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Zhang Y, Feng Y, Liu L, Jiang G, Wang M. Abnormal prefrontal cortical activation during the GO/NOGO and verbal fluency tasks in adult patients with comorbid generalized anxiety disorder and attention-deficit/hyperactivity disorder: An fNIRS study. J Psychiatr Res 2024; 172:281-290. [PMID: 38428164 DOI: 10.1016/j.jpsychires.2024.02.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 02/16/2024] [Accepted: 02/24/2024] [Indexed: 03/03/2024]
Abstract
Generalized anxiety disorder (GAD) and adult attention-deficit/hyperactivity disorder (ADHD) are commonly reported comorbidities. Adult GAD patients with comorbid ADHD are often underdiagnosed and undertreated. To explore the clinical value of functional near-infrared spectroscopy (fNIRS) data for assisting in the accurate diagnosis of ADHD in individuals with GAD, haemoglobin (HbO) concentration changes in the prefrontal cortex (PFC) were detected via fNIRS in 49 patients with both GAD and ADHD, 46 patients with GAD, and 34 healthy controls (HCs) during a verbal fluency task (VFT) and a GO/NOGO task. The correlations between PFC fNIRS data and the severity of inattention and hyperactivity symptoms assessed using the adult ADHD Self-Report Scale (ASRS) were analyzed. Our results showed that, during the GO/NOGO task, channels in the left dorsolateral PFC (channels 28 and 29) were hyperactivated, while channels in the medial PFC (channels 36, 37, and 47) were hypoactivated in participants with ADHD and GAD compared with those with GAD alone. During the VFT, compared with the HC group, both the ADHD + GAD group and the GAD group exhibited significantly decreased HbO activation in the medial PFC (channels 37, 38, and 48) and in the left ventrolateral PFC (channel 39); moreover, no difference was found between the ADHD + GAD group and the GAD group. Activation in the left dorsolateral PFC (channels 28 and 29) during the GO/NOGO task showed a significant positive correlation with ASRS-inattention scores. Our results indicated that fNIRS data collected during the GO/NOGO task may help to distinguish patients with comorbid GAD and ADHD from those with GAD alone.
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Affiliation(s)
- Yuchen Zhang
- Department of Children and Adolescents, Chongqing Mental Health Center, Chongqing, China
| | - Yaju Feng
- Department of Children and Adolescents, Chongqing Mental Health Center, Chongqing, China
| | - Linfeng Liu
- Department of Children and Adolescents, Chongqing Mental Health Center, Chongqing, China
| | - Guoqing Jiang
- Department of Children and Adolescents, Chongqing Mental Health Center, Chongqing, China.
| | - Minjian Wang
- Department of Children and Adolescents, Chongqing Mental Health Center, Chongqing, China.
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Abstract
Development of the frontal lobe is critical to acquisition, execution, and control of a wide range of functions, from basic motor response to complex decision-making. These functions are influenced by contingency-based (e.g., reward and response-cost/punishment) feedback that is mediated through the adaptive integration of fronto-subcortical neural circuitry. The frontal lobe manages incoming information and chooses the appropriate action based on one's goals in a particular context. This aspect of frontal function, while only one component, is crucial to development and maintenance of approach and avoidance behavior central to all human (and animal) behavior. Furthermore, disruptions in fronto-subcortical circuitry governing motivated behavior appear to contribute to a range of developmental disorders, including attention-deficit/hyperactivity disorder (ADHD), and confer vulnerability for psychopathology more broadly. The particular deficits that manifest in altered behavior depend upon the specific circuitry that is compromised due to the functional specificity of distinct regions of the frontal lobe and its interconnections with subcortical structures. Neurobiologic models of motivated behavior provide a valuable framework for characterizing developmental disorders from a transdiagnostic dimensional systems perspective. Improved characterization of approach and avoidance motivation across neurodevelopmental disorders has the potential to inform the development of novel interventions and personalized medicine.
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Affiliation(s)
- Keri Shiels Rosch
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, MD, United States.
| | - Stewart Mostofsky
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, MD, United States
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Fernández-Jaén A, Albert J, Fernández-Mayoralas DM, López-Martín S, Fernández-Perrone AL, Jimenez de la Peña M, Calleja-Pérez B, Recio Rodríguez M, López Arribas S. Cingulate Cortical Thickness and Dopamine Transporter ( DAT1) Genotype in Children and Adolescents With ADHD. J Atten Disord 2018; 22:651-660. [PMID: 27160695 DOI: 10.1177/1087054716647483] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This study aimed to examine the influence of dopamine transporter gene ( DAT1) 3'UTR genotype on cingulate cortical thickness in a large sample of children and adolescents with ADHD. METHOD Brain MRIs were acquired from 46 ADHD patients with homozygosity for the 10-repeat allele and 52 ADHD patients with a single copy or no copy of the allele. The cingulate cortex of each MRI scan was automatically parceled into sulci and gyri as well as into Brodmann areas (BA). RESULTS There were no group differences in age, gender, full-scale intelligence quotient, symptom severity, treatment status, comorbidity, or mean overall cortical thickness. Sulcus/gyrus- and BA-based analyses revealed that patients homozygous for the 10-repeat allele showed significantly greater thickness in right cingulate gyrus and right BA 24 compared with 9-repeat carriers. CONCLUSION These findings suggest that thickness of cingulate cortex is influenced by the presence of the 10-repeat allele in ADHD.
