Motivation deficit in ADHD is associated with dysfunction of the dopamine reward pathway

Membrane transporters as mediators of synaptic dopamine dynamics: implications for disease

Dopamine was first identified as a neurotransmitter localized to the midbrain over 50 years ago. The dopamine transporter (DAT; SLC6A3) and the vesicular monoamine transporter 2 (VMAT2; SLC18A2) are regulators of dopamine homeostasis in the presynaptic neuron. DAT transports dopamine from the extracellular space into the cytosol of the presynaptic terminal. VMAT2 then packages this cytosolic dopamine into vesicular compartments for subsequent release upon neurotransmission. Thus, DAT and VMAT2 act in concert to move the transmitter efficiently throughout the neuron. Accumulation of dopamine in the neuronal cytosol can trigger oxidative stress and neurotoxicity, suggesting that the proper compartmentalization of dopamine is critical for neuron function and risk of disease. For decades, studies have examined the effects of reduced transporter function in mice (e.g. DAT-KO, VMAT2-KO, VMAT2-deficient). However, we have only recently been able to assess the effects of elevated transporter expression using BAC transgenic methods (DAT-tg, VMAT2-HI mice). Complemented with in vitro work and neurochemical techniques to assess dopamine compartmentalization, a new focus on the importance of transporter proteins as both models of human disease and potential drug targets has emerged. Here, we review the importance of DAT and VMAT2 function in the delicate balance of neuronal dopamine.

Optimizing outcomes in ADHD treatment: from clinical targets to novel delivery systems

Our knowledge and understanding of the underlying neurobiology and symptomatic expression of ADHD has advanced dramatically over the past decade. Associated with these advances has been a similar explosion of new treatment options to individualize treatment for our patients. This article will: ∙ review strategies to measure ADHD symptoms and functional difficulties while seeking to achieve full symptomatic remission throughout the day ∙ summarize recent findings regarding the management and prioritization of ADHD and comorbid conditions and ∙ discuss the various pharmacologic treatment options with a focus on recently developed molecules and novel delivery systems.

The Influence of Extrinsic Reinforcement on Children with Heavy Prenatal Alcohol Exposure

BACKGROUND

Prenatal alcohol exposure affects inhibitory control and other aspects of attention and executive function. However, the efficacy of extrinsic reinforcement on these behaviors has not been tested.

METHODS

Alcohol-exposed children (AE; n = 34), children with attention-deficit/hyperactivity disorder (ADHD; n = 23), and controls (CON; n = 31) completed a flanker task with 4 reward conditions (no reward, reward, reward+occasional response cost, equal probability of reward+response cost). Inhibitory control was tested in the no reward conditions using a 3(group) × 2(flanker type) ANCOVA. Response to reinforcement was tested using 3(group) × 4(reward condition) × 4(flanker type) analysis of covariance (ANCOVA). Response time (RT) and accuracy were tested independently.

RESULTS

Groups did not differ on demographic variables. The flanker task was successful in taxing interference control, an aspect of executive attention (i.e., responses to incongruent stimuli were slower than to congruent stimuli) and the AE group demonstrated impaired executive control over the other groups. Overall, the AE group had significantly slower RTs compared to the CON and ADHD groups, which did not differ. However, reinforcement improved RT in all groups. While occasional response cost had the greatest benefit in the CON group, the type of reinforcement did not differentially affect the AE and ADHD groups. Accuracy across reward conditions did not differ by group, but was dependent on flanker type and reward condition.

CONCLUSIONS

Alcohol-exposed children, but not children with ADHD, had impaired interference control in comparison with controls, supporting a differential neurobehavioral profile in these 2 groups. Both clinical groups were equally affected by introduction of reinforcement, although the type of reinforcement did not differentially affect performance as it did in the control group, suggesting that reward or response cost could be used interchangeably to result in the same benefit.

Blunted Dopamine Transmission in Addiction: Potential Mechanisms and Implications for Behavior

Positron emission tomography (PET) imaging consistently shows blunted striatal dopamine release and decreased dopamine D2 receptor availability in addiction. Here, we review the preclinical and clinical studies indicating that this neurobiological phenotype is likely to be both a consequence of chronic drug consumption and a vulnerability factor in the development of addiction. We propose that, behaviorally, blunted striatal dopamine transmission could reflect the increased impulsivity and altered cost/benefit computations that are associated with addiction. The factors that influence blunted striatal dopamine transmission in addiction are unknown. Herein, we give an overview of various factors, genetic, environmental, and social, that are known to affect dopamine transmission and that have been associated with the vulnerability to develop addiction. Altogether, these data suggest that blunted dopamine transmission and decreased D2 receptor availability are biomarkers both for the development of addiction and resistance to treatment. These findings support the view that blunted dopamine reflects impulsive behavior and deficits in motivation, which lead to the escalation of drug use.

Current State and Model for Development of Technology-Based Care for Attention Deficit Hyperactivity Disorder

INTRODUCTION

Care (i.e., evaluation and intervention) delivered through technology is used in many areas of mental health services, including for persons with attention deficit hyperactivity disorder (ADHD). Technology can facilitate care for individuals with ADHD, their parents, and their care providers. The adoption of technological tools for ADHD care requires evidence-based studies to support the transition from development to integration into use in the home, school, or work for persons with the disorder. The initial phase, which is development of technological tools, has begun in earnest; however, the evidence base for many of these tools is lacking. In some instances, the uptake of a piece of technology into home use or clinical practice may be further along than the research to support its use.

METHODS

In this study, we review the current evidence regarding technology for ADHD and also propose a model to evaluate the support for other tools that have yet to be tested.

RESULTS

We propose using the Research Domain Criteria as a framework for evaluating the tools' relationships to dimensions related to ADHD.

CONCLUSION

This article concludes with recommendations for testing new tools that may have promise in improving the evaluation or treatment of persons with ADHD.

