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Custodio RJP, Hengstler JG, Cheong JH, Kim HJ, Wascher E, Getzmann S. Adult ADHD: it is old and new at the same time - what is it? Rev Neurosci 2024; 35:225-241. [PMID: 37813870 DOI: 10.1515/revneuro-2023-0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/25/2023] [Indexed: 10/11/2023]
Abstract
Even though the number of studies aiming to improve comprehension of ADHD pathology has increased in recent years, there still is an urgent need for more effective studies, particularly in understanding adult ADHD, both at preclinical and clinical levels, due to the increasing evidence that adult ADHD is highly distinct and a different entity from childhood ADHD. This review paper outlines the symptoms, diagnostics, and neurobiological mechanisms of ADHD, with emphasis on how adult ADHD could be different from childhood-onset. Data show a difference in the environmental, genetic, epigenetic, and brain structural changes, when combined, could greatly impact the behavioral presentations and the severity of ADHD in adults. Furthermore, a crucial aspect in the quest to fully understand this disorder could be through longitudinal analysis. In this way, we will determine if and how the pathology and pharmacology of ADHD change with age. This goal could revolutionize our understanding of the disorder and address the weaknesses in the current clinical classification systems, improving the characterization and validity of ADHD diagnosis, specifically those in adults.
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Affiliation(s)
- Raly James Perez Custodio
- Networking Group Aging, Department of Ergonomics, Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), Ardeystrasse 67, Dortmund 44139, Germany
| | - Jan G Hengstler
- Systems Toxicology, Department of Toxicology, Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), Ardeystrasse 67, Dortmund 44139, Germany
| | - Jae Hoon Cheong
- Institute for New Drug Development, School of Pharmacy, Jeonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju-si, Jeollabuk-do 54896, South Korea
| | - Hee Jin Kim
- Uimyung Research Institute for Neuroscience, Department of Pharmacy, Sahmyook University, 815 Hwarangro, Nowon-gu, Seoul 01795, South Korea
| | - Edmund Wascher
- Experimental Ergonomics, Department of Ergonomics, Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), Ardeystrasse 67, Dortmund 44139, Germany
| | - Stephan Getzmann
- Networking Group Aging, Department of Ergonomics, Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), Ardeystrasse 67, Dortmund 44139, Germany
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2
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Ponomarev R, Sklyar S, Krasilnikova V, Savina T. Digital Cognitive Training for Children with Attention Deficit Hyperactivity Disorder. JOURNAL OF PSYCHOLINGUISTIC RESEARCH 2023; 52:2303-2319. [PMID: 37544957 DOI: 10.1007/s10936-023-10003-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/08/2023]
Abstract
The present article used a pilot study to determine the effectiveness of digital cognitive mindfulness training developed based on dialectical behavioral therapy (DBT) in reducing attention deficit hyperactivity disorder (ADHD) symptoms in children. The sample consisted of 90 children (8-10 years old) diagnosed with ADHD. The participants were randomized into two groups: an experimental group (n = 45) and a control group (n = 45). Results were assessed at three time points: before, after the study, and one month after the end of the study. Regarding ADHD symptoms, the ANCOVA results showed that there were no statistically significant differences between the study groups for inattention and hyperactivity/impulsivity after testing. One month after completion of the program, there was a significant alleviation in symptoms of inattention, executive functioning, learning problems, aggression, and peer relationships. Hyperactivity was the only variable that showed a decrease both post-test and during follow-up. These results suggest that a DBT-based mindfulness program is a promising method of reducing ADHD symptoms in children.
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Affiliation(s)
- Roman Ponomarev
- Department of Special Pedagogy, Abai Kazakh National Pedagogical University, Almaty, Kazakhstan.