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Affiliation(s)
| | | | | | - Sara López-Martín
- 4 Univesidad Rey Juan Carlos, Madrid, Spain.,5 Centro Neuromottiva, Madrid, Spain
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Réveillon M, Lazeyras F, Van Calster L, Cojan Y, Sander D, Hüppi PS, Barisnikov K. Neural functional correlates of the impact of socio-emotional stimuli on performances on a flanker task in children aged 9-11 years. Neuropsychologia 2018; 145:106747. [PMID: 29627273 DOI: 10.1016/j.neuropsychologia.2018.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 03/17/2018] [Accepted: 04/04/2018] [Indexed: 10/17/2022]
Abstract
Immature cognition is susceptible to interference from competing information, and particularly in affectively charged situations. Several studies have reported activation in the anterior cingulate cortex, prefrontal cortex and amygdala associated with emotional conflict processing in adults but literature is lacking regarding children. Moreover, studies in children and adolescents still disagree regarding the functional activation of amygdala related to facial stimuli. In the purpose of investigating both the effect of socio-emotional stimuli and its interaction with interference control, we designed a flanker task associated with an event-related fMRI paradigm in 30 healthy children ages 9-11. In addition to happy, angry and neutral faces, we presented scrambled stimuli to examine a potential effect of faces. Regarding both brain and behavior results, no effect of emotional valence was observed. However, both results evidenced an emotional effect of faces compared with scrambled stimuli. This was expressed by faster RTs associated with increased amygdala activity and activation of the ventral ACC, in congruent trials only. When scrambled were inversely compared to faces, increased activity was observed within the lateral prefrontal cortex. Regarding the amygdala, the results suggest that in late school age children, activity in the amygdala seemed to underlie the socio-emotional effect induced by faces but not the emotional conflict. Studying brain regions involved in emotion regulation is important to further understand neurodevelopmental disorders and psychopathologies, particularly in late childhood and adolescence.
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Affiliation(s)
- Morgane Réveillon
- Child Clinical Neuropsychology Unit, University of Geneva, Bld. Du Pont-d'Arve 40, CH-1211 Geneva 4, Switzerland.
| | | | - Laurens Van Calster
- Child Clinical Neuropsychology Unit, University of Geneva, Bld. Du Pont-d'Arve 40, CH-1211 Geneva 4, Switzerland.
| | - Yann Cojan
- Department of Neuroscience, University Medical School of Geneva, Switzerland.
| | - David Sander
- Laboratory for the study of Emotion Elicitation and Expression, University of Geneva, Switzerland.
| | - Petra S Hüppi
- Division of Development and Growth, Department of Pediatrics, University Hospital of Geneva, Switzerland.
| | - Koviljka Barisnikov
- Child Clinical Neuropsychology Unit, University of Geneva, Bld. Du Pont-d'Arve 40, CH-1211 Geneva 4, Switzerland.
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5
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Ko CH, Hsieh TJ, Wang PW, Lin WC, Chen CS, Yen JY. The Altered Brain Activation of Phonological Working Memory, Dual Tasking, and Distraction Among Participants With Adult ADHD and the Effect of the MAOA Polymorphism. J Atten Disord 2018; 22:240-249. [PMID: 25777072 DOI: 10.1177/1087054715572609] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The present study aimed to reveal the brain correlates of phonological working memory (WM), dual tasking, and distraction in adult ADHD combined with the effect of polymorphisms of monoamine oxidase A ( MAOA rs1137070 Asp470Asp). METHOD A total of 29 participants with adult ADHD and 21 controls were recruited. They completed 0-back and 2-back tasks, as wells as 2-back tasks with a dual-task effect or a distracting effect, during functional magnetic resonance imaging scanning. RESULTS The brain activation of WM in the bilateral inferior frontal lobe, pars opercularis, was higher among the adult ADHD group. The genotype of MAOA significantly interacted with the ADHD effect in the left inferior frontal lobe, pars opercularis. Adults with ADHD had higher activation in the left lingual area in response to the dual-tasking effect. CONCLUSION The MAOA polymorphism moderated the altered activation in pars opercularis for WM among adults with ADHD. The higher lingual gyrus activation might indicate that higher attention resources are demanded to sustain the dual-task function of adults with ADHD.
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Affiliation(s)
- Chih-Hung Ko
- 1 Department of Psychiatry, Kaohsiung Medical University Hospital, Taiwan.,2 Department of Psychiatry, Faculty of Medicine, College of Medicince, Kaohsiung Medical University, Taiwan.,3 Department of Psychiatry, Kaohsiung Municipal Hsiao-Kang Hospital, Taiwan
| | - Tsyh-Jyi Hsieh
- 4 Department of Radiology, Faculty of Medicine, College of Medicince, Kaohsiung Medical University, Taiwan.,5 Department of Radiology, Kaohsiung Municipal Ta-Tung Hospital, Taiwan
| | - Peng-Wei Wang
- 1 Department of Psychiatry, Kaohsiung Medical University Hospital, Taiwan
| | - Wei-Chen Lin
- 6 Department of Medical Imaging, Kaohsiung Medical University Hospital, Taiwan
| | - Cheng-Sheng Chen
- 1 Department of Psychiatry, Kaohsiung Medical University Hospital, Taiwan.,2 Department of Psychiatry, Faculty of Medicine, College of Medicince, Kaohsiung Medical University, Taiwan
| | - Ju-Yu Yen
- 2 Department of Psychiatry, Faculty of Medicine, College of Medicince, Kaohsiung Medical University, Taiwan.,7 Department of Psychiatry, Kaohsiung Municipal Ta-Tung Hospital, Taiwan
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Magnard J, Berrut G, Cornu C, Deschamps T. Can Methodological Considerations Challenge the Dissociation of the Perceptual and Motor Inhibitory Processes? Exp Psychol 2017; 64:413-421. [PMID: 29268673 DOI: 10.1027/1618-3169/a000380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Using an original conflict task paradigm, Nassauer and Halperin (2003) argued that inhibition ability can be classified into two distinct perceptual and motor inhibitory processes. The current study examined the robustness of this paradigm by raising two major methodological points: the amount of information that needs to be processed and the task order (fixed vs. random). Sixty young adults performed the original or modified tasks. Overall, a decrease in the amount of information had the effect of removing the stimulus conflict on some subtests. Therefore, no more inhibition performance could be assessed. Even if the findings can be interpreted as a change in response-related complexity that relates reaction time performance to the informational processing load, the discrepancies in terms of the amount of information originally designed are necessary to induce inhibitory conflicts. Additionally, unlike previous recommendations, the fixed task order initially adopted cannot be considered an essential methodological requirement.