Executive Dysfunctions: The Role in Attention Deficit Hyperactivity and Post-traumatic Stress Neuropsychiatric Disorders

Executive functions (EFs) is an umbrella term for various cognitive processes controlled by a complex neural activity, which allow the production of different types of behaviors seeking to achieve specific objectives, one of them being inhibitory control. There is a wide consensus that clinical and behavioral alterations associated with EF, such as inhibitory control, are present in various neuropsychiatric disorders. This paper reviews the research literature on the relationship between executive dysfunction, frontal-subcortical neural circuit changes, and the psychopathological processes associated with attention deficit hyperactivity disorder (ADHD) and post-traumatic stress disorder (PTSD). A revision on the role of frontal-subcortical neural circuits and their presumable abnormal functioning and the high frequency of neuropsychiatric symptoms could explain the difficulties with putting effector mechanisms into action, giving individuals the necessary tools to act efficiently in their environment. Although, neuronal substrate data about ADHD and PTSD has been reported in the literature, it is isolated. Therefore, this review highlights the overlapping of neural substrates in the symptomatology of ADHD and PTSD disorders concerning EFs, especially in the inhibitory component. Thus, the changes related to impaired EF that accompany disorders like ADHD and PTSD could be explained by disturbances that have a direct or indirect impact on the functioning of these loops. Initially, the theoretical model of EF according to current neuropsychology will be presented, focusing on the inhibitory component. In a second stage, this component will be analyzed for each of the disorders of interest, considering the clinical aspects, the etiology and the neurobiological basis. Additionally, commonalities between the two neuropsychiatric conditions will be taken into consideration from the perspectives of cognitive and emotional inhibition. Finally, the implications and future prospects for research and interventions in the area will be outlined, with the intention of contributing scientific reference information that encompasses the knowledge and understanding of executive dysfunction and its relationship with these treated disorders.

Dopamine Does Double Duty in Motivating Cognitive Effort

Cognitive control is subjectively costly, suggesting that engagement is modulated in relationship to incentive state. Dopamine appears to play key roles. In particular, dopamine may mediate cognitive effort by two broad classes of functions: (1) modulating the functional parameters of working memory circuits subserving effortful cognition, and (2) mediating value-learning and decision-making about effortful cognitive action. Here, we tie together these two lines of research, proposing how dopamine serves "double duty", translating incentive information into cognitive motivation.

Nicotine-dopamine-transporter interactions during reward-based decision making

Our everyday-life comprises a multitude of decisions that we take whilst trying to maximize advantageous outcomes, limit risks and update current needs. The cognitive processes that guide decision making as well as the brain circuits they are based on are only poorly understood. Numerous studies point to a potential role of dopamine and nicotine in decision making but less is known about their interactions. Here, 26 healthy male subjects performed the Iowa Gambling Task (IGT) in two sessions following the administration of either nicotine or placebo. Striatal dopamine transporter (DAT) binding was measured by single-photon emission computed tomography (SPECT). Results indicate that lower DAT levels were associated with better performance in the IGT (p=0.0004). Cognitive modelling analysis using the prospect valence learning (PVL) model indicated that low DAT subjects' performance deteriorated following nicotine administration as indicated by an increased learning rate and a decreased response consistency. Our results shed light on the neurochemistry underlying reward-based decision making in humans by demonstrating a significant interaction between nicotine and the DAT. The observed interaction is consistent with the hypothesized associations between DAT expression and extracellular dopamine levels, suggestive of an inverted U-shape relationship between baseline dopamine and magnitude in response to a pro-dopaminergic compound. Our findings are of particular interest in the context of psychiatric disorders where aberrant decision making represents a part of the core symptomatology, such as addiction, schizophrenia or depression.

Cue-Evoked Dopamine Release Rapidly Modulates D2 Neurons in the Nucleus Accumbens During Motivated Behavior

Dopaminergic neurons that project from the ventral tegmental area (VTA) to the nucleus accumbens (NAc) fire in response to unpredicted rewards or to cues that predict reward delivery. Although it is well established that reward-related events elicit dopamine release in the NAc, the role of rapid dopamine signaling in modulating NAc neurons that respond to these events remains unclear. Here, we examined dopamine's actions in the NAc in the rat brain during an intracranial self-stimulation task in which a cue predicted lever availability for electrical stimulation of the VTA. To distinguish actions of dopamine at select receptors on NAc neurons during the task, we used a multimodal sensor that probes three aspects of neuronal communication simultaneously: neurotransmitter release, cell firing, and identification of dopamine receptor type. Consistent with prior studies, we first show dopamine release events in the NAc both at cue presentation and after lever press (LP). Distinct populations of NAc neurons encode these behavioral events at these same locations selectively. Using our multimodal sensor, we found that dopamine-mediated responses after the cue involve exclusively a subset of D2-like receptors (D2Rs), whereas dopamine-mediated responses proximal to the LP are mediated by both D1-like receptors (D1R) and D2Rs. These results demonstrate for the first time that dopamine-mediated responses after cues that predict reward availability are specifically linked to its actions at a subset of neurons in the NAc containing D2Rs.

SIGNIFICANCE STATEMENT

Successful reward procurement typically involves the completion of a goal-directed behavior in response to appropriate environmental cues. Although numerous studies link the mesolimbic dopamine system with these processes, how dopamine's effects are mediated on the receptor level within a key neural substrate, the nucleus accumbens, remains elusive. Here, we used a unique multimodal sensor that reveals three aspects of neuronal interactions: neurotransmitter release, cell firing, and dopamine-receptor type. We identified a key role of D2-like receptor (D2R)-expressing neurons in response to a reward-predicting cue, whereas both the D2R and D1R types modulate responses of neurons proximal to the goal-directed action. This work provides novel insight into the unique role of D2R-mediated neuronal activity to reward-associated cues, a fundamental aspect of motivated behaviors.