| | - Sergey Sklyar
- General and Applied Psychology Department, Faculty of Philosophy and Political Science, Al-Farabi KazNU, Almaty, Kazakhstan
| | - Varvara Krasilnikova
- Institute of Linguistics and Intercultural Communication, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Tamara Savina
- Department of Polyclinic Therapy, Sechenov First Moscow State Medical University, Moscow, Russian Federation
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3
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Peterson RK, Duvall P, Crocetti D, Palin T, Robinson J, Mostofsky SH, Rosch KS. ADHD-related sex differences in frontal lobe white matter microstructure and associations with response control under conditions of varying cognitive load and motivational contingencies. Brain Imaging Behav 2023; 17:674-688. [PMID: 37676408 PMCID: PMC11059212 DOI: 10.1007/s11682-023-00795-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 09/08/2023]
Abstract
Children with attention-deficit/hyperactivity disorder (ADHD) demonstrate reduced response inhibition, increased response time variability, and atypical frontal lobe white matter microstructure with emerging evidence of sex differences. This study aims to examine whether frontal lobe white matter microstructure is differentially impacted in ADHD by sex and whether this relates to Go/No-Go (GNG) task performance. Diffusion tensor imaging (DTI) from 187 children (8-12 years), including ADHD (n = 94) and typically developing controls (TD; n = 93). Participants completed three GNG tasks with varying cognitive demands and incentives (standard, cognitive, and motivational). Fractional anisotropy (FA) was examined as an index of white matter microstructure within bilateral frontal lobe regions of interest. Children with ADHD showed reduced FA in primary motor (M1) and supplementary motor area (SMA) regardless of sex. Sex-based dissociation for the effect of diagnosis was observed in medial orbitofrontal cortex (mOFC), with higher FA in girls with ADHD and lower FA in boys with ADHD. Both diagnosis and sex contributed to performance on measures of response inhibition and reaction time (RT) variability, with all children with ADHD demonstrating poorer performance on all GNG tasks, but boys with ADHD demonstrating more impulsivity on standard and motivational behavioral paradigms compared to girls with ADHD. Analyses revealed associations between reduced FA in M1, SMA, and mOFC and increased response inhibition and RT variability with some sex-based differences. These findings provide novel insights regarding the brain basis of ADHD and associated impairments in response inhibition and RT variability, and contribute to our understanding of sexual dimorphic behavioral outcomes.
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Affiliation(s)
- Rachel K Peterson
- Neuropsychology Department, Kennedy Krieger Institute, 1750 E. Fairmount Avenue, Baltimore, MD, 21231, USA.
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Philip Duvall
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Deana Crocetti
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Tara Palin
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Joshua Robinson
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Stewart H Mostofsky
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Keri S Rosch
- Neuropsychology Department, Kennedy Krieger Institute, 1750 E. Fairmount Avenue, Baltimore, MD, 21231, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, MD, USA
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4
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Dekkers TJ, van der Oord S. Editorial Perspective: When to start de-implementation of interventions: the case of cognitive training for children with ADHD. J Child Psychol Psychiatry 2022. [PMID: 36583264 DOI: 10.1111/jcpp.13751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/11/2022] [Indexed: 12/31/2022]
Affiliation(s)
- Tycho J Dekkers
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Accare Child Study Center, Groningen, The Netherlands.,Levvel, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands.,Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands.,Department of Child and Adolescent Psychiatry, Amsterdam University Medical Centers (AUMC), Amsterdam, The Netherlands
| | - Saskia van der Oord
- KU Leuven, Clinical Psychology, Faculty of Psychology and Educational Sciences, Leuven, Belgium
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5
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Saad JF, Griffiths KR, Kohn MR, Braund TA, Clarke S, Williams LM, Korgaonkar MS. Intrinsic Functional Connectivity in the Default Mode Network Differentiates the Combined and Inattentive Attention Deficit Hyperactivity Disorder Types. Front Hum Neurosci 2022; 16:859538. [PMID: 35754775 PMCID: PMC9218495 DOI: 10.3389/fnhum.2022.859538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/20/2022] [Indexed: 12/24/2022] Open
Abstract
Neuroimaging studies have revealed neurobiological differences in ADHD, particularly studies examining connectivity disruption and anatomical network organization. However, the underlying pathophysiology of ADHD types remains elusive as it is unclear whether dysfunctional network connections characterize the underlying clinical symptoms distinguishing ADHD types. Here, we investigated intrinsic functional network connectivity to identify neural signatures that differentiate the combined (ADHD-C) and inattentive (ADHD-I) presentation types. Applying network-based statistical (NBS) and graph theoretical analysis to task-derived intrinsic connectivity data from completed fMRI scans, we evaluated default mode network (DMN) and whole-brain functional network topology in a cohort of 34 ADHD participants (aged 8-17 years) defined using DSM-IV criteria as predominantly inattentive (ADHD-I) type (n = 15) or combined (ADHD-C) type (n = 19), and 39 age and gender-matched typically developing controls. ADHD-C were characterized from ADHD-I by reduced network connectivity differences within the DMN. Additionally, reduced connectivity within the DMN was negatively associated with ADHD-RS hyperactivity-impulsivity subscale score. Compared with controls, ADHD-C but not ADHD-I differed by reduced connectivity within the DMN; inter-network connectivity between the DMN and somatomotor networks; the DMN and limbic networks; and between the somatomotor and cingulo-frontoparietal, with ventral attention and dorsal attention networks. However, graph-theoretical measures did not significantly differ between groups. These findings provide insight into the intrinsic networks underlying phenotypic differences between ADHD types. Furthermore, these intrinsic functional connectomic signatures support neurobiological differences underlying clinical variations in ADHD presentations, specifically reduced within and between functional connectivity of the DMN in the ADHD-C type.