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Affiliation(s)
- Justine Magnard
- 1 Laboratory "Movement, Interactions, Performance" (EA 4334), Faculty of Sport Sciences, University of Nantes, France
| | - Gilles Berrut
- 1 Laboratory "Movement, Interactions, Performance" (EA 4334), Faculty of Sport Sciences, University of Nantes, France.,2 Centre Hospitalier Universitaire de Nantes, Pole de Gérontologie Clinique, Hôpital Bellier, Nantes, France
| | - Christophe Cornu
- 1 Laboratory "Movement, Interactions, Performance" (EA 4334), Faculty of Sport Sciences, University of Nantes, France
| | - Thibault Deschamps
- 1 Laboratory "Movement, Interactions, Performance" (EA 4334), Faculty of Sport Sciences, University of Nantes, France
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Schulz KP, Li X, Clerkin SM, Fan J, Berwid OG, Newcorn JH, Halperin JM. Prefrontal and parietal correlates of cognitive control related to the adult outcome of attention-deficit/hyperactivity disorder diagnosed in childhood. Cortex 2017; 90:1-11. [PMID: 28292705 DOI: 10.1016/j.cortex.2017.01.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/07/2016] [Accepted: 01/23/2017] [Indexed: 10/20/2022]
Abstract
The protracted and highly variable development of prefrontal cortex regions that support cognitive control has been purported to shape the adult outcome of attention-deficit/hyperactivity disorder (ADHD). This neurodevelopmental model was tested in a prospectively followed sample of 27 adult probands who were diagnosed with ADHD in childhood and 28 carefully matched comparison subjects aged 21-28 years. Probands were classified with persistent ADHD or remitted ADHD. Behavioral and neural responses to the Stimulus and Response Conflict Task (SRCT) performed during functional magnetic resonance imaging (fMRI) were compared in probands and comparison subjects and in probands with persistent and remitted ADHD. Response speed and accuracy for stimulus, response, and combined conflicts did not differ across groups. Orbitofrontal, inferior frontal and parietal activation was lower in probands than comparison subjects, but only for combined conflicts, when demand for cognitive control was highest. Reduced activation for combined conflicts in probands was almost wholly attributable to the persistence of ADHD; orbitofrontal, inferior frontal, anterior cingulate and parietal activation was lower in probands with persistent ADHD than both probands with remitted ADHD and comparison subjects, but did not differ between probands with remitted ADHD and comparison subjects. These data provide the first evidence that prefrontal and parietal activation during cognitive control parallels the adult outcome of ADHD diagnosed in childhood, with persistence of symptoms linked to reduced activation and symptom recovery associated with activation indistinguishable from adults with no history of ADHD.
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Affiliation(s)
- Kurt P Schulz
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Xiaobo Li
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, USA
| | - Suzanne M Clerkin
- Department of Psychology, Purchase College of the State University of New York, Purchase, NY, USA
| | - Jin Fan
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Psychology, Queens College of the City University of New York, Flushing, NY, USA
| | - Olga G Berwid
- Department of Behavioral Sciences, York College of the City University of New York, Jamaica, NY, USA
| | - Jeffrey H Newcorn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jeffrey M Halperin
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Psychology, Queens College of the City University of New York, Flushing, NY, USA
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Antisaccade-related brain activation in children with attention-deficit/hyperactivity disorder--A pilot study. Psychiatry Res 2015; 234:272-9. [PMID: 26459074 PMCID: PMC4663690 DOI: 10.1016/j.pscychresns.2015.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 09/09/2015] [Accepted: 10/01/2015] [Indexed: 11/23/2022]
Abstract
While antisaccade paradigms invoke circuitry associated with cognitive control and attention-deficit/hyperactivity disorder (ADHD), there is a dearth of functional magnetic resonance imaging (fMRI) investigations using antisaccade tasks among children with ADHD. Neural correlates associated with antisaccade performance were examined with fMRI in 11 children with ADHD (10 medicated) matched to 11 typically developing children. Significantly greater brain activation in regions in right dorsolateral prefrontal cortex and caudate nucleus was observed in children with ADHD relative to the control group. This pattern separated the children into their respective groups in a taxonomic manner. Sensitivity analyses probing comorbidity and medication-specific effects showed that results were consistent; however, the caudate nucleus difference was only detectable in the full sample, or in subsets with a more relaxed cluster threshold. Antisaccade performance did not significantly differ between the groups, perhaps as a result of greater brain activation or medication effects in the ADHD group. Thus, antisaccade paradigms may have sensitivity and specificity for the investigation of cognitive control deficits and associated neural correlates in ADHD, and may contribute towards the development of new treatment approaches for children with the disorder.