Functional reversal of (-)-Stepholidine analogues by replacement of benzazepine substructure using the ring-expansion strategy

(-)-Stepholidine is an active ingredient of the Chinese herb Stephania and naturally occurring tetrahydroprotoberberine alkaloid with mixed dopamine receptor D1 agonistic and dopamine receptor D2 antagonistic activities. In this work, a series of novel hexahydrobenzo[4,5]azepino [2,1-a]isoquinolines were designed and synthesized as ring-expanded analogues of (-)-Stepholidine. Initial pharmacological assays demonstrated that a benzazepine replacement was associated with significant increase in selectivity and functional reversal at dopamine receptor D1 . Compound-(-)-15e (Ki  = 5.32 ± 0.01 nm) is more potent than (-)-Stepholidine (Ki  = 13 nm) and was identified as a selective dopamine receptor D1 antagonist (IC50  = 0.14 μm). Moreover, molecular modeling suggested that (-)-15e might exert its dopamine receptor D1 antagonistic activities through interacting with the transmembrane helix 7 of dopamine receptor D1 .

Effect of Exercise Training on Striatal Dopamine D2/D3 Receptors in Methamphetamine Users during Behavioral Treatment

Methamphetamine use disorder is associated with striatal dopaminergic deficits that have been linked to poor treatment outcomes, identifying these deficits as an important therapeutic target. Exercise attenuates methamphetamine-induced neurochemical damage in the rat brain, and a preliminary observation suggests that exercise increases striatal D2/D3 receptor availability (measured as nondisplaceable binding potential (BPND)) in patients with Parkinson's disease. The goal of this study was to evaluate whether adding an exercise training program to an inpatient behavioral intervention for methamphetamine use disorder reverses deficits in striatal D2/D3 receptors. Participants were adult men and women who met DSM-IV criteria for methamphetamine dependence and were enrolled in a residential facility, where they maintained abstinence from illicit drugs of abuse and received behavioral therapy for their addiction. They were randomized to a group that received 1 h supervised exercise training (n=10) or one that received equal-time health education training (n=9), 3 days/week for 8 weeks. They came to an academic research center for positron emission tomography (PET) using [(18)F]fallypride to determine the effects of the 8-week interventions on striatal D2/D3 receptor BPND. At baseline, striatal D2/D3 BPND did not differ between groups. However, after 8 weeks, participants in the exercise group displayed a significant increase in striatal D2/D3 BPND, whereas those in the education group did not. There were no changes in D2/D3 BPND in extrastriatal regions in either group. These findings suggest that structured exercise training can ameliorate striatal D2/D3 receptor deficits in methamphetamine users, and warrants further evaluation as an adjunctive treatment for stimulant dependence.

Genetic Variants of Angiotensin-Converting Enzyme Are Linked to Autism: A Case-Control Study

Background

Autism is a disease of complex nature with a significant genetic component. The importance of renin-angiotensin system (RAS) elements in cognition and behavior besides the interaction of angiotensin II (Ang II), the main product of angiotensin-converting enzyme (ACE), with neurotransmitters in CNS, especially dopamine, proposes the involvement of RAS in autism. Since the genetic architecture of autism has remained elusive, here we postulated that genetic variations in RAS are associated with autism.

Methods

Considering the relation between the three polymorphisms of ACE (I/D, rs4343 and rs4291) with the level of ACE activity, we have investigated this association with autism, in a case-control study. Genotype and allele frequencies of polymorphisms were determined in DNAs extracted from venous blood of 120 autistic patients and their age and sex-matched healthy controls, using polymerase chain reaction (PCR) and PCR–restriction fragment length polymorphism (PCR–RFLP) methods.

Results

There were strong associations between both DD genotype of ACE I/D and the D allele, with autism (P = 0.006, OR = 2.9, 95% CI = 1.64–5.13 and P = 0.006, OR = 2.18, 95% CI = 1.37–3.48 respectively). Furthermore, a significant association between the G allele of rs4343 and autism was observed (P = 0.006, OR = 1.84, 95%CI = 1.26–2.67). Moreover, haplotype analysis revealed an association between DTG haplotype and autism (P = 0.008).

Conclusion

Our data suggests the involvement of RAS genetic diversity in increasing the risk of autism.

Transactional Links Between Teacher-Student Relationships and Adolescent Rule-Breaking Behavior and Behavioral School Engagement: Moderating Role of a Dopaminergic Genetic Profile Score

Throughout adolescence, there is an increase in rule-breaking behavior and a decrease in behavioral school engagement. The role of teacher-student relationship quality in the development of these adjustment problems remains understudied. This study examined how adolescent-reported teacher-student affiliation and dissatisfaction and parent-reported rule-breaking behavior and behavioral engagement impact one another throughout adolescence. In addition, we examined the moderating effect of genes by means of a Biologically Informed Multilocus genetic Profile Score (BIMPS), a composite score reflecting the cumulative effect of multiple dopaminergic genes, with a higher score indicating higher dopamine signaling in the adolescent brain. We used three-year longitudinal data from 1111 adolescents (51 % boys; M age = 13.79), and their parents. Cross-lagged analyses revealed a transactional process in which adolescents who display more rule-breaking behavior and less behavioral engagement experienced increased subsequent dissatisfaction with their teachers, which in turn further increased their adjustment problems. Also, adolescents with more adjustment problems experienced decreased subsequent affiliation with their teachers. The other way around, adolescents' behavioral engagement also benefitted from positive relationships with teachers. Multi-group analyses revealed genetic moderation for behavioral engagement, but not for rule-breaking. Specifically, adolescents who had a BIMPS score coding for moderate levels of dopamine signaling (instead of high or low signaling) were most affected in their behavioral engagement when they experienced dissatisfaction with their teachers. Our study findings may guide schools in implementing interventions to create a supportive class and school environment including positive, supportive teacher-student relationships and indicate that providing a such a supportive school environment is important for all adolescents.