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Affiliation(s)
- Jacqueline F. Saad
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
- School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Kristi R. Griffiths
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Michael R. Kohn
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
- Centre for Research Into Adolescent’s Health, Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, NSW, Australia
| | - Taylor A. Braund
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
- School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Simon Clarke
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
- Centre for Research Into Adolescent’s Health, Department of Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, NSW, Australia
| | - Leanne M. Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
- Sierra Pacific Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, United States
| | - Mayuresh S. Korgaonkar
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
- School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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6
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Li T, van Rooij D, Roth Mota N, Buitelaar JK, Hoogman M, Arias Vasquez A, Franke B. Characterizing neuroanatomic heterogeneity in people with and without ADHD based on subcortical brain volumes. J Child Psychol Psychiatry 2021; 62:1140-1149. [PMID: 33786843 PMCID: PMC8403135 DOI: 10.1111/jcpp.13384] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder. Neuroanatomic heterogeneity limits our understanding of ADHD's etiology. This study aimed to parse heterogeneity of ADHD and to determine whether patient subgroups could be discerned based on subcortical brain volumes. METHODS Using the large ENIGMA-ADHD Working Group dataset, four subsamples of 993 boys with and without ADHD and to subsamples of 653 adult men, 400 girls, and 447 women were included in analyses. We applied exploratory factor analysis (EFA) to seven subcortical volumes in order to constrain the complexity of the input variables and ensure more stable clustering results. Factor scores derived from the EFA were used to build networks. A community detection (CD) algorithm clustered participants into subgroups based on the networks. RESULTS Exploratory factor analysis revealed three factors (basal ganglia, limbic system, and thalamus) in boys and men with and without ADHD. Factor structures for girls and women differed from those in males. Given sample size considerations, we concentrated subsequent analyses on males. Male participants could be separated into four communities, of which one was absent in healthy men. Significant case-control differences of subcortical volumes were observed within communities in boys, often with stronger effect sizes compared to the entire sample. As in the entire sample, none were observed in men. Affected men in two of the communities presented comorbidities more frequently than those in other communities. There were no significant differences in ADHD symptom severity, IQ, and medication use between communities in either boys or men. CONCLUSIONS Our results indicate that neuroanatomic heterogeneity in subcortical volumes exists, irrespective of ADHD diagnosis. Effect sizes of case-control differences appear more pronounced at least in some of the subgroups.
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Affiliation(s)
- Ting Li
- Department of Human GeneticsDonders Institute for Brain, Cognition and BehaviourRadboud University Medical CenterNijmegenThe Netherlands
| | - Daan van Rooij
- Department of Cognitive NeuroscienceDonders Institute for Brain, Cognition and BehaviourRadboud University Medical CenterNijmegenThe Netherlands
| | - Nina Roth Mota
- Department of Human GeneticsDonders Institute for Brain, Cognition and BehaviourRadboud University Medical CenterNijmegenThe Netherlands
- Department of PsychiatryDonders Institute for Brain, Cognition and BehaviourRadboud University Medical CenterNijmegen
The Netherlands
| | - Jan K. Buitelaar
- Department of Cognitive NeuroscienceDonders Institute for Brain, Cognition and BehaviourRadboud University Medical CenterNijmegenThe Netherlands
| | - Martine Hoogman
- Department of Human GeneticsDonders Institute for Brain, Cognition and BehaviourRadboud University Medical CenterNijmegenThe Netherlands
| | - Alejandro Arias Vasquez
- Department of Human GeneticsDonders Institute for Brain, Cognition and BehaviourRadboud University Medical CenterNijmegenThe Netherlands
- Department of Cognitive NeuroscienceDonders Institute for Brain, Cognition and BehaviourRadboud University Medical CenterNijmegenThe Netherlands
- Department of PsychiatryDonders Institute for Brain, Cognition and BehaviourRadboud University Medical CenterNijmegen
The Netherlands
| | - Barbara Franke
- Department of Human GeneticsDonders Institute for Brain, Cognition and BehaviourRadboud University Medical CenterNijmegenThe Netherlands
- Department of PsychiatryDonders Institute for Brain, Cognition and BehaviourRadboud University Medical CenterNijmegen
The Netherlands
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7