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Hoegl T, Bender S, Buchmann J, Kratz O, Moll GH, Heinrich H. [Transcranial magnetic stimulation (TMS), inhibition processes and attention deficit/hyperactivity disorder (ADHD) - an overview]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2014; 42:415-28; quiz 428-9. [PMID: 25335520 DOI: 10.1024/1422-4917/a000320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Motor system excitability can be tested by transcranial magnetic stimulation CFMS). In this article, an overview of recent methodological developments and research findings related to attention deficit/hyperactivity disorder (ADHD) is provided. Different TMS parameters that reflect the function of interneurons in the motor cortex may represent neurophysiological markers of inhibition in ADHD, particularly the so-called intracortical inhibition. In children with a high level of hyperactivity and impulsivity, intracortical inhibition was comparably low at rest as shortly before the execution of a movement. TMS-evoked potentials can also be measured in the EEG so that investigating processes of excitability is not restricted to motor areas in future studies. The effects of methylphenidate on motor system excitability may be interpreted in the sense of a 'fine-tuning' with these mainly dopaminergic effects also depending on genetic parameters (DAT1 transporter). A differentiated view on the organization of motor control can be achieved by a combined analysis of TMS parameters and event-related potentials. Applying this bimodal approach, strong evidence for a deviant implementation of motor control in children with ADHD and probably compensatory mechanisms (with involvement of the prefrontal cortex) was obtained. These findings, which contribute to a better understanding of hyperactivity/impulsivity, inhibitory processes and motor control in ADHD as well as the mechanisms of medication, underline the relevance of TMS as a neurophysiological method in ADHD research.
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Affiliation(s)
- Thomas Hoegl
- Kinder- u. Jugendabteilung für Psychische Gesundheit, Universitätsklinikum Erlangen
| | - Stephan Bender
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, J. W. Goethe Universitätsklinikum, Frankfurt am Main
| | - Johannes Buchmann
- Klinik für Psychiatrie, Neurologie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Zentrum Nervenheilkunde, Universität Rostock
| | - Oliver Kratz
- Kinder- u. Jugendabteilung für Psychische Gesundheit, Universitätsklinikum Erlangen
| | - Gunther H Moll
- Kinder- u. Jugendabteilung für Psychische Gesundheit, Universitätsklinikum Erlangen
| | - Hartmut Heinrich
- Kinder- u. Jugendabteilung für Psychische Gesundheit, Universitätsklinikum Erlangen Heckscher-Klinikum, München
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Bhaijiwala M, Chevrier A, Schachar R. Withholding and canceling a response in ADHD adolescents. Brain Behav 2014; 4:602-14. [PMID: 25328838 PMCID: PMC4086366 DOI: 10.1002/brb3.244] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 05/27/2014] [Accepted: 06/01/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Deficient response inhibition in situations involving a trade-off between response execution and response stopping is a hallmark of attention deficit hyperactive disorder (ADHD). There are two key components of response inhibition; reactive inhibition where one attempts to cancel an ongoing response and prospective inhibition is when one withholds a response pending a signal to stop. Prospective inhibition comes into play prior to the presentation of the stop signal and reactive inhibition follows the presentation of a signal to stop a particular action. The aim of this study is to investigate the neural activity evoked by prospective and reactive inhibition in adolescents with and without ADHD. METHODS Twelve adolescents with ADHD and 12 age-matched healthy controls (age range 9-18) were imaged while performing the stop signal task (SST). RESULTS Reactive inhibition activated right inferior frontal gyrus (IFG) in both groups. ADHD subjects activated IFG bilaterally. In controls, prospective inhibition invoked preactivation of the same part of right IFG that activated during reactive inhibition. In ADHD subjects, prospective inhibition was associated with deactivation in this region. Controls also deactivated the medial prefrontal cortex (MPFC) during prospective inhibition, whereas ADHD subjects activated the same area. DISCUSSION This pattern of activity changes in the same structures, but in opposite directions, was also evident across all phases of the task in various task-specific areas like the superior and middle temporal gyrus and other frontal areas. CONCLUSION Differences between ADHD and control participants in task-specific and default mode structures (IFG and MPFC) were evident during prospective, but not during reactive inhibition.