Cognitive Neurostimulation: Learning to Volitionally Sustain Ventral Tegmental Area Activation

Activation of the ventral tegmental area (VTA) and mesolimbic networks is essential to motivation, performance, and learning. Humans routinely attempt to motivate themselves, with unclear efficacy or impact on VTA networks. Using fMRI, we found untrained participants' motivational strategies failed to consistently activate VTA. After real-time VTA neurofeedback training, however, participants volitionally induced VTA activation without external aids, relative to baseline, Pre-test, and control groups. VTA self-activation was accompanied by increased mesolimbic network connectivity. Among two comparison groups (no neurofeedback, false neurofeedback) and an alternate neurofeedback group (nucleus accumbens), none sustained activation in target regions of interest nor increased VTA functional connectivity. The results comprise two novel demonstrations: learning and generalization after VTA neurofeedback training and the ability to sustain VTA activation without external reward or reward cues. These findings suggest theoretical alignment of ideas about motivation and midbrain physiology and the potential for generalizable interventions to improve performance and learning.

Advancing biomedical imaging

Imaging reveals complex structures and dynamic interactive processes, located deep inside the body, that are otherwise difficult to decipher. Numerous imaging modalities harness every last inch of the energy spectrum. Clinical modalities include magnetic resonance imaging (MRI), X-ray computed tomography (CT), ultrasound, and light-based methods [endoscopy and optical coherence tomography (OCT)]. Research modalities include various light microscopy techniques (confocal, multiphoton, total internal reflection, superresolution fluorescence microscopy), electron microscopy, mass spectrometry imaging, fluorescence tomography, bioluminescence, variations of OCT, and optoacoustic imaging, among a few others. Although clinical imaging and research microscopy are often isolated from one another, we argue that their combination and integration is not only informative but also essential to discovering new biology and interpreting clinical datasets in which signals invariably originate from hundreds to thousands of cells per voxel.

Behavioral and transcriptomic profiling of mice null for Lphn3, a gene implicated in ADHD and addiction

Background

The Latrophilin 3 (LPHN3) gene (recently renamed Adhesion G protein‐coupled receptor L3 (ADGRL3)) has been linked to susceptibility to attention deficit/hyperactivity disorder (ADHD) and vulnerability to addiction. However, its role and function are not well understood as there are no known functional variants.

Methods

To characterize the function of this little known gene, we phenotyped Lphn3 null mice. We assessed motivation for food reward and working memory via instrumental responding tasks, motor coordination via rotarod, and depressive‐like behavior via forced swim. We also measured neurite outgrowth of primary hippocampal and cortical neuron cultures. Standard blood chemistries and blood counts were performed. Finally, we also evaluated the transcriptome in several brain regions.

Results

Behaviorally, loss of Lphn3 increases both reward motivation and activity levels. Lphn3 null mice display significantly greater instrumental responding for food than wild‐type mice, particularly under high response ratios, and swim incessantly during a forced swim assay. However, loss of Lphn3 does not interfere with working memory or motor coordination. Primary hippocampal and cortical neuron cultures demonstrate that null neurons display comparatively enhanced neurite outgrowth after 2 and 3 days in vitro. Standard blood chemistry panels reveal that nulls have low serum calcium levels. Finally, analysis of the transcriptome from prefrontal cortical, striatal, and hippocampal tissue at different developmental time points shows that loss of Lphn3 results in genotype‐dependent differential gene expression (DGE), particularly for cell adhesion molecules and calcium signaling proteins. Much of the DGE is attenuated with age, and is consistent with the idea that ADHD is associated with delayed cortical maturation.

Conclusions

Transcriptome changes likely affect neuron structure and function, leading to behavioral anomalies consistent with both ADHD and addiction phenotypes. The data should further motivate analyses of Lphn3 function in the developmental timing of altered gene expression and calcium signaling, and their effects on neuronal structure/function during development.

Phenotypic abnormalities in a chorea-acanthocytosis mouse model are modulated by strain background

Chorea-acanthocytosis (ChAc) is an autosomal recessive hereditary disease characterized by neurodegeneration in the striatum and acanthocytosis that is caused by mutations in the VPS13A gene. We previously produced a ChAc model mice encoding a human disease mutation with deletion of exons 60-61 in the VPS13A gene. The behavioral and pathological phenotypes of the model mice varied a good deal from individual to individual, indicating that differences between individuals may be caused by the content of a genetic hybrid 129/Sv and C57BL/6J strain background. To establish the effect of the genetic background on phenotype, we backcrossed the ChAc-model mice to different inbred strains: C57BL/6J and 129S6/Sv. Although no significant difference between ChAc-mutant mice and wild-type mice on the C57BL/6J background was observed, the ChAc-mutant mice on the 129S6/Sv showed abnormal motor function and behavior. Furthermore, we produced ChAc-mutant mice on two different inbred strains: BALB/c and FVB. Significant reduction in weight was observed in ChAc mutant mice on the FVB and 129S6 backgrounds. We found a marked increase in the osmotic fragility of red blood cells in the ChAc mutant mice backcrossed to 129S6/Sv and FVB. The phenotypes varied according to strain, with ChAc mutant mice on the FVB and 129S6 backgrounds showing remarkably abnormal motor function and behavior. These results indicate that there are modifying genetic factors of ChAc symptoms.

Animal-Assisted Interventions for Children with Attention Deficit/Hyperactivity Disorder: A Theoretical Review and Consideration of Future Research Directions

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most prevalent neurodevelopmental disorders and is characterized by core symptoms of inattention, impulsivity, and hyperactivity. Given the limitations of the existing treatment strategies, it seems necessary to consider the further exploration of alternative treatment approaches. In this review, the application and complementary use of animal-assisted interventions to the treatment of ADHD were discussed. Several mechanisms including calming, socializing, motivating, and cognitive effects of animal-assisted interventions were explored. Since studies directly investigating these effects on ADHD are scarce, so each of them were examined in terms of how it could benefit the treatment of ADHD. These effects can have a positive effect on several core symptoms of ADHD.