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Genetic variations influence brain changes in patients with attention-deficit hyperactivity disorder. Transl Psychiatry 2021; 11:349. [PMID: 34091591 PMCID: PMC8179928 DOI: 10.1038/s41398-021-01473-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 05/04/2021] [Accepted: 05/12/2021] [Indexed: 12/12/2022] Open
Abstract
Attention-deficit hyperactivity disorder (ADHD) is a neurological and neurodevelopmental childhood-onset disorder characterized by a persistent pattern of inattentiveness, impulsiveness, restlessness, and hyperactivity. These symptoms may continue in 55-66% of cases from childhood into adulthood. Even though the precise etiology of ADHD is not fully understood, it is considered as a multifactorial and heterogeneous disorder with several contributing factors such as heritability, auxiliary to neurodevelopmental issues, severe brain injuries, neuroinflammation, consanguineous marriages, premature birth, and exposure to environmental toxins. Neuroimaging and neurodevelopmental assessments may help to explore the possible role of genetic variations on ADHD neuropsychobiology. Multiple genetic studies have observed a strong genetic association with various aspects of neuropsychobiological functions, including neural abnormalities and delayed neurodevelopment in ADHD. The advancement in neuroimaging and molecular genomics offers the opportunity to analyze the impact of genetic variations alongside its dysregulated pathways on structural and functional derived brain imaging phenotypes in various neurological and psychiatric disorders, including ADHD. Recently, neuroimaging genomic studies observed a significant association of brain imaging phenotypes with genetic susceptibility in ADHD. Integrating the neuroimaging-derived phenotypes with genomics deciphers various neurobiological pathways that can be leveraged for the development of novel clinical biomarkers, new treatment modalities as well as therapeutic interventions for ADHD patients. In this review, we discuss the neurobiology of ADHD with particular emphasis on structural and functional changes in the ADHD brain and their interactions with complex genomic variations utilizing imaging genetics methodologies. We also highlight the genetic variants supposedly allied with the development of ADHD and how these, in turn, may affect the brain circuit function and related behaviors. In addition to reviewing imaging genetic studies, we also examine the need for complementary approaches at various levels of biological complexity and emphasize the importance of combining and integrating results to explore biological pathways involved in ADHD disorder. These approaches include animal models, computational biology, bioinformatics analyses, and multimodal imaging genetics studies.
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8
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Demidenko MI, Weigard AS, Ganesan K, Jang H, Jahn A, Huntley ED, Keating DP. Interactions between methodological and interindividual variability: How Monetary Incentive Delay (MID) task contrast maps vary and impact associations with behavior. Brain Behav 2021; 11:e02093. [PMID: 33750042 PMCID: PMC8119872 DOI: 10.1002/brb3.2093] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 02/01/2021] [Accepted: 02/05/2021] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Phenomena related to reward responsiveness have been extensively studied in their associations with substance use and socioemotional functioning. One important task in this literature is the Monetary Incentive Delay (MID) task. By cueing and delivering performance-contingent reward, the MID task has been demonstrated to elicit robust activation of neural circuits involved in different phases of reward responsiveness. However, systematic evaluations of common MID task contrasts have been limited to between-study comparisons of group-level activation maps, limiting their ability to directly evaluate how researchers' choice of contrasts impacts conclusions about individual differences in reward responsiveness or brain-behavior associations. METHODS In a sample of 104 participants (Age Mean = 19.3, SD = 1.3), we evaluate similarities and differences between contrasts in: group- and individual-level activation maps using Jaccard's similarity index, region of interest (ROI) mean signal intensities using Pearson's r, and associations between ROI mean signal intensity and psychological measures using Bayesian correlation. RESULTS Our findings demonstrate more similarities than differences between win and loss cues during the anticipation contrast, dissimilarity between some win anticipation contrasts, an apparent deactivation effect in the outcome phase, likely stemming from the blood oxygen level-dependent undershoot, and behavioral associations that are less robust than previously reported. CONCLUSION Consistent with recent empirical findings, this work has practical implications for helping researchers interpret prior MID studies and make more informed a priori decisions about how their contrast choices may modify results.
