disorder treatments, methylphenidate (MPH) and atomoxetine (ATM), on prefrontal cortex (PFC) function in monkeys and explored the receptor mechanisms underlying enhancement of PFC function at the behavioral and cellular levels.

METHOD

Monkeys performed a working memory task after administration of a wide range of MPH or ATM doses. The optimal doses were challenged with the α(2)-adrenoceptor antagonist, idazoxan, or the D(1) dopamine receptor antagonist, SCH23390 (SCH). In a parallel physiology study, neurons were recorded from the dorsolateral PFC of a monkey performing a working memory task. ATM, SCH, or the α(2) antagonist, yohimbine, were applied to the neurons by iontophoresis.

RESULTS

MPH and ATM generally produced inverted-U dose-response curves, with improvement occurring at moderate doses, but not at higher doses. The beneficial effects of these drugs were blocked by idazoxan or SCH. At the cellular level, ATM produced an inverted-U dose-response effect on memory-related firing, enhancing firing for preferred directions (increasing "signals") and decreasing firing for the nonpreferred directions (decreasing "noise"). The increase in persistent firing for the preferred direction was blocked by yohimbine, whereas the suppression of firing for the nonpreferred directions was blocked by SCH.

CONCLUSIONS

Optimal doses of MPH or ATM improved PFC cognitive function in monkeys. These enhancing effects appeared to involve indirect stimulation of α(2) adrenoceptors and D(1) dopamine receptors in the PFC. These receptor actions likely contribute to their therapeutic effects in the treatment of attention-deficit/hyperactivity disorder.

The pleasures of play: pharmacological insights into social reward mechanisms

Like human children, most young mammals devote a significant amount of time and energy playing together, and social play is fun. Although social play is very pleasurable, it is more than just a frivolous activity: it is crucial for the development of behavioral flexibility, the acquisition of social and cognitive competence, and the maintenance of group cohesion. Social play is a natural reinforcer, and the neurotransmitter systems intimately implicated in the motivational, pleasurable and cognitive aspects of natural and drug rewards, such as opioids, endocannabinoids, dopamine and norepinephrine, play an important modulatory role in the performance of social play. In this review, we address the notion that social play is rewarding, and discuss recent developments in the neuropharmacology of this behavior. This provides a framework to understand how the brain processes social emotions, to make young individuals enjoy social play.

What are the cognitive effects of stimulant medications? Emphasis on adults with attention-deficit/hyperactivity disorder (ADHD)

The relevant literature concerning cognitive effects of amphetamine and methylphenidate, was reviewed, with an emphasis on research conducted in adults diagnosed with attention-deficit/hyperactivity disorder. As first-line treatment for ADHD, stimulant drugs are well-known to improve attention and concentration. Yet, there is increasing evidence that (as with children and adolescents), they do not promote learning and academic achievement in adult college students with ADHD. A review of neuropsychological studies indicates that, although response latencies are reduced, performance of ADHD adults on tests of 'distractibility' and 'planning' is also not consistently improved by stimulants. Studies in non-ADHD adults suggest that stimulants do not promote acquisition of new information, might improve retention of previously acquired information, and facilitate memory consolidation, but may actually impair performance of tasks that require adaptation, flexibility and planning. It is still not clear if improvement only occurs when there is a baseline deficit. Stimulants may influence cognition by their effects on physiological arousal. Regardless, the evidence does not support the conclusion that stimulants are cognitive 'enhancers.'

Motivational influences on response inhibition measures

Psychological research has placed great emphasis on inhibitory control due to its integral role in normal cognition and clinical disorders. The stop-signal task and associated measure--stop-signal reaction time (SSRT)--provides a well-established paradigm for measuring response inhibition. However, motivational influences on stop-signal performance and SSRT have not been examined. We conceptualize the stop-signal paradigm as a decision-making task involving the trade-off between fast responding and accurate inhibition. In 4 experiments, we demonstrate that performance trade-offs are influenced by inherent motivational biases and explicit strategic control. As a result, SSRT was lower when participants favored correct stopping over fast responding than when the same participants favored fast responding over correct stopping. We present a novel variant of the stop-signal task that uses monetary incentives to manipulate motivated speed-accuracy trade-offs. By sampling performance at multiple-trade-off settings, we obtain a measure of inhibitory ability that is independent of trade-off bias, and thus, more easily interpretable when comparing across participants. We present a working theoretical model to explain the effects of motivational context on response inhibition.

The Effects of Methylphenidate on Neural Substrates Associated with Interference Suppression in Children with ADHD: A Preliminary Study Using Event Related fMRI

OBJECTIVE

The core deficit of attention deficit hyperactivity disorder (ADHD) is associated with frontal cortex and related circuitry. Children with ADHD and a medication history have shown atypical brain activation in prefrontal and striatal brain regions during cognitive challenge. We investigated two cognitive control operations such as interference suppression (IS) and response inhibition (RI) in children with ADHD. We also assessed the brain functions affected by the methylphenidate (MPH) effect by comparing the blood-oxygen level dependent (BOLD) signals in ADHD children on and off medication.

METHODS

Eight children (9-11 years of age) with combined-type ADHD underwent rapid event-related functional magnetic resonance imaging (fMRI) during performance of a modified flanker task. Two fMRI (3.0 T) scans were conducted with a one week interval-one with MPH treatment and the other without. Functional maps were generated through group averaging and performance-based correlational analyses.

RESULTS

Performances of the two cognitive control operations did not differ significantly between on-MPH and off-MPH status other than the reaction time to incongruent stimuli in ADHD children. In those affected by MPH treatment, an increased activation in the right prefrontal cortex during incongruent task was observed relative to a neutral trial in children with ADHD.

CONCLUSION

On the treatment of MPH, the ADHD children exhibited increased activation of the right frontal cortex during interference suppression. This finding suggested that MPH affected the right frontal cortex in ADHD compensating for a reduced level of interference suppression. Future studies will be required to ascertain the MPH effect of cognitive brain regions among large number of children with ADHD.