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Affiliation(s)
- Mehereen Bhaijiwala
- Institute of Medical Science, University of Toronto 7213 Medical Sciences Building, 1 King's College Circle, Toronto, Ontario, M5S1A8, Canada ; Neurosciences and Mental Health and the Department of Psychiatry, The Hospital for Sick Children 555 University Avenue, Toronto, Ontario, M5G1X8, Canada
| | - Andre Chevrier
- Institute of Medical Science, University of Toronto 7213 Medical Sciences Building, 1 King's College Circle, Toronto, Ontario, M5S1A8, Canada ; Neurosciences and Mental Health and the Department of Psychiatry, The Hospital for Sick Children 555 University Avenue, Toronto, Ontario, M5G1X8, Canada
| | - Russell Schachar
- Institute of Medical Science, University of Toronto 7213 Medical Sciences Building, 1 King's College Circle, Toronto, Ontario, M5S1A8, Canada ; Neurosciences and Mental Health and the Department of Psychiatry, The Hospital for Sick Children 555 University Avenue, Toronto, Ontario, M5G1X8, Canada
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11
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Diagnosis of Attention-Deficit/Hyperactivity Disorder (AD/HD) in Childhood: A Review of the Literature. ACTA ACUST UNITED AC 2014. [DOI: 10.1007/bf03340933] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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12
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Robb A, Findling RL. Challenges in the transition of care for adolescents with attention-deficit/hyperactivity disorder. Postgrad Med 2013; 125:131-40. [PMID: 23933901 DOI: 10.3810/pgm.2013.07.2685] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is often considered a childhood disorder. However, in those diagnosed with ADHD as children, inattention, impulsivity, and hyperactivity can persist into adulthood, causing significant functional impairment and emotional distress, even if the condition no longer meets diagnostic criteria. This review examines the developmental and psychosocial factors to consider in adolescents with ADHD and the strategies that facilitate the transition from pediatric to adult care. Our findings are based on PubMed database searches conducted on November 29, 2011, that identified articles pertaining to ADHD and continuity or transition in medical care for adolescents published in English within the 5-year period preceding this date. Adolescents with ADHD face specific burdens associated with transitioning into adulthood that can impede the achievement of academic and occupational goals. The main finding of the literature review was that ADHD treatment rates decline sharply from childhood through young adulthood, despite the fact that functional impairment often persists. Moreover, although psychosocial therapy can play an important role in resolving functional difficulties and encouraging patient adherence to pharmacotherapy, the existing literature focuses mainly on pharmacotherapy as first-line treatment for ADHD. Therefore, careful, advanced planning to ensure continuity of medical and psychiatric care is essential. This planning involves the pediatric service that has been providing care, the adult service that will assume the responsibility of providing care, the young person with ADHD, and the family. Although recommendations for planning initiatives have been developed by a variety of professional organizations, they do not seem to be routinely implemented for the transition of ADHD care. Such careful advanced transition planning can ensure continuity of treatment, encourage treatment adherence, and help young individuals adjust to new life circumstances and avoid negative educational, social, and vocational results. Guidelines designed to facilitate this transition of care may be helpful.
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Affiliation(s)
- Adelaide Robb
- Center for Translational Science, Children's National Medical Center, Washington, DC 20010, USA.
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Cain RE, Wasserman MC, Waterhouse BD, McGaughy JA. Atomoxetine facilitates attentional set shifting in adolescent rats. Dev Cogn Neurosci 2013; 1:552-9. [PMID: 21927630 DOI: 10.1016/j.dcn.2011.04.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Adolescent rats show immaturities in executive function and are less able than adult rats to learn reinforcement reversals and shift attentional set. These two forms of executive function rely on the functional integrity of the orbitofrontal and prelimbic cortices respectively. Drugs used to treat attention deficit disorder, such as atomoxetine, that increase cortical catecholamine levels improve executive functions in humans, non-human primates and adult rats with prefrontal lesions. Cortical noradrenergic systems are some of the last to mature in primates and rats. Moreover, norepinephrine transporters (NET) are higher in juvenile rats than adults. The underdeveloped cortical noradrenergic system and higher number of NET are hypothesized to underlie the immaturities in executive function found in adolescents. We assessed executive function in male Long-Evans rats using an intra-dimensional/extradimensional set shifting task. We administered the NET blocker, atomoxetine (0.0, 0.1, 0.9 mg/kg/ml; i.p.), prior to the test of attentional set shift and a reinforcement reversal. The lowest dose of drug facilitated attentional set shifting but had no effect on reversal learning. These data demonstrate that NET blockade allows adolescent rats to more easily perform attentional set shifting.
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Affiliation(s)
- Rachel E Cain
- University of New Hampshire, Department of Psychology, Durham, NH 03824, United States
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Lewis-Morrarty E, Dozier M, Bernard K, Terracciano SM, Moore SV. Cognitive flexibility and theory of mind outcomes among foster children: preschool follow-up results of a randomized clinical trial. J Adolesc Health 2012; 51:S17-22. [PMID: 22794528 PMCID: PMC3407592 DOI: 10.1016/j.jadohealth.2012.05.005] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 05/04/2012] [Accepted: 05/04/2012] [Indexed: 11/19/2022]
Abstract
Young children who experience early adversity are at risk for problems regulating emotions, behavior, and physiology, which in turn place them at risk for later psychopathology, school problems, and peer relation difficulties. Therefore, early parenting interventions are critical in helping this vulnerable population develop adequate self-regulatory capabilities. Attachment and Biobehavioral Catch-up (ABC) is an intervention developed to help parents learn to behave in ways that enhance young children's self-regulatory capabilities. In the present study, we found that preschool-aged foster children who had received the ABC intervention showed stronger cognitive flexibility and theory of mind skills, relative to foster children who had received a control intervention. Foster children who had received the ABC intervention showed capabilities in these areas that were not significantly different from a comparison group of children who were never in foster care. These findings are promising in suggesting that the ABC intervention enhances the development of foster children's self-regulatory capabilities.
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15
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White matter abnormalities and their impact on attentional performance in adult attention-deficit/hyperactivity disorder. Eur Arch Psychiatry Clin Neurosci 2012; 262:351-60. [PMID: 21879383 DOI: 10.1007/s00406-011-0251-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Accepted: 08/13/2011] [Indexed: 01/11/2023]
Abstract
Inattention is the most important behavioral feature of adult patients with attention-deficit/hyperactivity disorder (ADHD). Neuroimaging studies in ADHD have demonstrated abnormalities primarily in the frontostriatal circuitry and were mostly conducted in children. We investigated white matter (WM) integrity in adult ADHD patients and the correlation of WM microstructure and neuropsychological parameters in 37 (21 men) never-medicated adult ADHD patients and 34 age- and gender-matched healthy controls. All subjects underwent clinical interviews, rating scales, and neuropsychological tests of attentional performance. Diffusion tensor imaging (DTI) was acquired, and 12 WM regions-of-interest (ROIs) within the attentional network were chosen. Group differences of mean fractional anisotropy (FA) and mean diffusivity (MD) values were calculated for each ROI, and patients' DTI measures were then correlated with measures of attentional performance. FA values in ADHD patients were significantly reduced in the left inferior longitudinal fasciculus (ILF), while MD values were significantly increased in ADHD patients in the frontal portion of the left frontooccipital fasciculus (IFO). In ADHD patients, MD values were negatively correlated with attentional performance in the left ILF. Our findings provide further support for disturbed frontostriatal structural connectivity and also point to an involvement of the left temporal white matter with an impact on attentional performance.