“Turning Intentions Into Actions”

Contemporary models of attention-deficit/hyperactivity disorder (ADHD) provide frameworks for understanding this condition that move beyond the diagnostic symptom criteria. ADHD is currently viewed as a developmental syndrome of impaired self-regulatory processes that underlie the common symptoms and functional problems. Most clinic-referred adults with ADHD report chronic difficulties executing their intended plans despite recognizing the negative consequences for not doing so. Seeing as the psychosocial treatments for adult ADHD intervene at the level of life impairments and functioning, it is important that interventions directly target these implementation problems. The goal of this article is to discuss the case of a young woman with ADHD who has difficulties engaging in the various tasks she needs to perform to pursue her post-college goals. In particular, a cognitive-behavioral therapy approach that emphasizes implementation strategies designed to help adults with ADHD follow through on their plans is illustrated.

Jitter Reduces Response-Time Variability in ADHD: An Ex-Gaussian Analysis

OBJECTIVE

"Jitter" involves randomization of intervals between stimulus events. Compared with controls, individuals with ADHD demonstrate greater intrasubject variability (ISV) performing tasks with fixed interstimulus intervals (ISIs). Because Gaussian curves mask the effect of extremely slow or fast response times (RTs), ex-Gaussian approaches have been applied to study ISV.

METHOD

This study applied ex-Gaussian analysis to examine the effects of jitter on RT variability in children with and without ADHD. A total of 75 children, aged 9 to 14 years (44 ADHD, 31 controls), completed a go/no-go test with two conditions: fixed ISI and jittered ISI.

RESULTS

ADHD children showed greater variability, driven by elevations in exponential (tau), but not normal (sigma) components of the RT distribution. Jitter decreased tau in ADHD to levels not statistically different than controls, reducing lapses in performance characteristic of impaired response control.

CONCLUSION

Jitter may provide a nonpharmacologic mechanism to facilitate readiness to respond and reduce lapses from sustained (controlled) performance.

Driving behaviour in adults with attention deficit/hyperactivity disorder

BACKGROUND

Little is known about the impact of cognitive impairments on driving in adults with ADHD. The present study compared the performance of adults with and without ADHD in a driving simulator on two different routes: an urban route which we hypothesised would exacerbate weak impulse control in ADHD and a motorway route, to challenge deficits in sustained attention.

METHODS

Adults with (n = 22, 16 males) and without (n = 21, 18 males) ADHD completed a simulated driving session while eye movement data were recorded simultaneously. Participants also completed the Manchester Driving Behaviour Questionnaire (DBQ) and the Conners Adult ADHD Rating Scale (CAARS). Measures of driving performance included average speed, proportion distance travelled over speed limit (speeding) and lane deviation. These variables and the eye movement measures (spread of fixations, mean fixation duration) were compared between groups and routes. Also, driving behaviours, including responses to programmed events, were categorised and the frequencies within categories were compared between groups. Finally, speech analysis was performed to compare emotional verbal expressions during driving between groups.

RESULTS

ADHD participants reported significantly more Violations and Lapses on the DBQ than control participants and significantly more accidents. Average speed and speeding were also higher but did not interact with route type. ADHD participants showed poorer vehicle control, greater levels of frustration with other road users (including greater frequencies of negative comments) and a trend for less safe driving when changing lanes/overtaking on the motorway. These effects were predicted by hyperactive/impulsive CAARS scores. They were also more likely to cause a crash/near miss when an event occurred on the urban route.

CONCLUSIONS

The results suggest that difficulty regulating and controlling impulsive behavior, reflected in speeding, frustration with other road users, less safety when changing lanes on the motorway and a greater likelihood of an accident following an unexpected event, underlie impaired driving in ADHD. Hyperactivity/impulsivity symptoms correlated with these indices. Deficits in sustained attention seemed to play a lesser role in this particular study, although further research is needed to determine whether effects on attention emerge over longer periods of time and/or are influenced by the novelty of the simulator environment.

Blunted neural response to rewards as a vulnerability factor for depression: Results from a family study

Depressive disorders are associated with significant economic and public health burdens as well as increased morbidity. Yet, perhaps due to the heterogeneous nature of the disease, prevention and intervention efforts are only moderately efficacious. A better understanding of core mechanisms of depressive disorders might aid in the development of more targeted intervention, and perhaps help identify individuals at risk. One mechanism that may be particularly important to depressive phenotypes is reward insensitivity. Examination of neurobiological correlates of reward-processing, which should relate more directly to the neuropathology of depression, may be helpful in identifying liability for the disorder. To that end, we used a family study design to examine whether a neural response to rewards is a familial risk factor for depression in a sample of probands with a wide range of internalizing psychopathology, as well as their biological siblings. Event-related potentials were recorded during a simple forced-choice gambling paradigm, in which participants could either win or lose small amounts of money. Lower levels of positive affect in probands predicted a reduced neural response to rewards in siblings, even over and above the sibling's own level of positive and negative affect. Additionally, the neural response to rewards was familial (i.e., correlated among siblings). Combined, these analyses suggest that a blunted neural response to rewards may be useful in identifying individuals vulnerable to depressive illnesses.

VI. The role of physical activity in reducing barriers to learning in children with developmental disorders

Emerging research suggests that physical activity may be an effective non-pharmaceutical intervention approach for childhood developmental disorders. Findings indicate that both single bouts of activity and chronic physical activity associate with improved mental health and classroom performance in children with attention-deficit/hyperactivity disorder and children with autism spectrum disorders. This review describes the research in this area and identifies limitations and challenges to the translation of these findings to promote physical activity in clinical practice and educational policy.