Probing compulsive and impulsive behaviors, from animal models to endophenotypes: a narrative review

Failures in cortical control of fronto-striatal neural circuits may underpin impulsive and compulsive acts. In this narrative review, we explore these behaviors from the perspective of neural processes and consider how these behaviors and neural processes contribute to mental disorders such as obsessive-compulsive disorder (OCD), obsessive-compulsive personality disorder, and impulse-control disorders such as trichotillomania and pathological gambling. We present findings from a broad range of data, comprising translational and human endophenotypes research and clinical treatment trials, focussing on the parallel, functionally segregated, cortico-striatal neural projections, from orbitofrontal cortex (OFC) to medial striatum (caudate nucleus), proposed to drive compulsive activity, and from the anterior cingulate/ventromedial prefrontal cortex to the ventral striatum (nucleus accumbens shell), proposed to drive impulsive activity, and the interaction between them. We suggest that impulsivity and compulsivity each seem to be multidimensional. Impulsive or compulsive behaviors are mediated by overlapping as well as distinct neural substrates. Trichotillomania may stand apart as a disorder of motor-impulse control, whereas pathological gambling involves abnormal ventral reward circuitry that identifies it more closely with substance addiction. OCD shows motor impulsivity and compulsivity, probably mediated through disruption of OFC-caudate circuitry, as well as other frontal, cingulate, and parietal connections. Serotonin and dopamine interact across these circuits to modulate aspects of both impulsive and compulsive responding and as yet unidentified brain-based systems may also have important functions. Targeted application of neurocognitive tasks, receptor-specific neurochemical probes, and brain systems neuroimaging techniques have potential for future research in this field.

Motor inhibition and cognitive flexibility in pathologic skin picking

BACKGROUND

Individuals with pathologic skin picking (PSP) often report significant difficulty resisting the urges and drive to engage in picking behavior. Studies have shown significant inhibitory deficiencies (i.e. increased impulsivity) in subjects with other putative obsessive-compulsive spectrum disorders, such as trichotillomania, using objective tests. This study sought to assess motor inhibitory control and aspects of cognitive flexibility in a sample of individuals with PSP.

METHOD

Twenty subjects with PSP (mean age 33.1+/-14.3 years; 85% female) and 20 healthy controls (mean age 31.6+/-9.1 years; 85% female) underwent cognitive assessments using the Stop-signal and Intra-dimensional/Extra-dimensional (ID/ED) set-shift tasks. Groups were matched for age, gender, and education.

RESULTS

PSP was associated with significantly impaired stop-signal reaction times but intact ID/ED cognitive flexibility compared to controls. Measures of disease severity in the PSP subjects did not covary significantly with stop-signal performance.

CONCLUSION

The finding of impaired inhibitory control but intact set-shift cognitive flexibility draws remarkable parallels with findings in trichotillomania but differs from obsessive compulsive disorder. These findings have important implications for understanding potential neurobiological dysfunction in PSP, how the disorder should be classified, and suggest new potential treatment directions.

Striatal dopamine d2/d3 receptor availability is reduced in methamphetamine dependence and is linked to impulsivity

While methamphetamine addiction has been associated with both impulsivity and striatal dopamine D(2)/D(3) receptor deficits, human studies have not directly linked the latter two entities. We therefore compared methamphetamine-dependent and healthy control subjects using the Barratt Impulsiveness Scale (version 11, BIS-11) and positron emission tomography with [(18)F]fallypride to measure striatal dopamine D(2)/D(3) receptor availability. The methamphetamine-dependent subjects reported recent use of the drug 3.3 g per week, and a history of using methamphetamine, on average, for 12.5 years. They had higher scores than healthy control subjects on all BIS-11 impulsiveness subscales (p < 0.001). Volume-of-interest analysis found lower striatal D(2)/D(3) receptor availability in methamphetamine-dependent than in healthy control subjects (p < 0.01) and a negative relationship between impulsiveness and striatal D(2)/D(3) receptor availability in the caudate nucleus and nucleus accumbens that reached statistical significance in methamphetamine-dependent subjects. Combining data from both groups, voxelwise analysis indicated that impulsiveness was related to D(2)/D(3) receptor availability in left caudate nucleus and right lateral putamen/claustrum (p < 0.05, determined by threshold-free cluster enhancement). In separate group analyses, correlations involving the head and body of the caudate and the putamen of methamphetamine-dependent subjects and the lateral putamen/claustrum of control subjects were observed at a weaker threshold (p < 0.12 corrected). The findings suggest that low striatal D(2)/D(3) receptor availability may mediate impulsive temperament and thereby influence addiction.

The role of the right inferior frontal gyrus: inhibition and attentional control

There is growing interest regarding the role of the right inferior frontal gyrus (RIFG) during a particular form of executive control referred to as response inhibition. However, tasks used to examine neural activity at the point of response inhibition have rarely controlled for the potentially confounding effects of attentional demand. In particular, it is unclear whether the RIFG is specifically involved in inhibitory control, or is involved more generally in the detection of salient or task relevant cues. The current fMRI study sought to clarify the role of the RIFG in executive control by holding the stimulus conditions of one of the most popular response inhibition tasks–the Stop Signal Task–constant, whilst varying the response that was required on reception of the stop signal cue. Our results reveal that the RIFG is recruited when important cues are detected, regardless of whether that detection is followed by the inhibition of a motor response, the generation of a motor response, or no external response at all.

Is there an inhibitory-response-control system in the rat? Evidence from anatomical and pharmacological studies of behavioral inhibition

Many common psychiatric conditions, such as attention deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), Parkinson's disease, addiction and pathological gambling are linked by a failure in the mechanisms that control, or inhibit, inappropriate behavior. Models of rat behavioral inhibition permit us to study in detail the anatomical and pharmacological bases of inhibitory failure, using methods that translate directly with patient assessment in the clinic. This review updates current ideas relating to behavioral inhibition based on two significant lines of evidence from rat studies: (1) To integrate new findings from the stop-signal task into existing models of behavioral inhibition, in particular relating to 'impulsive action' control. The stop-signal task has been used for a number of years to evaluate psychiatric conditions and has recently been translated for use in the rat, bringing a wealth of new information to behavioral inhibition research. (2) To consider the importance of the subthalamic nucleus (STN) in the neural circuitry of behavioral inhibition. This function of this nucleus is central to a number of 'disinhibitory' disorders such as Parkinson's disease and OCD, and their therapies, but its role in behavioral inhibition is still undervalued, and often not considered in preclinical models of behavioral control. Integration of these findings has pinpointed the orbitofrontal cortex (OF), dorsomedial striatum (DMStr) and STN within a network that normally inhibits many forms of behavior, including both impulsive and compulsive forms. However, there are distinct differences between behavioral subtypes in their neurochemical modulation. This review brings new light to the classical view of the mechanisms that inhibit behavior, in particular suggesting a far more prominent role for the STN, a structure that is usually omitted from conventional behavioral-inhibition networks. The OF-DMStr-STN circuitry may form the basis of a control network that defines behavioral inhibition and that acts to suppress or countermand many forms of inappropriate or maladaptive behavior.