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Hartmann AS, Rief W, Hilbert A. Laboratory snack food intake, negative mood, and impulsivity in youth with ADHD symptoms and episodes of loss of control eating. Where is the missing link? Appetite 2012; 58:672-8. [PMID: 22251461 DOI: 10.1016/j.appet.2012.01.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 12/24/2011] [Accepted: 01/03/2012] [Indexed: 11/16/2022]
Abstract
To compare laboratory food intake, negative mood and trait impulsivity and their association with attention deficit hyperactivity disorder (ADHD) and loss of control (LOC) eating in youth (middle childhood to early adolescence). Ninety 10-14 year old youths with symptoms of ADHD, symptoms of LOC eating, and control participants took part in a laboratory snack food meal after having rated trait impulsivity. Negative mood was self-reported pre and post snack food meal, while representativeness of eating behavior and liking of the food was assessed post laboratory snack food meal. The ADHD group consumed more snack food than the other groups. Food intake was not influenced by negative mood or trait impulsivity. All groups exhibited a decrease in negative mood from pre to post food intake that was not accounted for by level of hunger or liking of the food. The greater food intake of the ADHD group compared to the other groups may contribute to the development of overweight and therefore be in accordance with the high co-morbidity reported between ADHD and obesity in youth. The influence of impulsivity and negative mood on food intake could not be shown, which corroborates a recent review on the association of negative mood and bingeing in adults but needs further assessment, particularly in the younger age groups.
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Compensatory brain activation in children with attention deficit/hyperactivity disorder during a simplified Go/No-go task. J Neural Transm (Vienna) 2011; 119:613-9. [DOI: 10.1007/s00702-011-0744-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Accepted: 11/20/2011] [Indexed: 10/14/2022]
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Fassbender C, Schweitzer JB, Cortes CR, Tagamets MA, Windsor TA, Reeves GM, Gullapalli R. Working memory in attention deficit/hyperactivity disorder is characterized by a lack of specialization of brain function. PLoS One 2011; 6:e27240. [PMID: 22102882 PMCID: PMC3213127 DOI: 10.1371/journal.pone.0027240] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 10/12/2011] [Indexed: 11/18/2022] Open
Abstract
Working memory impairments are frequent in Attention Deficit/Hyperactivity Disorder (ADHD) and create problems along numerous functional dimensions. The present study utilized the Visual Serial Addition Task (VSAT) and functional magnetic resonance imaging (fMRI) to explore working memory processes in thirteen typically developing (TD) control and thirteen children with ADHD, Combined type. Analysis of Variance (ANOVA) was used to examine both main effects and interactions. Working memory-specific activity was found in TD children in the bilateral prefrontal cortex. In contrast the within-group map in ADHD did not reveal any working-memory specific regions. Main effects of condition suggested that the right middle frontal gyrus (BA6) and the right precuneus were engaged by both groups during working memory processing. Group differences were driven by significantly greater, non-working memory-specific, activation in the ADHD relative to TD group in the bilateral insula extending into basal ganglia and the medial prefrontal cortex. A region of interest analysis revealed a region in left middle frontal gyrus that was more active during working memory in TD controls. Thus, only the TD group appeared to display working memory-modulated brain activation. In conclusion, children with ADHD demonstrated reduced working memory task specific brain activation in comparison to their peers. These data suggest inefficiency in functional recruitment by individuals with ADHD represented by a poor match between task demands and appropriate levels of brain activity.
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Affiliation(s)
- Catherine Fassbender
- MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California, United States of America.
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Newman LA, McGaughy J. Adolescent rats show cognitive rigidity in a test of attentional set shifting. Dev Psychobiol 2011; 53:391-401. [PMID: 21365641 PMCID: PMC10722888 DOI: 10.1002/dev.20537] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 01/27/2011] [Indexed: 12/11/2022]
Abstract
As neuropsychiatric disorders such as schizophrenia, attention deficit disorder, and mood disorders all impact executive function and are likely to be diagnosed prior to adulthood, it is important to understand the normal ontogeny of executive function. Previous behavioral research has shown that adolescents' executive function is different than that of adults. In the present study, we use a previously validated cognitive test, the intradimensional/extradimensional (ID/ED) set-shifting task, to assess attentional set shifting and reversal learning in adolescent and adult, male, Long-Evans rats. These data suggest that adolescent rats are more cognitively rigid than adult rats and have impairments in the shifting, but not formation, of an attentional set. Adolescent rats are also more susceptible to distraction than adult rats when an irrelevant stimulus dimension is introduced as part of a complex stimulus. Moreover, we find that attentional set shifting becomes adult-like at an earlier age than reversal learning. As these functions are mediated by distinct prefrontal subregions, that is, the prelimbic and orbitofrontal cortices, respectively, we hypothesize that prefrontal cortical subregions show slightly different developmental trajectories.