Emotional Eating Phenotype is Associated with Central Dopamine D2 Receptor Binding Independent of Body Mass Index

PET studies have provided mixed evidence regarding central D2/D3 dopamine receptor binding and its relationship with obesity as measured by body mass index (BMI). Other aspects of obesity may be more tightly coupled to the dopaminergic system. We characterized obesity-associated behaviors and determined if these related to central D2 receptor (D2R) specific binding independent of BMI. Twenty-two obese and 17 normal-weight participants completed eating- and reward-related questionnaires and underwent PET scans using the D2R-selective and nondisplaceable radioligand (N-[¹¹C]methyl)benperidol. Questionnaires were grouped by domain (eating related to emotion, eating related to reward, non-eating behavior motivated by reward or sensitivity to punishment). Normalized, summed scores for each domain were compared between obese and normal-weight groups and correlated with striatal and midbrain D2R binding. Compared to normal-weight individuals, the obese group self-reported higher rates of eating related to both emotion and reward (p < 0.001), greater sensitivity to punishment (p = 0.06), and lower non-food reward behavior (p < 0.01). Across normal-weight and obese participants, self-reported emotional eating and non-food reward behavior positively correlated with striatal (p < 0.05) and midbrain (p < 0.05) D2R binding, respectively. In conclusion, an emotional eating phenotype may reflect altered central D2R function better than other commonly used obesity-related measures such as BMI.

ADHD symptomatology is best conceptualized as a spectrum: a dimensional versus unitary approach to diagnosis

The aim of this paper is to build a case for the utility of conceptualizing ADHD, not as a unitary disorder that contains several subtypes, but rather as a marker of impairment in attention and/or impulsivity that can be used to identify one of several disorders belonging to a spectrum. The literature will be reviewed to provide an overview of what is known about ADHD in terms of heterogeneity in symptomatology, neuropsychology, neurobiology, as well as comorbidity with other diseases and treatment options. The data from these areas of research will be critically analyzed to support the construct of a spectrum of disorders that can capture the great variability that exists between individuals with ADHD and can discriminate between separate disorders that manifest similar symptoms. The symptoms associated with ADHD can be viewed as dimensional markers that point to a spectrum of related disorders that have as part of their characteristics impairments of attention and impulsivity. The spectrum can accommodate symmetrically and asymmetrically comorbid psychiatric disorders associated with ADHD as well as the wide heterogeneity known to be a part of the ADHD disorder. Individuals presenting with impairments associated with ADHD should be treated as having a positive marker for a spectrum disorder that has as part of its characteristics impairments of attention and/or impulsivity. The identification of impairment in attention and/or impulsivity should be a starting point for further testing rather than being an endpoint of diagnosis that results in pharmacological treatment that may or may not be the optimal therapy. Rather than continuing to attribute a large amount of heterogeneity in symptom presentation as well as a high degree of symmetric and asymmetric comorbidity to a single disorder, clinical evaluation should turn to the diagnosis of the type of attentional deficit and/or impulsivity an individual has in order to colocate the individual's disorder on a spectrum that captures the heterogeneity in symptomatology, the symmetrical and asymmetrical comorbidity, as well as subthreshold presentation and other variants often worked into the disorder of ADHD. The spectrum model can accommodate not only the psychophysiological profiles of patients, but is also consistent with what is known about the functional heterogeneity of the prefrontal cortex as well as the construct that cognitive processes are supported by overlapping and collaborative networks.

[Attention deficit hyperactivity disorder]

Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood psychiatric disorders and can persist into the adulthood. ADHD has important social, academic and occupational consequences. ADHD diagnosis is based on the fulfillment of several clinical criteria, which can vary depending on the diagnostic system used. The clinical presentation can show great between-patient variability and it has been related to a dysfunction in the fronto-striatal and meso-limbic circuits. Recent investigations support a model in which multiple genetic and environmental factors interact to create a neurobiological susceptibility to develop the disorder. However, no clear causal association has yet been identified. Although multimodal treatment including both pharmacological and psychosocial interventions is usually recommended, no convincing evidence exists to support this recommendation. Pharmacological treatment has fundamentally shown to improve ADHD symptoms in the short term, while efficacy data for psychosocial interventions are scarce and inconsistent. Yet, drug treatment is increasingly popular and the last 2 decades have witnessed a sharp increase in the prescription of anti-ADHD medications coinciding with the marketing of new drugs to treat ADHD.

Adaptive effort investment in cognitive and physical tasks: a neurocomputational model

Despite its importance in everyday life, the computational nature of effort investment remains poorly understood. We propose an effort model obtained from optimality considerations, and a neurocomputational approximation to the optimal model. Both are couched in the framework of reinforcement learning. It is shown that choosing when or when not to exert effort can be adaptively learned, depending on rewards, costs, and task difficulty. In the neurocomputational model, the limbic loop comprising anterior cingulate cortex (ACC) and ventral striatum in the basal ganglia allocates effort to cortical stimulus-action pathways whenever this is valuable. We demonstrate that the model approximates optimality. Next, we consider two hallmark effects from the cognitive control literature, namely proportion congruency and sequential congruency effects. It is shown that the model exerts both proactive and reactive cognitive control. Then, we simulate two physical effort tasks. In line with empirical work, impairing the model's dopaminergic pathway leads to apathetic behavior. Thus, we conceptually unify the exertion of cognitive and physical effort, studied across a variety of literatures (e.g., motivation and cognitive control) and animal species.

Tourette syndrome and comorbid ADHD: causes and consequences

Attention deficit hyperactivity disorder (ADHD) is the most common comorbid condition in patients with Tourette syndrome (TS). The co-occurrence of ADHD and TS is in most cases associated with a higher social and psychopathological impairment. Comorbidity between Tourette and ADHD appears to have a complex and partially known pathogenesis in which genetic, environmental, and neurobiological factors can be implicated. Genetic studies have revealed an involvement of dopaminergic, catecholaminergic, and GABAergic genes that modulated the activity of neurotransmitters. Furthermore, there are a lot of networks implicated in the development of ADHD and TS, involving cortical and striatal areas and basal ganglia. Although a large number of studies tried to find a common pathogenesis, the complex pathways responsible are not clear. The genes implicated in both disorders are currently unidentified, but it is probable that epigenetic factors associated with neural modifications can represent a substrate for the development of the diseases.