Evaluation of genetic variability in the dopamine receptor D2 in relation to behavioral inhibition and impulsivity/sensation seeking: an exploratory study with d-amphetamine in healthy participants

The dopamine D2 receptor (DRD2) appears to be involved in impulsive behaviors, and particularly in behavioral inhibition. We sought to determine whether inhibition and impulsivity were related to genetic polymorphisms in the DRD2 gene (DRD2) in healthy volunteers (N = 93). Participants received placebo or d-amphetamine in random order. They performed the stop task, measuring behavioral inhibition, and rated their mood states on each session. They also completed the Zuckerman-Kuhlman Personality Questionnaire, including an Impulsivity subscale. We investigated the association between 12 single nucleotide polymorphisms (SNPs) and haplotypes in DRD2 and stop task performance in the nondrug (i.e., placebo) session and on the personality measure of impulsivity. We secondarily evaluated the DRD2 SNPs in relation to response to d-amphetamine on stop task performance and mood ratings. Mood was not related to genotypes in either the drug free condition or in response to drug. However, 2 SNPs, rs4648317 and rs12364283, and a haplotype block consisting of those SNPs, were associated with better performance on the stop task in the drug free condition and lower scores on the Impulsivity subscale. We also found that rs12364283 was associated with effects of d-amphetamine on stop task performance: d-amphetamine decreased stop reaction time (RT) in the A/A group but increased stop RT in the combined A/G + G/G genotype. Of the SNPs we evaluated, rs12364283, which has been associated with DRD2 expression, was the most significantly associated with inhibition and impulsivity. The significant relationship between DRD2 genotype and both behavioral inhibition and impulsivity suggests a possible common genetic influence on behavioral and self-report measures of impulsivity.

Differential effects of atomoxetine on executive functioning and lexical decision in attention-deficit/hyperactivity disorder and reading disorder

OBJECTIVE

The effects of a promising pharmacological treatment for attention-deficit/hyperactivity disorder (ADHD), atomoxetine, were studied on executive functions in both ADHD and reading disorder (RD) because earlier research demonstrated an overlap in executive functioning deficits in both disorders. In addition, the effects of atomoxetine were explored on lexical decision.

METHODS

Sixteen children with ADHD, 20 children with ADHD + RD, 21 children with RD, and 26 normal controls were enrolled in a randomized placebo-controlled crossover study. Children were measured on visuospatial working memory, inhibition, and lexical decision on the day of randomization and following two 28-day medication periods.

RESULTS

Children with ADHD + RD showed improved visuospatial working memory performance and, to a lesser extent, improved inhibition following atomoxetine treatment compared to placebo. No differential effects of atomoxetine were found for lexical decision in comparison to placebo. In addition, no effects of atomoxetine were demonstrated in the ADHD and RD groups.

CONCLUSION

Atomoxetine improved visuospatial working memory and to a lesser degree inhibition in children with ADHD + RD, which suggests differential developmental pathways for co-morbid ADHD + RD as compared to ADHD and RD alone.

CLINICAL TRIAL REGISTRY

B4Z-MC-LYCK, NCT00191906; http://clinicaltrials.gov/ct2/show/NCT00191906.

Cross-species models of OCD spectrum disorders

Several axis-I neuropsychiatric disorders are characterised by repetitive motor habits suggestive of underlying inhibitory dyscontrol, and may constitute members of a putative obsessive-compulsive (OC) spectrum. Notable examples include obsessive-compulsive disorder (OCD) and trichotillomania (repetitive hair-pulling). Multiple tiers of evidence link these conditions with underlying dysregulation of fronto-striatal circuitry and monoamine systems. These abnormalities represent key targets for existing and novel treatment interventions. Nonetheless, the brain bases of these conditions, and treatment mechanisms, remain poorly characterised. Animal models of repetitive habits and inhibitory control problems show great potential for augmenting our understanding of the pathophysiology and treatment of OC spectrum conditions. Here, we begin by describing clinical features of OC spectrum disorders, and criteria used to assess the validity of animal models of symptomatology. Namely, face validity (phenomenological similarity between inducing conditions and specific symptoms of the human phenomenon), predictive validity (similarity in response to treatment) and construct validity (similarity in underlying physiological or psychological mechanisms). We then survey animal models of OC spectrum conditions within this framework, focusing on (i) ethological models; (ii) genetic and pharmacological models; and (iii) behavioral models. Key future research directions are highlighted.

An FMRI study of the effects of psychostimulants on default-mode processing during Stroop task performance in youths with ADHD

OBJECTIVE

The authors examined the effect of psychostimulants on brain activity in children and adolescents with ADHD performing the Stroop Color and Word Test.

METHOD

The authors acquired 52 functional MRI scans in 16 youths with ADHD who were known responders to stimulant medication and 20 healthy comparison youths. Participants with ADHD were scanned on and off medication in a counterbalanced design, and comparison subjects were scanned once without medication.

RESULTS

Stimulant medication significantly improved suppression of default-mode activity in the ventral anterior cingulate cortex in the ADHD group. When off medication, youths with ADHD were unable to suppress default-mode activity to the same degree as comparison subjects, whereas when on medication, they suppressed this activity to comparison group levels. Greater activation of the lateral prefrontal cortex when off medication predicted a greater reduction in ADHD symptoms when on medication. Granger causality analyses demonstrated that activity in the lateral prefrontal and ventral anterior cingulate cortices mutually influenced one another but that the influence of the ventral anterior cingulate cortex on the lateral prefrontal cortex was significantly reduced in youths with ADHD off medication relative to comparison subjects and increased significantly to normal levels when ADHD youths were on medication.

CONCLUSIONS

Psychostimulants in youths with ADHD improved suppression of default-mode activity in the ventral anterior cingulate and posterior cingulate cortices, components of a circuit in which activity has been shown to correlate with the degree of mind-wandering during attentional tasks. Stimulants seem to improve symptoms in youths with ADHD by normalizing activity within this circuit and improving its functional interactions with the lateral prefrontal cortex.

Stimulant treatment reduces lapses in attention among children with ADHD: the effects of methylphenidate on intra-individual response time distributions

Recent research has suggested that intra-individual variability in reaction time (RT) distributions of children with ADHD is characterized by a particularly large rightward skew that may reflect lapses in attention. The purpose of the study was to provide the first randomized, placebo-controlled test of the effects of the stimulant methylphenidate (MPH) on this tail and other RT distribution characteristics. Participants were 49 9- to 12-year-old children with ADHD. Children participated in a 3-day double-blind, placebo-controlled medication assessment during which they received long-acting MPH (Concerta), with the nearest equivalents of 0.3 and 0.6 mg/kg t.i.d. immediate-release MPH. Children completed a simple two-choice speeded discrimination task on and off of medication. Mode RT and deviation from the mode were used to examine the peak and skew, respectively, of RT distributions. MPH significantly reduced the peak and skew of RT distributions. Importantly, the two medication effects were uncorrelated suggesting that MPH works to improve both the speed and variability in responding. The improvement in variability with stimulant treatment is interpreted as a reduction in lapses in attention. This, in turn, may reflect stimulant enhancement of self-regulatory processes theorized to be at the core of ADHD.