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Affiliation(s)
- Lori A Newman
- Department of Psychology, University of New Hampshire, Durham, New Hampshire 03824, USA
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Abstract
Structural and functional imaging studies in subjects with attention deficit hyperactivity disorder (ADHD) are reviewed with the goal of gleaning information about neurodevelopmental abnormalities characterizing the disorder. Structural imaging studies, particularly those with longitudinal designs, suggest that brain maturation is delayed by a few years in ADHD. However, a maturational delay model alone is incomplete: alternate courses are suggested by differences associated with phenotypic factors, such as symptom remission/persistence and exposure to stimulant treatment. Findings from functional imaging studies point to multiple loci of abnormalities that are not limited to frontal-striatal circuitry, which is important for executive and motivational function, but also include parietal, temporal and motor cortices, and the cerebellum. However, a definitive conclusion about maturational delays or alternate trajectories cannot be drawn from this work as activation patterns are influenced by task-specific factors that may induce variable performance levels and strategies across development. In addition, no studies have implemented cross-sectional or longitudinal designs, without which the developmental origin of differences in activation cannot be inferred. Thus, current task-evoked functional imaging provides information about dynamic or state-dependent differences rather than fixed or trait-related differences. In the future, task-free functional imaging holds promise for revealing neurodevelopmental information that is minimally influenced by performance/strategic differences. Further, studies using longitudinal designs that identify sources of phenotypic heterogeneity in brain maturation and characterize the relationship between brain function and underlying structural properties are needed to provide a comprehensive view of neurodevelopmental abnormalities in ADHD.
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Halperin JM, Healey DM. The influences of environmental enrichment, cognitive enhancement, and physical exercise on brain development: can we alter the developmental trajectory of ADHD? Neurosci Biobehav Rev 2010; 35:621-34. [PMID: 20691725 DOI: 10.1016/j.neubiorev.2010.07.006] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2010] [Revised: 07/11/2010] [Accepted: 07/28/2010] [Indexed: 10/19/2022]
Abstract
Attention-deficit/Hyperactivity Disorder (ADHD) is characterized by a pervasive pattern of developmentally inappropriate inattentive, impulsive and hyperactive behaviors that typically begin during the preschool years and often persist into adulthood. The most effective and widely used treatments for ADHD are medication and behavior modification. These empirically-supported interventions are generally successful in reducing ADHD symptoms, but treatment effects are rarely maintained beyond the active intervention. Because ADHD is now generally thought of as a chronic disorder that is often present well into adolescence and early adulthood, the need for continued treatment throughout the lifetime is both costly and problematic for a number of logistical reasons. Therefore, it would be highly beneficial if treatments would have lasting effects that remain after the intervention is terminated. This review examines the burgeoning literature on the underlying neural determinants of ADHD along with research demonstrating powerful influences of environmental factors on brain development and functioning. Based upon these largely distinct scientific literatures, we propose an approach that employs directed play and physical exercise to promote brain growth which, in turn, could lead to the development of potentially more enduring treatments for the disorder.
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Affiliation(s)
- Jeffrey M Halperin
- Department of Psychology, Queens College of the City University of New York 11367, USA.
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Bedard ACV, Trampush JW, Newcorn JH, Halperin JM. Perceptual and motor inhibition in adolescents/young adults with childhood-diagnosed ADHD. Neuropsychology 2010; 24:424-34. [PMID: 20604617 PMCID: PMC2900812 DOI: 10.1037/a0018752] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE This study examined perceptual and motor inhibition in a longitudinal sample of adolescents/young adults who were diagnosed with ADHD in childhood, and as a function of the relative persistence of ADHD. METHOD Ninety-eight participants diagnosed with ADHD in childhood were reevaluated approximately 10 years later. Eighty-five never-ADHD controls similar in age, IQ, sociodemographic background, and gender distribution served as a comparison group. Participants were administered a psychiatric interview and the Stimulus and Response Conflict Tasks (Nassauer & Halperin, 2003). RESULTS Participants with childhood ADHD demonstrated slower and less accurate responses to both control and conflict conditions relative to the comparison group, as well as more variable responses in both conditions of the motor inhibition task; there was no specific effect of childhood ADHD on perceptual or motor inhibition. ADHD persisters and partial remitters did not differ in overall accuracy, speed or variability in responding, but relative to partial remitters, persisters demonstrated greater slowing in response to perceptual conflict. CONCLUSIONS These findings are consistent with theories positing state regulation, but not inhibitory control deficits in the etiology of ADHD, and suggest that improved perceptual inhibition may be associated with better outcome for ADHD.
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Affiliation(s)
| | - Joey W. Trampush
- Neuropsychology Doctoral Subprogram, Graduate Center of the City University of New York, New York, USA
| | | | - Jeffrey M. Halperin
- Department of Psychiatry, Mount Sinai School of Medicine, New York, USA
- Neuropsychology Doctoral Subprogram, Graduate Center of the City University of New York, New York, USA
- Department of Psychology, Queens College of the City University of New York, Flushing, New York, USA
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Dillo W, Göke A, Prox-Vagedes V, Szycik GR, Roy M, Donnerstag F, Emrich HM, Ohlmeier MD. Neuronal correlates of ADHD in adults with evidence for compensation strategies--a functional MRI study with a Go/No-Go paradigm. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2010; 8:Doc09. [PMID: 20421953 PMCID: PMC2858877 DOI: 10.3205/000098] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Revised: 03/27/2010] [Indexed: 11/30/2022]
Abstract
Objective: Response inhibition impairment is one of the most characteristic symptoms of attention-deficit/hyperactivity disorder (ADHD). Thus functional magnetic resonance imaging (fMRI) during a Go/No-Go task seems to be an ideal tool for examining neuronal correlates of inhibitory control deficits in ADHD. Prior studies have shown frontostriatal abnormalities in children and adolescents. The aim of our study was to investigate whether adults with ADHD would still show abnormal brain activation in prefrontal brain regions during motor response inhibition tasks. Methods: fMRI was used to compare brain activation in 15 untreated adult patients with ADHD and 15 healthy reference volunteers during performance of a Go/No-Go task. Results: In contrast to various other studies with children and adolescents with ADHD, we found no significant difference in the activity of anterior cingulate cortex (ACC) or other frontostriatal structures between ADHD and healthy adults. Significantly enhanced activity was found in the parietal cortex, which is known to play an important role in building up attention. Conclusion: We hypothesize that the enhanced activity is due to the ability of adult ADHD patients to compensate their deficits for a short time, which is demonstrated in our study by equal task performance in both groups.