CONCLUSION

In this paper, recent advances in neurobiology of ADHD and TS are reviewed, providing a basis for understanding the complex common pathogenesis underlying the frequent co-occurrence of the two conditions and the therapeutic choices.

Elevated background noise in adult attention deficit hyperactivity disorder is associated with inattention

Background

Inattention and distractibility are core symptoms of attention deficit hyperactivity disorder (ADHD). Still the neuronal organization is largely unknown. Previously we studied the electrophysiological activity of a distinct neuronal network—the retina—and found no change in stimulus-driven neural activity in patients with ADHD. However there is growing evidence for an elevated non stimulus-driven neural activity, or neuronal background noise, as underlying pathophysiological correlate. To further examine the biological bases that might underlie ADHD and problems with inattention, we performed a new analysis to test the hypothesis of an elevated background noise as underlying neuronal correlate for ADHD and problems with inattention in humans. A direct measure of background noise in patients with ADHD has not been described yet.

Methods

The retinal background noise was assessed based on pattern electroretinogram (PERG) data in 20 unmedicated ADHD patients and 20 healthy controls. The PERG is an electrophysiological measure for retinal ganglion cell function. ADHD severity was assessed by interview and questionnaire.

Results

Noise amplitude was significantly higher (138%) in patients with ADHD compared to the control group (p = 0.0047). Noise amplitude correlated significantly with psychometric measures for ADHD (CAARS) especially inattention (r = 0.44, p = 0.004).

Conclusions

The data provide evidence that an elevated background noise is associated with symptoms of inattention in ADHD and support the use of therapeutic interventions that reduce noise and distraction in patients with ADHD.

Characterizing heterogeneity in children with and without ADHD based on reward system connectivity

One potential obstacle limiting our ability to clarify ADHD etiology is the heterogeneity within the disorder, as well as in typical samples. In this study, we utilized a community detection approach on 106 children with and without ADHD (aged 7-12 years), in order to identify potential subgroups of participants based on the connectivity of the reward system. Children with ADHD were compared to typically developing children within each identified community, aiming to find the community-specific ADHD characteristics. Furthermore, to assess how the organization in subgroups relates to behavior, we evaluated delay-discounting gradient and impulsivity-related temperament traits within each community. We found that discrete subgroups were identified that characterized distinct connectivity profiles in the reward system. Importantly, which connections were atypical in ADHD relative to the control children were specific to the community membership. Our findings showed that children with ADHD and typically developing children could be classified into distinct subgroups according to brain functional connectivity. Results also suggested that the differentiation in "functional" subgroups is related to specific behavioral characteristics, in this case impulsivity. Thus, combining neuroimaging data and community detection might be a valuable approach to elucidate heterogeneity in ADHD etiology and examine ADHD neurobiology.

Increased brain activity to unpleasant stimuli in individuals with the 7R allele of the DRD4 gene

The aim of the study was to examine functional brain activity in response to unpleasant images in individuals with the 7-repeat (7R) allele compared to individuals with the 4-repeat (4R) allele of the dopamine receptor D4 (DRD4) gene (VNTR in exon 3). Based on the response ready hypothesis, individuals with the DRD4-4R/7R genotype were expected to show greater functional brain activity in response to unpleasant compared to neutral stimuli in specific regions of the frontal, temporal, parietal and limbic lobes, which form the networks involved in attentional, emotional, and preparatory responses. Functional Magnetic Resonance Imaging activity was studied in 26 young adults (13 with the DRD4-4R/7R genotype and 13 with the DRD4-4R/4R genotype). Participants were asked to look at and subjectively rate unpleasant and neutral images. Results showed increased brain activity in response to unpleasant images compared to neutral images in the right temporal lobe in participants with the DRD4-4R/7R genotype versus participants with the DRD4-4R/4R genotype. The increase in right temporal lobe activity in individuals with DRD4-4R/7R suggests greater involvement in processing negative emotional stimuli. Intriguingly, no differences were found between the two genotypes in the subjective ratings of the images. The findings corroborate the response ready hypothesis, which suggests that individuals with the 7R allele are more responsive to negative emotional stimuli compared to individuals with the 4R allele of the DRD4 gene.

Healthy body, healthy mind?: the effectiveness of physical activity to treat ADHD in children

Data from animal studies provide convincing evidence that physical exercise enhances brain development and neurobehavioral functioning in areas believed to be impaired in children with attention-deficit/hyperactivity disorder (ADHD). To a lesser but still compelling extent, results from studies in typically developing children and adults indicate beneficial effects of exercise on many of the neurocognitive functions that have been shown to be impaired in children with ADHD. Together, these data provide a strong rationale for why a program of structured physical exercise might serve as an effective intervention for children with ADHD.

Computer-based cognitive training for ADHD: a review of current evidence

There has been an increasing interest in and the use of computer-based cognitive training as a treatment of attention-deficit/hyperactivity disorder (ADHD). The authors' review of current evidence, based partly on a stringent meta-analysis of 6 randomized controlled trials (RCTs) published in 2013, and an overview of 8 recently published RCTs highlights the inconsistency of findings between trials and across blinded and nonblinded ADHD measures within trials. Based on this, they conclude that more evidence from well-blinded studies is required before cognitive training can be supported as a frontline treatment of core ADHD symptoms.

Attention deficits and hyperactivity-impulsivity: what have we learned, what next?

The domains of self-regulation, self-control, executive function, inattention, and impulsivity cut across broad swathes of normal and abnormal development. Attention-deficit/hyperactivity disorder is a common syndrome that encompasses a portion of these domains. In the past 25 years research on attention-deficit/hyperactivity disorder has been characterized by dramatic advances in genetic, neural, and neuropsychological description of the syndrome as well as clarification of its multidimensional phenotypic structure. The limited clinical applicability of these research findings poses the primary challenge for the next generation. It is likely that clinical breakthroughs will require further refinement in describing heterogeneity or clinical/biological subgroups, renewed focus on the environment in the form of etiological events as well as psychosocial contexts of development, and integration of both with biological understanding.