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Affiliation(s)
| | - Alexander S Weigard
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA.,Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | | | - Hyesue Jang
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Andrew Jahn
- The Functional MRI Laboratory, University of Michigan, Ann Arbor, MI, USA
| | - Edward D Huntley
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Daniel P Keating
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA.,Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
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9
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Leikauf JE, Correa C, Bueno AN, Sempere VP, Williams LM. StopWatch: Pilot study for an Apple Watch application for youth with ADHD. Digit Health 2021; 7:20552076211001215. [PMID: 33868703 PMCID: PMC8020230 DOI: 10.1177/20552076211001215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 02/16/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction To address the need for non-pharmacologic, scalable approaches for managing
attention-deficit and hyperactivity disorder (ADHD) in young people, we report the
results of a study of an application developed for a wearable device (Apple Watch) that
was designed to track movement and provide visual and haptic feedback for ADHD. Methods Six-week, open label pilot study with structured rating scales ADHD and semi-structured
qualitative interview. Apple Watch software application given to users that uses
actigraphy and graphic interface as well as haptic feedback to provide feedback to users
about level of movement during periods of intentional focus. Linear mixed models to
estimate trajectories. Results Thirty-two participants entered the study. This application was associated with
improvement in ADHD symptoms over the 6 weeks of the study. We observed an ADHD-Rating
Scale change of β = −1.2 units/week (95% CI = −0.56 to −1.88, F = 13.4,
P = .0004). Conclusions These positive clinical outcomes highlight the promise of such wearable applications
for ADHD and the need to pursue their further development.
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10
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Henderson TA, van Lierop MJ, McLean M, Uszler JM, Thornton JF, Siow YH, Pavel DG, Cardaci J, Cohen P. Functional Neuroimaging in Psychiatry-Aiding in Diagnosis and Guiding Treatment. What the American Psychiatric Association Does Not Know. Front Psychiatry 2020; 11:276. [PMID: 32351416 PMCID: PMC7176045 DOI: 10.3389/fpsyt.2020.00276] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 03/23/2020] [Indexed: 12/12/2022] Open
Abstract
While early efforts in psychiatry were focused on uncovering the neurobiological basis of psychiatric symptoms, they made little progress due to limited ability to observe the living brain. Today, we know a great deal about the workings of the brain; yet, none of this neurobiological awareness has translated into the practice of psychiatry. The categorical system which dominates psychiatric diagnosis and thinking fails to match up to the real world of genetics, sophisticated psychological testing, and neuroimaging. Nevertheless, the American Psychiatric Association (APA) recently published a position paper stating that neuroimaging provided no benefit to the diagnosis and treatment of psychiatric disorders. Using the diagnosis of depression as a model, we illustrate how setting aside the unrealistic expectation of a pathognomonic "fingerprint" for categorical diagnoses, we can avoid missing the biological and, therefore, treatable contributors to psychopathology which can and are visualized using functional neuroimaging. Infection, toxicity, inflammation, gut-brain dysregulation, and traumatic brain injury can all induce psychiatric manifestations which masquerade as depression and other psychiatric disorders. We review these and provide illustrative clinical examples. We further describe situations for which single photon emission computed tomography (SPECT) and positron emission tomography (PET) functional neuroimaging already meet or exceed the criteria set forth by the APA to define a neuroimaging biomarker, including the differential diagnosis of Alzheimer's disease and other dementias, the differential diagnosis of ADHD, and the evaluation of traumatic brain injury. The limitations, both real and perceived, of SPECT and PET functional neuroimaging in the field of psychiatry are also elaborated. An important overarching concept for diagnostic imaging in all its forms, including functional neuroimaging, is that imaging allows a clinician to eliminate possibilities, narrow the differential diagnosis, and tailor the treatment plan. This progression is central to any medical diagnostic process.