Acute aerobic exercise and information processing: modulation of executive control in a Random Number Generation task

The immediate and short-term aftereffects of a bout of aerobic exercise on young adults' executive functions were assessed. Sixteen participants performed a Random Number Generation (RNG) task, which measured two aspects of executive function, before, during, and after ergometer cycling exercise. In a separate session, participants completed the same sequence of testing while seated on an ergometer without pedaling. Results suggest that aerobic exercise: (1) selectively influences RNG indices related to the ability to alternate ascending and descending runs throughout the entire exercise bout; (2) induces a shift to a less effortful number generation strategy, particularly during the first few minutes of the exercise; and (3) has no significant influence on RNG performance as soon as the exercise terminates. The strategic adjustments observed during the exercise are interpreted in the framework of Hockey's [Hockey, G. R. J. (1997). Compensatory control in the regulation of human performance under stress and high workload: A cognitive-energetical framework. Biological Psychology, 45, 73-93.] compensatory control model and suggest that concurrent effortful processes induced by cycling exercise may draw upon available attention resources and influence executive processing.

Effect of acute and repeated treatment with desipramine or methylphenidate on serial reversal learning in rats

Administration of stimulant and non-stimulant drugs that inhibit monoamine reuptake is known to improve cognitive and behavioral symptoms of attention deficit hyperactivity disorder (ADHD). Although this may reflect acute actions of these drugs, clinical observations suggest that prolonged treatment with these agents may result in a better therapeutic outcome. In the current study, we compared the effects of acute and repeated treatment with the stimulant drug, methylphenidate (MPH), and the non-stimulant norepinephrine reuptake inhibitor desipramine (DMI) in rats performing a reversal learning task meant to study behavioral flexibility in rats. Furthermore, we tested the effect of an acute challenge administration with these agents or vehicle on reversal performance of rats repeatedly treated with the drug or vehicle. Our results suggest the acute and repeated treatment with DMI improves reversal learning performance in a qualitatively and quantitatively similar manner. Further repeated treatment with DMI seems to produce a reversal learning improvement that persists at least 24 h after drug administration. Repeated MPH treatment only improved performance in the first within session reversal administered, suggesting that its beneficial effects may depend upon the complexity of the reversal condition tested. The differential outcome produced by stimulant and non-stimulant medications in this study may be explained in light of their distinct actions on brain catecholaminergic systems.

Dopamine release in dissociable striatal subregions predicts the different effects of oral methylphenidate on reversal learning and spatial working memory

Previous data suggest that methylphenidate can have variable effects on different cognitive tasks both within and between individuals. This is thought to be underpinned by inverted U-shaped relationships between cognitive performance and dopaminergic activity in relatively separate fronto-striatal circuits and reflected by individual differences in trait impulsivity. Direct evidence for this is currently lacking. In this study, we demonstrate for the first time that therapeutic doses of oral methylphenidate administered to young healthy subjects result in different sized changes in D(2)/D(3) receptor availability in different regions of the human striatum and that the change in receptor availability within an individual subregion predicts cognitive performance on a particular task. Methylphenidate produced significantly different effects on reversal learning and spatial working memory tasks within individuals. Performance on the reversal learning task was predicted by the drug-induced change in D(2)/D(3) receptor availability in postcommissural caudate, measured using [(11)C]-raclopride radioligand PET imaging, whereas performance on the spatial working memory task was predicted by changes in receptor availability in the ventral striatum. Reversal learning performance was also predicted by subjects' trait impulsivity, such that the most impulsive individuals benefited more from methylphenidate, consistent with this drug's beneficial effects on cognition in attention deficit hyperactivity disorder.

The Emerging Neurobiology of Attention Deficit Hyperactivity Disorder: The Key Role of the Prefrontal Association Cortex

Attention deficit/hyperactivity disorder (ADHD) is characterized by symptoms of inattention, impulsivity, and locomotor hyperactivity. Recent advances in neurobiology, imaging, and genetics have led to a greater understanding of the etiology and treatment of ADHD. Studies have found that ADHD is associated with weaker function and structure of prefrontal cortex (PFC) circuits, especially in the right hemisphere. The prefrontal association cortex plays a crucial role in regulating attention, behavior, and emotion, with the right hemisphere specialized for behavioral inhibition. The PFC is highly dependent on the correct neurochemical environment for proper function: noradrenergic stimulation of postsynaptic alpha-2A adrenoceptors and dopaminergic stimulation of D1 receptors is necessary for optimal prefrontal function. ADHD is associated with genetic changes that weaken catecholamine signaling and, in some patients, with slowed PFC maturation. Effective pharmacologic treatments for ADHD all enhance catecholamine signaling in the PFC and strengthen its regulation of attention and behavior. Recent animal studies show that therapeutic doses of stimulant medications preferentially increase norepinephrine and, to a lesser extent, dopamine, in the PFC. These doses reduce locomotor activity and improve PFC regulation of attention and behavior through enhanced catecholamine stimulation of alpha-2A and D1 receptors. These findings in animals are consistent with improved PFC function in normal human subjects and, more prominently, in patients with ADHD. Thus, a highly cohesive story is emerging regarding the etiology and treatment of ADHD.

Models of response inhibition in the stop-signal and stop-change paradigms

The stop-signal paradigm is very useful for the study of response inhibition. Stop-signal performance is typically described as a race between a go process, triggered by a go stimulus, and a stop process, triggered by the stop signal. Response inhibition depends on the relative finishing time of these two processes. Numerous studies have shown that the independent horse-race model of Logan and Cowan [Logan, G.D., Cowan, W.B., 1984. On the ability to inhibit thought and action: a theory of an act of control. Psychological Review 91, 295-327] accounts for the data very well. In the present article, we review the independent horse-race model and related models, such as the interactive horse-race model [Boucher, L., Palmeri, T.J., Logan, G.D., Schall, J.D., 2007. Inhibitory control in mind and brain: an interactive race model of countermanding saccades. Psychological Review 114, 376-397]. We present evidence that favors the independent horse-race model but also some evidence that challenges the model. We end with a discussion of recent models that elaborate the role of a stop process in inhibiting a response.

Methylphenidate restores link between stop-signal sensory impact and successful stopping in adults with attention-deficit/hyperactivity disorder

BACKGROUND

The ability to revise one's action plans, as reflected in so-called stopping performance, is of fundamental importance to adaptive behavior. Previous studies in children and adults with attention-deficit/hyperactivity disorder (ADHD) have revealed impaired stopping, which improved after the administration of methylphenidate (MPH). Event-related brain potentials revealed that one crucial mechanism in adequate stopping is the link between the cortical areas that process the signal to stop and the motor system (stop N1). This stop N1 was severely compromised in adults with ADHD. The present study investigates whether methylphenidate can restore the stop N1, in addition to improving stopping performance. The acute effect of a serotonergic reuptake inhibition on these parameters was also assessed.