Differentiating neural reward responsiveness in autism versus ADHD

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Brain responsiveness to social and monetary reward were studied in ADHD versus ASD.

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Clinical groups versus TDC had different ventral striatum activation to both rewards.

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Medial prefrontal overactivation in response to social reward was ADHD specific.

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Ventral striatal underactivation in response to monetary reward was ASD specific.

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Fronto-striato-parietal underactivation for money was shared by both clinical groups.

Although attention deficit hyperactivity disorders (ADHD) and autism spectrum disorders (ASD) share certain neurocognitive characteristics, it has been hypothesized to differentiate the two disorders based on their brain's reward responsiveness to either social or monetary reward. Thus, the present fMRI study investigated neural activation in response to both reward types in age and IQ-matched boys with ADHD versus ASD relative to typically controls (TDC). A significant group by reward type interaction effect emerged in the ventral striatum with greater activation to monetary versus social reward only in TDC, whereas subjects with ADHD responded equally strong to both reward types, and subjects with ASD showed low striatal reactivity across both reward conditions. Moreover, disorder-specific neural abnormalities were revealed, including medial prefrontal hyperactivation in response to social reward in ADHD versus ventral striatal hypoactivation in response to monetary reward in ASD. Shared dysfunction was characterized by fronto-striato-parietal hypoactivation in both clinical groups when money was at stake. Interestingly, lower neural activation within parietal circuitry was associated with higher autistic traits across the entire study sample. In sum, the present findings concur with the assumption that both ASD and ADHD display distinct and shared neural dysfunction in response to reward.

ADHD, altered dopamine neurotransmission, and disrupted reinforcement processes: implications for smoking and nicotine dependence

Attention deficit hyperactivity disorder (ADHD) is a common and impairing disorder affecting millions of children, adolescents, and adults. Individuals with ADHD smoke cigarettes at rates significantly higher than their non-diagnosed peers and the disorder also confers risk for a number of related adverse smoking outcomes including earlier age of initiation, faster progression to regular use, heavier smoking/greater dependence, and more difficulty quitting. Progress in our understanding of dopamine neurotransmission and basic behavioral reinforcement processes in ADHD may help increase our understanding of the ADHD-smoking comorbidity. This review will examine how these areas have been studied and how further work may aid in the development of better prevention and treatment for smoking in those with ADHD.

Genetic targeting of the amphetamine and methylphenidate-sensitive dopamine transporter: on the path to an animal model of attention-deficit hyperactivity disorder

Alterations in dopamine (DA) signaling underlie the most widely held theories of molecular and circuit level perturbations that lead to risk for attention-deficit hyperactivity disorder (ADHD). The DA transporter (DAT), a presynaptic reuptake protein whose activity provides critical support for DA signaling by limiting DA action at pre- and postsynaptic receptors, has been consistently associated with ADHD through pharmacological, behavioral, brain imaging and genetic studies. Currently, the animal models of ADHD exhibit significant limitations, stemming in large part from their lack of construct validity. To remedy this situation, we have pursued the creation of a mouse model derived from a functional nonsynonymous variant in the DAT gene (SLC6A3) of ADHD probands. We trace our path from the identification of these variants to in vitro biochemical and physiological studies to the production of the DAT Val559 mouse model. We discuss our initial findings with these animals and their promise in the context of existing rodent models of ADHD.

Region- and domain-dependent action of nomifensine

The dopamine (DA) terminal fields in the rat dorsal striatum (DS) and nucleus accumbens core (NAcc) are organized as patchworks of domains that exhibit distinct kinetics of DA release and clearance. The present study used fast-scan cyclic voltammetry recordings of electrically evoked DA overflow to test the hypothesis that nomifensine might exhibit domain-dependent actions within the NAcc, as we previously found to be the case within the DS. Within the NAcc, nomifensine preferentially enhanced evoked DA overflow in the slow domains compared with the fast domains. To seek a kinetic explanation for nomifensine's selective actions, we quantified the apparent KM of DA clearance by numerically evaluating the derivative of the descending phase of the DA signal after the end of the stimulus. For comparison, we likewise quantified the apparent KM in the domains of the DS. As expected, because it is a competitive inhibitor, nomifensine significantly increased the apparent KM in both the fast and slow domains of both the NAcc and DS. However, our analysis also led to the novel finding that nomifensine preferentially increases the apparent KM in the NAcc compared with the DS; the apparent KM increased by ~500% in the NAcc and by ~200% in the DS.

Individual differences in impulsive and risky choice: effects of environmental rearing conditions

The present experiment investigated early-rearing environment modulation of individual differences in impulsive and risky choice. Rats were reared in an isolated condition (IC; n=12), in which they lived alone without novel stimuli, or an enriched condition (EC; n=11), in which they lived among conspecifics with novel stimuli. The impulsive choice task involved choices between smaller-sooner (SS) versus larger-later (LL) rewards. The risky choice task involved choices between certain-smaller (C-S) versus uncertain-larger (U-L) rewards. Following choice testing, incentive motivation to work for food was measured using a progressive ratio task and correlated with choice behavior. HPLC analyses were conducted to determine how monoamine concentrations within the prefrontal cortex (PFC) and nucleus accumbens (NAC) related to behavior in different tasks. IC rats were more impulsive than EC rats, but they did not differ in risky choice behavior. However, choice behavior across tasks was significantly correlated (i.e., the more impulsive rats were also riskier). There were no group differences in monoamine levels, but noradrenergic and serotonergic concentrations were significantly correlated with impulsive and risky choice. Furthermore, serotonin and norepinephrine concentrations in the NAC significantly correlated with incentive motivation and the timing of the reward delays within the choice tasks. These results suggest a role for domain general processes in impulsive and risky choice and indicate the importance of the NAC and/or PFC in timing, reward processing, and choice behavior.