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Affiliation(s)
- Theodore A Henderson
- The Synaptic Space, Inc., Denver, CO, United States.,Neuro-Luminance, Inc., Denver, CO, United States.,Dr. Theodore Henderson, Inc., Denver, CO, United States.,International Society of Applied Neuroimaging, Denver, CO, United States
| | - Muriel J van Lierop
- International Society of Applied Neuroimaging, Denver, CO, United States.,Private Practice, Toronto, ON, Canada
| | - Mary McLean
- International Society of Applied Neuroimaging, Denver, CO, United States.,Private Practice, Toronto, ON, Canada
| | - John Michael Uszler
- International Society of Applied Neuroimaging, Denver, CO, United States.,Nuclear Medicine, Providence St. John's Health Center, Santa Monica, CA, United States.,Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, CA, United States
| | - John F Thornton
- International Society of Applied Neuroimaging, Denver, CO, United States.,Rossiter-Thornton Associates, Toronto, ON, Canada
| | - Yin-Hui Siow
- International Society of Applied Neuroimaging, Denver, CO, United States.,Nuclear Medicine, Southlake Regional Health Centre, Newmarket, ON, Canada
| | - Dan G Pavel
- International Society of Applied Neuroimaging, Denver, CO, United States.,PathFinder Brain SPECT, Deerfield, IL, United States
| | - Joe Cardaci
- International Society of Applied Neuroimaging, Denver, CO, United States.,Fremantle-School of Medicine, University of Notre Dame, Fremantle, WA, Australia.,Diagnostic Nuclear Medicine, Hollywood Private Hospital, Nedlands, WA, Australia.,Consultant Physician, Perth, WA, Australia
| | - Phil Cohen
- International Society of Applied Neuroimaging, Denver, CO, United States.,Nuclear Medicine, Lions Gate Hospital, Vancouver, BC, Canada.,Radiology, University of British Columbia, Vancouver, BC, Canada
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11
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Dajani DR, Burrows CA, Nebel MB, Mostofsky SH, Gates KM, Uddin LQ. Parsing Heterogeneity in Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder with Individual Connectome Mapping. Brain Connect 2019; 9:673-691. [PMID: 31631690 PMCID: PMC6862970 DOI: 10.1089/brain.2019.0669] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Traditional diagnostic systems for neurodevelopmental disorders define diagnostic categories that are heterogeneous in behavior and underlying neurobiological alterations. The goal of this study was to parse heterogeneity in a core executive function (EF), cognitive flexibility, in children with a range of abilities (N = 132; children with autism spectrum disorder, attention-deficit/hyperactivity disorder [ADHD], and typically developing children) using directed functional connectivity profiles derived from resting-state functional magnetic resonance imaging data. Brain regions activated in response to a cognitive flexibility task in adults were used to guide region-of-interest selection to estimate individual connectivity profiles in this study. We expected to find subgroups of children who differed in their network connectivity metrics and symptom measures. Unexpectedly, we did not find a stable or valid subgrouping solution, which suggests that categorical models of the neural substrates of cognitive flexibility in children may be invalid. Exploratory analyses revealed dimensional associations between network connectivity metrics and ADHD symptomatology and EF ability across the entire sample. Results shed light on the validity of conceptualizing the neural substrates of cognitive flexibility categorically in children. Ultimately, this work may provide a foundation for the development of a revised nosology focused on neurobiological substrates as an alternative to traditional symptom-based classification systems.
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Affiliation(s)
- Dina R. Dajani
- Department of Psychology, University of Miami, Coral Gables, Florida
| | - Catherine A. Burrows
- Institute on Community Integration, University of Minnesota, Minneapolis, Minnesota
| | - Mary Beth Nebel
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, Maryland
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stewart H. Mostofsky
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, Maryland
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kathleen M. Gates
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, North Carolina
| | - Lucina Q. Uddin
- Department of Psychology, University of Miami, Coral Gables, Florida
- Neuroscience Program, University of Miami Miller School of Medicine, Miami, Florida
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Miquel M, Nicola SM, Gil-Miravet I, Guarque-Chabrera J, Sanchez-Hernandez A. A Working Hypothesis for the Role of the Cerebellum in Impulsivity and Compulsivity. Front Behav Neurosci 2019; 13:99. [PMID: 31133834 PMCID: PMC6513968 DOI: 10.3389/fnbeh.2019.00099] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 04/23/2019] [Indexed: 12/27/2022] Open
Abstract
Growing evidence associates cerebellar abnormalities with several neuropsychiatric disorders in which compulsive symptomatology and impulsivity are part of the disease pattern. Symptomatology of autism, addiction, obsessive-compulsive (OCD), and attention deficit/hyperactivity (ADHD) disorders transcends the sphere of motor dysfunction and essentially entails integrative processes under control of prefrontal-thalamic-cerebellar loops. Patients with brain lesions affecting the cortico-striatum thalamic circuitry and the cerebellum indeed exhibit compulsive symptoms. Specifically, lesions of the posterior cerebellar vermis cause affective dysregulation and deficits in executive function. These deficits may be due to impairment of one of the main functions of the cerebellum, implementation of forward internal models of the environment. Actions that are independent of internal models may not be guided by predictive relationships or a mental representation of the goal. In this review article, we explain how this deficit might affect executive functions. Additionally, regionalized cerebellar lesions have been demonstrated to impair other brain functions such as the emergence of habits and behavioral inhibition, which are also altered in compulsive disorders. Similar to the infralimbic cortex, clinical studies and research in animal models suggest that the cerebellum is not required for learning goal-directed behaviors, but it is critical for habit formation. Despite this accumulating data, the role of the cerebellum in compulsive symptomatology and impulsivity is still a matter of discussion. Overall, findings point to a modulatory function of the cerebellum in terminating or initiating actions through regulation of the prefrontal cortices. Specifically, the cerebellum may be crucial for restraining ongoing actions when environmental conditions change by adjusting prefrontal activity in response to the new external and internal stimuli, thereby promoting flexible behavioral control. We elaborate on this explanatory framework and propose a working hypothesis for the involvement of the cerebellum in compulsive and impulsive endophenotypes.