METHODS

Twelve adult combined-type ADHD patients received either placebo, MPH .4 mg/kg or .6 mg/kg, or 20 mg paroxetine in a double-blind, randomized, within-subjects design.

RESULTS

The .6 mg/kg dose of methylphenidate improved stopping performance, whereas it did not affect go reaction time (RT). It also restored the stop N1 that was absent under placebo. Methylphenidate reduced a later stop-related potential, the stop P3, which may reflect monitoring of failed stops. Paroxetine had no effect on stopping performance or on stop N1, but it reduced stop P3.

CONCLUSIONS

A .6 mg/kg dose of methylphenidate improves stopping performance and directly targets a stop-related brain mechanism that has been reported before to be compromised in a group of ADHD patients. This mechanism was not influenced by acute serotonergic reuptake inhibition.

Atomoxetine modulates right inferior frontal activation during inhibitory control: a pharmacological functional magnetic resonance imaging study

BACKGROUND

Atomoxetine, a selective noradrenaline reuptake inhibitor (SNRI) licensed for the treatment of attention-deficit/hyperactivity disorder (ADHD), has been shown to improve response inhibition in animals, healthy volunteers, and adult patients. However, the mechanisms by which atomoxetine improves inhibitory control have yet to be determined.

METHODS

The effects of atomoxetine (40 mg) were measured with a stop-signal functional magnetic resonance imaging (fMRI) paradigm in 19 healthy volunteers, in a within-subject, double-blind, placebo-controlled design.

RESULTS

Atomoxetine improved inhibitory control and increased activation in the right inferior frontal gyrus when volunteers attempted to inhibit their responses (irrespective of success). Plasma levels of drug correlated significantly with right inferior frontal gyrus activation only during successful inhibition.

CONCLUSIONS

These results show that atomoxetine exerts its beneficial effects on inhibitory control via modulation of right inferior frontal function, with implications for understanding and treating inhibitory dysfunction of ADHD and other disorders.

Neurocognitive effects of switching from methylphenidate-IR to OROS-methylphenidate in children with ADHD

OBJECTIVES

This study evaluated neurocognitive changes after switching from immediate release forms of methylphenidate (MPH-IR) to osmotic release oral system methylphenidate (OROS-MPH).

METHODS

102 children with attention-deficit/hyperactivity disorder (ADHD) participated in an open label, 28 day trial, performing neurocognitive test at baseline and at 28 days after the switch from MPH-IR to OROS-MPH.

RESULTS

There were significant improvements in the commission error and the reaction time of both visual and auditory continuous performance tests (CPTs) at 28 days after switching from MPH-IR to OROS-MPH. A positive correlation was observed between the improvement in parent/caregiver-rated IOWA Conners total score (Delta IOWA) and the reduction in commission error (r = 0.3, p = 0.001) and reduction in reaction time variability (r = 0.3, p = 0.006) of visual CPT. In a linear regression model, the change in parent/caregiver-rated IOWA Conners scale total scores were significant predictors of change in commission error (beta = 0.3, p = 0.005, CI = 0.4-2.3, adjusted R(2) = 0.12) and RT variability (beta = 0.3, p = 0.004, CI = 0.5-2.4, adjusted R(2) = 0.09) of visual CPT.

CONCLUSIONS

These data suggest that MPH-IR may be successfully switched to OROS-MPH treatment with associated improvements in neurocognitive performance. Large-scale controlled trials are needed to replicate these findings.

Paying attention to reading: the neurobiology of reading and dyslexia

Extraordinary progress in functional brain imaging, primarily advances in functional magnetic resonance imaging, now allows scientists to understand the neural systems serving reading and how these systems differ in dyslexic readers. Scientists now speak of the neural signature of dyslexia, a singular achievement that for the first time has made what was previously a hidden disability, now visible. Paralleling this achievement in understanding the neurobiology of dyslexia, progress in the identification and treatment of dyslexia now offers the hope of identifying children at risk for dyslexia at a very young age and providing evidence-based, effective interventions. Despite these advances, for many dyslexic readers, becoming a skilled, automatic reader remains elusive, in great part because though children with dyslexia can be taught to decode words, teaching children to read fluently and automatically represents the next frontier in research on dyslexia. We suggest that to break through this "fluency" barrier, investigators will need to reexamine the more than 20-year-old central dogma in reading research: the generation of the phonological code from print is modular, that is, automatic and not attention demanding, and not requiring any other cognitive process. Recent findings now present a competing view: other cognitive processes are involved in reading, particularly attentional mechanisms, and that disruption of these attentional mechanisms play a causal role in reading difficulties. Recognition of the role of attentional mechanisms in reading now offer potentially new strategies for interventions in dyslexia. In particular, the use of pharmacotherapeutic agents affecting attentional mechanisms not only may provide a window into the neurochemical mechanisms underlying dyslexia but also may offer a potential adjunct treatment for teaching dyslexic readers to read fluently and automatically. Preliminary studies suggest that agents traditionally used to treat disorders of attention, particularly attention-deficit/hyperactivity disorder, may prove to be an effective adjunct to improving reading in dyslexic students.

Age-related grey matter volume correlates of response inhibition and shifting in attention-deficit hyperactivity disorder

BACKGROUND

Children with attention-deficit hyperactivity disorder (ADHD) have difficulties with executive function and impulse control which may improve with age.

AIMS

To map the brain correlates of executive function in ADHD and determine age-related changes in reaction times and brain volumes.

METHOD

Attention-deficit hyperactivity disorder and control groups were compared on the change task measures of response inhibition (stop signal reaction time, SSRT) and shifting (change response reaction time, CRRT). Voxel-wise magnetic resonance imaging (MRI) correlations of reaction times and grey matter volume were determined, along with bivariate correlations of reaction times, brain volumes and age.

RESULTS

Individuals in the ADHD group had longer SSRTs and CRRTs. Anterior cingulate, striatal and medial temporal volumes highly correlated with SSRT. Striatal and cerebellar volumes strongly correlated with CRRT. Older children had faster reaction times and larger regional brain volumes. In controls, orbitofrontal, medial temporal and cerebellar volumes correlated with CRRT but not SSRT. Neither reaction times nor regional brain volumes were strongly age-dependent.

CONCLUSIONS

Our evidence supports delayed brain maturation in ADHD and implies that some features of ADHD improve with age.

Inhibition of the norepinephrine transporter improves behavioral flexibility in rats and monkeys

RATIONALE

Poor cognitive control, including reversal learning deficits, has been reported in children with attention deficit hyperactivity disorder, in stimulant-dependent humans, and in animal models of these disorders; these conditions have each been associated with abnormal catecholaminergic function within the prefrontal cortex.