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Affiliation(s)
- Marta Miquel
- Área de Psicobiología, School of Health Science, Universitat Jaume I, Castellón de la Plana, Spain
| | - Saleem M Nicola
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, NY, United States.,Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Isis Gil-Miravet
- Área de Psicobiología, School of Health Science, Universitat Jaume I, Castellón de la Plana, Spain
| | - Julian Guarque-Chabrera
- Área de Psicobiología, School of Health Science, Universitat Jaume I, Castellón de la Plana, Spain
| | - Aitor Sanchez-Hernandez
- Área de Psicobiología, School of Health Science, Universitat Jaume I, Castellón de la Plana, Spain
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Samea F, Soluki S, Nejati V, Zarei M, Cortese S, Eickhoff SB, Tahmasian M, Eickhoff CR. Brain alterations in children/adolescents with ADHD revisited: A neuroimaging meta-analysis of 96 structural and functional studies. Neurosci Biobehav Rev 2019; 100:1-8. [PMID: 30790635 PMCID: PMC7966818 DOI: 10.1016/j.neubiorev.2019.02.011] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 01/21/2019] [Accepted: 02/16/2019] [Indexed: 01/06/2023]
Abstract
The findings of neuroimaging studies in children/adolescents with ADHD, and even those of previous meta-analyses, are divergent. Here, Activation Likelihood Estimation meta-analysis, following the current best-practice guidelines, was conducted. We searched multiple databases and traced the references up to June 2018. Then, we extracted the reported coordinates reflecting group comparison between ADHD and healthy subjects from 96 eligible studies, containing 1914 unique participants. The analysis of pooled structural and functional, sub-analyses restricted to modality, and in-/decreased contrast did not yield any significant findings. However, further sub-analyses in the task-fMRI experiments (neutral stimuli only) led to aberrant activity in the left pallidum/putamen and decreased activity (male subjects only) in the left inferior frontal gyrus. The overall findings indicate a lack of regional convergence in children/adolescents with ADHD, which might be due to heterogeneous clinical populations, various experimental design, preprocessing, statistical procedures in individual publications. Our results highlight the need for further high-powered investigations, but may also indicate ADHD pathophysiology might rest in network interactions rather than just regional abnormality.
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Affiliation(s)
- Fateme Samea
- Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran
| | - Solmaz Soluki
- Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran
| | - Vahid Nejati
- Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran; Department of Psychology, Shahid Beheshti University, Tehran, Iran
| | - Mojtaba Zarei
- Institute of Medical Science and Technology, Shahid Beheshti University, Tehran, Iran
| | - Samuele Cortese
- Center for Innovation in Mental Health, Academic Unit of Psychology, University of Southampton, Southampton, UK; Faculty of Medicine, Clinical and Experimental Sciences (CNS and Psychiatry), University of Southampton, Southampton, UK; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK; Department of Child and Adolescent Psychiatry, NYU Langone Medical Center, New York, USA
| | - Simon B Eickhoff
- Institute for Systems Neuroscience, Medical Faculty, Heinrich-Heine University Düsseldorf, Germany; Institute of Neuroscience and Medicine (INM-1, INM-7), Research Center Jülich, Jülich, Germany
| | - Masoud Tahmasian
- Institute of Medical Science and Technology, Shahid Beheshti University, Tehran, Iran.