OBJECTIVES

In the current studies, we sought to explore how elevations in extracellular catecholamine levels, produced by pharmacological inhibition of catecholamine reuptake proteins, affect behavioral flexibility in rats and monkeys.

MATERIALS AND METHODS

Adult male Long-Evans rats and vervet monkeys were trained, respectively, on a four-position discrimination task or a three-choice visual discrimination task. Following systemic administration of pharmacological inhibitors of the dopamine and/or norepinephrine membrane transporters, rats and monkeys were exposed to retention or reversal of acquired discriminations.

RESULTS

In accordance with our a priori hypothesis, we found that drugs that inhibit norepinephrine transporters, such as methylphenidate, atomoxetine, and desipramine, improved reversal performance in rats and monkeys; this was mainly due to a decrease in the number of perseverative errors. Interestingly, the mixed dopamine and norepinephrine transporters inhibitor methylphenidate, if anything, impaired performance during retention in both rats and monkeys, while administration of the selective dopamine transporter inhibitor GBR-12909 increased premature responses but did not alter reversal learning performance.

CONCLUSIONS

Our results suggest that pharmacological inhibition of the membrane norepinephrine, but not membrane dopamine, transporter is associated with enhanced behavioral flexibility. These data, combined with earlier reports, may indicate that enhanced extracellular catecholamine levels in cortical regions, secondary to norepinephrine reuptake inhibition, improves multiple aspects of inhibitory control over responding in rats and monkeys.

Methylphenidate improves response inhibition but not reflection-impulsivity in children with attention deficit hyperactivity disorder (ADHD)

RATIONALE

Impulsivity is a cardinal feature of attention deficit hyperactivity disorder (ADHD), which is thought to underlie many of the cognitive and behavioural symptoms associated with the disorder. Impairments on some measures of impulsivity have been shown to be responsive to pharmacotherapy. However, impulsivity is a multi-factorial construct and the degree to which different forms of impulsivity contribute to impairments in ADHD or respond to pharmacological treatments remains unclear.

OBJECTIVES

The aims of the study were to assess the effects of methylphenidate (MPH) on the performance of children with ADHD on measures of reflection-impulsivity and response inhibition and to compare with the performance of healthy volunteers.

METHODS

Twenty-one boys (aged 7-13 years) diagnosed with ADHD underwent a double-blind, placebo-controlled trial of MPH (0.5 mg/kg) during which they performed the Information Sampling Task (IST) and the Stop Signal Task. A healthy age- and education-matched control group was tested on the same measures without medication.

RESULTS

Children with ADHD were impaired on measures of response inhibition, but did not demonstrate reflection-impulsivity on the IST. However, despite sampling a similar amount of information as their peers, the ADHD group made more poor decisions. MPH improved performance on measures of response inhibition and variability of response, but did not affect measures of reflection-impulsivity or quality of decision-making.

CONCLUSIONS

MPH differentially affected two forms of impulsivity in children with ADHD and failed to ameliorate their poor decision-making on the information sampling test.

Development of attentional processes in ADHD and normal children

Attention Deficit Hyperactivity Disorder (ADHD) is a developmental disorder. Typical development of attentional processes is rapid during early childhood. ADHD results in impairment in response inhibition, error monitoring, attentional disengagement, executive attention, and delay aversion and may effect the ongoing development of these processes during childhood. We examined the development of attentional processes in children with ADHD and normal children. Two hundred forty children (120 in each group) in the age range of 6-9 years participated in the study. Four tasks: Stop-Signal, attentional disengagement, attention network, and choice delay task were administered. Stop signal reaction time, switch costs, conflict effect, and percentage choice of short delay reward was higher in ADHD group compared to normal group. Post error of slowing was less in ADHD children. Endogenous orienting effect was more in normal children compared to ADHD children. Different developmental trajectories were observed for control functions in normal children. Major development in response inhibition occurred in 7-8 years, error monitoring in 6-9 years, and attentional disengagement in 7-9 years. Late development in alerting network was observed in normal children at age 9 years. No developmental changes occurred on these control functions in ADHD children aged 6-9 years. Age related changes were observed on delay aversion between 6 and 9 years in normal children, while it changed between 6 and 7 years in ADHD children. Performance was not changed on orienting and conflict attentional networks in both the children except conflict effect reduced between 7 and 9 years in ADHD children under double cue condition. Conflict network was interacted with the alerting and orienting network in normal children; specifically conflict network interacted with the orienting network in younger children (age 6 years) and with alerting network in older children (age 9 years). In ADHD group interaction between alerting and conflict network was observed only in the double cue condition. Together these results indicated that the deficits in control processes accumulate with age in ADHD children Present study favors the conceptual view of ADHD as a stable deficit in cognitive control functions, which are implicated in the pathology of ADHD. These results have theoretical implication for the theories of executive control and ADHD.

CNTRICS final task selection: executive control

The third meeting of the Cognitive Neuroscience Treatment Research to Improve Cognition in Schizophrenia (CNTRICS) was focused on selecting promising measures for each of the cognitive constructs selected in the first CNTRICS meeting. In the domain of executive control, the 2 constructs of interest were "rule generation and selection" and "dynamic adjustments in control." CNTRICS received 4 task nominations for each of these constructs, and the breakout group for executive control evaluated the degree to which each of these tasks met prespecified criteria. For rule generation and selection, the breakout group for executive control recommended the intradimensional/extradimensional shift task and the switching Stroop for translation for use in clinical trial contexts in schizophrenia research. For dynamic adjustments in control, the breakout group recommended conflict and error adaptation in the Stroop and the stop signal task for translation for use in clinical trials. This article describes the ways in which each of these tasks met the criteria used by the breakout group to recommend tasks for further development.

Acute effects of cocaine on the neurobiology of cognitive control

Compromised ability to exert control over drug urges and drug-seeking behaviour is a characteristic of addiction. One specific cognitive control function, impulse control, has been shown to be a risk factor for the development of substance problems and has been linked in animal models to increased drug administration and relapse. We present evidence of a direct effect of cocaine on the neurobiology underlying impulse control. In a laboratory test of motor response inhibition, an intravenous cocaine administration improved task performance in 13 cocaine users. This improvement was accompanied by increased activation in right dorsolateral and inferior frontal cortex, regions considered critical for this cognitive function. Similarly, for both inhibitory control and action monitoring processes, cocaine normalized activation levels in lateral and medial prefrontal regions previously reported to be hypoactive in users relative to drug-naive controls. The acute amelioration of neurocognitive dysfunction may reflect a chronic dysregulation of those brain regions and the cognitive processes they subserve. Furthermore, the effects of cocaine on midline function suggest a dopaminergically mediated intersection between cocaine's acute reinforcing effects and its effects on cognitive control.

Methylphenidate disrupts social play behavior in adolescent rats

Methylphenidate is the first-choice treatment for attention-deficit/hyperactivity disorder (ADHD), but its mechanism of action is incompletely understood. The cognitive effects of methylphenidate have been extensively studied, but little is known about its effects on spontaneous social behavior. During adolescence, rats display a characteristic, highly vigorous form of social behavior, termed social play behavior, which is of critical importance for social and cognitive development. We investigated the neurobehavioral mechanisms by which methylphenidate affects social play behavior in rats. Methylphenidate (0.3-3.0 mg/kg, s.c. or p.o.) abolished social play behavior, without altering general social interest. This effect of methylphenidate did not depend upon the baseline level of social play and was not secondary to changes in locomotion. Furthermore, the play-suppressant effect of methylphenidate was not subject to tolerance or sensitization. Methylphenidate blocked both the initiation to play and the responsivity to play initiation. The effect of methylphenidate was mimicked by the noradrenaline reuptake inhibitor atomoxetine, which is also used for the treatment of ADHD, and was blocked by an alpha-2 adrenoceptor antagonist. In addition, combined administration of subeffective doses of methylphenidate and atomoxetine suppressed social play. However, blockade of alpha-1 adrenoceptors, beta-adrenoceptors, or dopamine receptors did not alter the effect of methylphenidate. These data show that methylphenidate selectively blocks the most vigorous part of the behavioral repertoire of adolescent rats through a noradrenergic mechanism. We suggest that the effect of methylphenidate on social play is a reflection of its therapeutic effect in ADHD, that is, improved behavioral inhibition. However, given the importance of social play for development, these findings may also indicate an adverse side effect of methylphenidate.

Poor response inhibition: at the nexus between substance abuse and attention deficit/hyperactivity disorder

The co-morbidity between attention deficit hyperactivity disorder (ADHD) and substance abuse and dependence disorders may have multiple causes and consequences. In this review, we will describe neurobehavioral, genetic and animal model studies that support the notion that a common, genetically determined failure of response inhibition function is an endophenotype for both disorders. Through an impairment in the ability to cognitively control pre-potent behaviors, subjects can exhibit a collection of ADHD-like traits (impulsivity and hyperactivity), as well as susceptibility for the initiation of drug taking and its ultimate progression to an inflexible, uncontrollable form. At the neural level, dysfunction within circuitry that includes the ventrolateral frontal and cingulate cortices, as well as in associated basal ganglia zones, contributes to a common pattern of behavioral impairment, explaining aspects of co-morbidity. Animal models of substance abuse/dependence and ADHD that exhibit deficits in response inhibition have substantiated the role of this endophenotype in both disorders and their co-morbidity and should provide a testing ground for interventions targeting it. New directions for research that will further explore this hypothesis and begin to reveal the underlying biological mechanisms will be proposed.

The neuropsychopharmacology of action inhibition: cross-species translation of the stop-signal and go/no-go tasks

BACKGROUND AND RATIONALE

The term 'action inhibition' encapsulates the ability to prevent any form of planned physical response. Growing evidence suggests that different 'stages' or even subtypes of action inhibition activate subtly different neuropharmacological and neuroanatomical processes.

OBJECTIVES

In this review, we present evidence from two commonly used and apparently similar behavioural tests, the stop-signal task and the go/no-go task, to determine if these have similar neuroanatomical and neurochemical modulation.

RESULTS

Whilst performance of the stop-signal and go/no-go tasks is modulated across only subtly different anatomical networks, serotonin (5-HT) is strongly implicated in inhibitory control on the go/no-go but not the stop-signal task, whereas the stop-signal reaction time appears more sensitive to the action of noradrenaline.

CONCLUSIONS

There is clear neuropharmacological and neuroanatomical evidence that stop-signal and go/no-go tasks represent different forms of action inhibition. This evidence translates with remarkable consistency across species. We discuss the possible implications of this evidence with respect to the development of novel therapeutic treatments for disorders in which inhibitory deficits are prominent and debilitating.

The effects of modafinil on mood and cognition in Huntington's disease

RATIONALE

The wake-promoting agent modafinil selectively improves neuropsychological task performance in healthy volunteers, in adults with attention deficit hyperactivity disorder (ADHD) and in schizophrenia. We examined whether modafinil induced similar effects in individuals with Huntington's disease (HD).

MATERIALS AND METHODS

Twenty patients with genetically proven, mild HD participated in a double-blind, randomised, placebo-controlled cross-over study using a single 200 mg dose of modafinil. Patients undertook a battery of neuropsychological tests including measures of cognition and mood.

RESULTS

Modafinil increased alertness as indexed by visual analogue scales. Modafinil did not elicit any significant improvements in cognitive function or mood. Modafinil had a deleterious effect on visual recognition and working memory.

CONCLUSIONS

Two hundred milligrams acute modafinil administration did improve alertness but did not improve cognition or mood in patients with mild HD. A multiple dose, chronic administration study is needed before the potential clinical utility of modafinil in HD is discounted.

Methylphenidate in the treatment of female adolescents with cooccurrence of attention deficit/hyperactivity disorder and borderline personality disorder: a preliminary open-label trial

Recent studies reported symptomatic overlap between attention deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD). Methylphenidate (MPH) is the most efficient treatment for ADHD. We assessed the efficacy and tolerability of MPH treatment in adolescent females who met the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV criteria for both disorders. Fourteen BPD/ADHD female adolescents aged 14-19 years were treated with MPH for 12 weeks, targeting ADHD, BPD symptoms, and aggressive behavior, as rated by ADHD-rating scale (ADHD-RS) and Clinical Global Impression-Severity (CGI-S) scale for BPD and aggressive behavior severity. A significant improvement was detected in both ADHD and BPD severity (baseline vs. end point, ADHD-RS: 33.1+/-4.8 vs. 17.6+/-5.2, P<0.001; BPD CGI-S: 4.6+/-0.8 vs. 3.4+/-0.8, P<0.0005, respectively) as well as in aggressive behavior (Aggression CGI-S: 3.5+/-1.3 vs. 1.8+/-0.5, P<0.001). MPH was well tolerated. MPH may be useful and well tolerated in treating some shared symptoms of ADHD and BPD among female adolescents. Controlled studies are needed to substantiate these findings.

Visual fields in children with attention-deficit / hyperactivity disorder before and after treatment with stimulants

PURPOSE

This study aimed to evaluate visual function in children with attention-deficit/hyperactivity disorder (ADHD), to correlate these data with the morphology of the optic nerve, and to find out if and how psychostimulant medication affects visual functions.

METHODS

The visual acuity (VA) and visual fields (VFs) of 18 children with ADHD (two girls and 16 boys), aged 6-17 years, were examined before and after treatment with psychostimulants. A control group, consisting of 24 children (nine girls and 15 boys), aged 7-18 years, were examined twice to evaluate the repeatability of the tests and the learning effect. Fundus photographs were analysed by digital planimetry.