| | - Claudia R Eickhoff
- Institute of Neuroscience and Medicine (INM-1, INM-7), Research Center Jülich, Jülich, Germany; Institute of Clinical Neuroscience and Medical Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Department of Psychiatry, Psychotherapy, and Psychosomatics, RWTH Aachen University, Aachen, Germany
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Bessette KL, Stevens MC. Neurocognitive Pathways in Attention-Deficit/Hyperactivity Disorder and White Matter Microstructure. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2019; 4:233-242. [PMID: 30478002 PMCID: PMC6549508 DOI: 10.1016/j.bpsc.2018.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND This study sought to identify attention-deficit/hyperactivity disorder (ADHD) abnormalities in relationships between brain white matter structure and individual differences in several types of impulsive behavior. METHODS Adolescents, n = 67 with ADHD combined subtype and n = 68 without ADHD, were given neuropsychological tests and underwent diffusion tensor imaging scans. Principal component analysis reduced test scores into factors representing different types of impulsive behavior. Tract-based spatial statistics quantified white matter integrity in relationship to components of impulsive behavior. ADHD versus non-ADHD differences in the strength and nature of linear relationships between regional white matter and three impulsivity components were examined using multiple regression. RESULTS Principal component analysis found three separate impulsivity-related factors that were interpreted as motor response inhibition, impulsive choice, and delay aversion. Relationships between regional fractional anisotropy and response inhibition or impulsive choice did not differ between ADHD and non-ADHD groups. There was a significant interaction between diagnostic group and delay aversion test performance relationships with regional fractional anisotropy. For youths without ADHD, greater anisotropy in numerous tracts predicted better delay aversion test performance. In contrast, anisotropy in regions including the corpus callosum, corona radiata, internal capsule, and corticospinal tracts had either a negative or no relationship with delay aversion test performance in ADHD. CONCLUSIONS The results provide additional support that different proposed etiological pathways to ADHD have discretely different neurobiological features. Large disorganization of white matter microstructure appears to contribute to reward-based ADHD pathways rather than motor inhibition.
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Affiliation(s)
- Katie L Bessette
- Olin Neuropsychiatry Research Center, The Institute of Living, Hartford, Connecticut; Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
| | - Michael C Stevens
- Olin Neuropsychiatry Research Center, The Institute of Living, Hartford, Connecticut; Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.
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Bathelt J, Johnson A, Zhang M, Astle DE. The cingulum as a marker of individual differences in neurocognitive development. Sci Rep 2019; 9:2281. [PMID: 30783161 PMCID: PMC6381161 DOI: 10.1038/s41598-019-38894-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 01/11/2019] [Indexed: 01/21/2023] Open
Abstract
The canonical approach to exploring brain-behaviour relationships is to group individuals according to a phenotype of interest, and then explore the neural correlates of this grouping. A limitation of this approach is that multiple aetiological pathways could result in a similar phenotype, so the role of any one brain mechanism may be substantially underestimated. Building on advances in network analysis, we used a data-driven community-clustering algorithm to identify robust subgroups based on white-matter microstructure in childhood and adolescence (total N = 313, mean age: 11.24 years). The algorithm indicated the presence of two equal-size groups that show a critical difference in fractional anisotropy (FA) of the left and right cingulum. Applying the brain-based grouping in independent samples, we find that these different 'brain types' had profoundly different cognitive abilities with higher performance in the higher FA group. Further, a connectomics analysis indicated reduced structural connectivity in the low FA subgroup that was strongly related to reduced functional activation of the default mode network. These results provide a proof-of-concept that bottom-up brain-based groupings can be identified that relate to cognitive performance. This provides a first demonstration of a complimentary approach for investigating individual differences in brain structure and function, particularly for neurodevelopmental disorders where researchers are often faced with phenotypes that are difficult to define at the cognitive or behavioural level.
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Affiliation(s)
- Joe Bathelt
- MRC Cognition & Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom.
| | - Amy Johnson
- MRC Cognition & Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
| | - Mengya Zhang
- MRC Cognition & Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
| | - Duncan E Astle
- MRC Cognition & Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
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Neuroscience-Informed Treatments. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2019; 17:50-51. [PMID: 31975961 PMCID: PMC6493151 DOI: 10.1176/appi.focus.17101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Dimensional and Categorical Approaches to Understanding Attention-Deficit/Hyperactivity Disorder: New Frontiers in Translational Research. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2018; 3:652-653. [PMID: 30092914 DOI: 10.1016/j.bpsc.2018.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 11/22/2022]
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