RESULTS

Visual acuity increased significantly (p = 0.0039) in the ADHD group after treatment. The difference between the two VF examinations was significantly larger in the ADHD group compared with the control group (p = 0.036). Significantly more ADHD subjects had subnormal VF results without stimulants, compared with controls (p = 0.0043), but with stimulants the difference was no longer significant.

CONCLUSIONS

Children with ADHD showed better VA and VF results with than without psychostimulant medication.

Similar effects of the selective noradrenaline reuptake inhibitor atomoxetine on three distinct forms of impulsivity in the rat

Atomoxetine is a noradrenaline-specific reuptake inhibitor used clinically for the treatment of childhood and adult attention deficit hyperactivity disorder (ADHD). Studies in human volunteers and patient groups have shown that atomoxetine improves stop-signal reaction time (SSRT) performance, an effect consistent with a reduction in motor impulsivity. However, ADHD is a heterogeneous disorder and it is of interest to determine whether atomoxetine is similarly effective against other forms of impulsivity, as well as the attentional impairment present in certain subtypes of ADHD. The present study examined the effects of atomoxetine on impulsivity using an analogous SSRT task in rats and two additional tests of impulsivity; delay discounting of reward and the five-choice serial reaction time task (5CSRTT), the latter providing an added assessment of sustained visual attention. Atomoxetine produced a significant dose-dependent speeding of SSRT. In addition, atomoxetine produced a selective, dose-dependent decrease in premature responding on the 5CSRTT. Finally, on the delay-discounting task, atomoxetine significantly decreased impulsivity by increasing preference for the large-value reward across increasing delay. These findings conclusively demonstrate that atomoxetine decreases several distinct forms of impulsivity in rats. The apparent contrast of these effects with stimulant drugs such as amphetamine and methylphenidate, which generally act to increase impulsivity on the 5CSRTT, may provide new insights into the mechanisms of action of stimulant and nonstimulant drugs in ADHD.

Neuroimaging of attention deficit hyperactivity disorder: can new imaging findings be integrated in clinical practice?

Recent advances in neuroimaging research have helped elucidate the neurobiology of attention deficit hyperactivity disorder (ADHD) and the mechanisms by which medications used to treat ADHD exert their effects. The complex nature and array of imaging techniques, however, present challenges for the busy clinician in assessing possible clinical uses of brain imaging. Even though currently there are no accepted uses for imaging in diagnosing ADHD (other than ruling out identifiable medical or neurologic conditions that may mimic ADHD), this review introduces the main imaging techniques used to study ADHD, identifies relevant complexities facing psychiatric researchers in implementing neuroimaging techniques for clinical purposes, and provides benchmarks to help determine when imaging modalities have advanced to a point that they are deemed clinically useful.

A review of the effects of modafinil on cognition in schizophrenia

Modafinil, a wake-promoting agent believed to operate via the hypocretin/orexin system, has a similar clinical profile to that of conventional, dopaminergic stimulants but different biochemical and pharmacological properties. There is increasing interest in the use of modafinil to improve cognition in schizophrenia as well as in other disorders such as attention-deficit/hyperactivity disorder. Recent research has focused on enhancing cognition in patients with schizophrenia because of the association between cognitive performance and functional outcome. Initial findings indicate that modafinil may lead to better executive functioning and attentional performance in patients with schizophrenia. The results further suggest that patient characteristics such as overall current cognitive functioning levels, genetic polymorphisms, and medication status may be important mediators for the effectiveness of modafinil, allowing for future treatment to be targeted to those most likely to benefit. Currently, further research is required to address the potential benefits and risks of chronic administration of modafinil to patients with schizophrenia.

Atomoxetine improved response inhibition in adults with attention deficit/hyperactivity disorder

BACKGROUND

Atomoxetine, a highly selective noradrenaline reuptake inhibitor (SNRI), shows efficacy in the treatment of attention-deficit/hyperactivity disorder (ADHD). Compared with psychostimulants, atomoxetine has a distinct mode of brain action and potentially lower addictive potential. Studies have yet to assess whether atomoxetine improves cognition following a single oral dose in ADHD.

METHODS

Twenty-two adults with DSM-IV ADHD were administered a single oral dose of atomoxetine (60 mg) in a placebo-controlled double-blind crossover design. Cognitive effects were assessed using stop-signal, sustained attention, spatial working memory, and set-shifting paradigms. Normative cognitive data from 20 healthy volunteers were collected for comparison.

RESULTS

The ADHD patients under placebo conditions showed response inhibition and working memory deficits compared with healthy volunteers. Atomoxetine treatment in the ADHD patients was associated with shorter stop-signal reaction times and lower numbers of commission errors on the sustained attention task.

CONCLUSIONS

Atomoxetine improved inhibitory control, most likely via noradrenergically mediated augmentation of prefrontal cortex function. These results have implications for understanding the mechanisms by which atomoxetine exerts beneficial clinical effects and suggest novel treatment directions for other disorders of impulsivity.

Sensitivity of the five-choice serial reaction time task to the effects of various psychotropic drugs in Sprague-Dawley rats

BACKGROUND

Attentional deficits accompany many psychiatric disorders, underscoring the need for rodent models of attention to screen novel therapeutic agents and characterize the biological basis of attention. The five-choice serial reaction time task (5CSRTT) is one such model. Here, we characterized the effects of four standard psychotropic agents on performance in the 5CSRTT.

METHODS

Male Sprague-Dawley rats were trained in the 5CSRTT (5-sec inter-trial interval and .5-sec stimulus duration) until they reliably performed at > 60% accuracy and < 20% omissions. They were then treated systemically with the stimulant methylphenidate (MPH) (.063-2.0 mg/kg), the N-methyl-D-aspartate antagonist dizocilpine (MK-801) (.008-.25 mg/kg), the norepinephrine reuptake inhibitor desipramine (DMI) (.63-10 mg/kg), or the kappa-receptor agonist U69,593 (.25-2.0 mg/kg) 30 min before testing.

RESULTS

Methylphenidate (.5 mg/kg) increased accuracy. Dizocilpine impaired accuracy (.25 mg/kg), increased premature responses (.063-.25 mg/kg), and increased omissions (.25 mg/kg). Desipramine decreased premature responses (5.0 mg/kg) but increased omissions (10 mg/kg), correct response latencies (5.0-10.0 mg/kg), and reward latencies (5.0-10.0 mg/kg). The kappa-opioid agonist U69,593 (1.0-2.0 mg/kg) increased omissions and correct response latencies.

CONCLUSIONS

In Sprague-Dawley rats, psychotropic drugs with distinct pharmacological profiles produced distinguishable effects in the 5CSRTT. The effects of these classes of drugs under our testing conditions are qualitatively similar to their effects in humans.