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Affiliation(s)
- Wolfgang Dillo
- Department of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany.
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Sonuga-Barke EJS, Halperin JM. Developmental phenotypes and causal pathways in attention deficit/hyperactivity disorder: potential targets for early intervention? J Child Psychol Psychiatry 2010; 51:368-89. [PMID: 20015192 DOI: 10.1111/j.1469-7610.2009.02195.x] [Citation(s) in RCA: 233] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Early intervention approaches have rarely been implemented for the prevention of attention deficit/hyperactivity disorder (ADHD). In this paper we explore whether such an approach may represent an important new direction for therapeutic innovation. We propose that such an approach is most likely to be of value when grounded in and informed by developmental models of the dynamic, complex and heterogeneous nature of the condition. First, we set out a rationale for early intervention grounded in the science of ADHD viewed through developmental models. Second, we re-examine the concept of disorder-onset from the perspective of developmental trajectories and phenotypes. Third, we examine potential causal pathways to ADHD with regard to originating risk, pathophysiological mediators, environmental moderators and developmental continuities. Finally, we explore the potential value of strategies for identifying young children at risk for ADHD, and implementing interventions in ways that can target these underlying pathogenic processes. The utility of such an approach represents an important area for future research but still requires 'proof of concept'. Therefore prior to widespread clinical implementation, far greater knowledge is required of (i) developmental pathways into ADHD, (ii) the value of identifying neuropsychological mediators of these pathways, and (iii) the extent to which targeting mediating mechanisms will improve treatment outcomes for children with ADHD.
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Affiliation(s)
- Edmund J S Sonuga-Barke
- Developmental Brain-Behaviour Laboratory, University of Southampton, Southampton, SO17 1BJ, UK
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25
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Abstract
Attention deficit/hyperactivity disorder (ADHD) is the behavioural disorder most commonly diagnosed in childhood. In addition to the main symptoms of inattention, impulsiveness and hyperactivity, neurological soft signs (NSS) are often associated with ADHD. NSS are discrete motor and sensory disorders that cannot be linked to specific cerebral lesions. We review all the scientific contributions on NSS in ADHD. The conclusions support the presence of an alteration in the neural networks for motor control inhibition, at the base of the pathophysiology of NSS in children with ADHD, as well as a possible central role of dopamine in these neural circuits.
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Affiliation(s)
- Augusto Pasini
- Unit of Child Neurology and Psychiatry, Department of Neuroscience, University of Rome Tor Vergata, Rome, Italy.
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26
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Konrad A, Dielentheis TF, El Masri D, Bayerl M, Fehr C, Gesierich T, Vucurevic G, Stoeter P, Winterer G. Disturbed structural connectivity is related to inattention and impulsivity in adult attention deficit hyperactivity disorder. Eur J Neurosci 2010; 31:912-9. [DOI: 10.1111/j.1460-9568.2010.07110.x] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Singh MK, Chang KD, Mazaika P, Garrett A, Adleman N, Kelley R, Howe M, Reiss A. Neural correlates of response inhibition in pediatric bipolar disorder. J Child Adolesc Psychopharmacol 2010; 20:15-24. [PMID: 20166792 PMCID: PMC2835388 DOI: 10.1089/cap.2009.0004] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Pediatric bipolar disorder is characterized by core deficits in mood and executive function and commonly co-occurs with attention-deficit/hyperactivity disorder (ADHD). We aimed to examine response inhibition in this population, as an element of executive function, which, if aberrant, may interfere with learning and information processing. METHODS Children (9-18 years) with bipolar I or II disorder (BD, n = 26) and age, gender, and intelligence quotient (IQ) comparable healthy children (HC, n = 22) without any psychopathology were given a standardized Go/NoGo computerized task measuring response inhibition. A whole-brain functional magnetic resonance imaging (MRI) group analysis was performed using statistical parametric mapping software (SPM2) for comparing NoGo to Go epochs. RESULTS There were no statistically significant group differences between groups in age, gender, or ethnicity. The BD group had high rates of co-morbid disorders, including 81% with ADHD, 62% with oppositional defiant disorder (ODD), and 46% with anxiety disorders. This BD group had fewer correct responses on Go (84% vs. 96%, T[46] = 3.35, p = 0.002) and overall (85% vs. 94%, T[46] = 4.12, p = 0.0002) trials as compared to the HC group. However, there were no statistically significant group differences in response inhibition on NoGo trials (p = 0.11). In the NoGo-Go contrast, the BD group showed increased neural activation in the right dorsolateral prefrontal cortex (DLPFC) compared to HC (T[46] = 4.21, p < 0.001). CONCLUSIONS During accurate NoGo but impaired Go trial performance, children with BD showed increased right DLPFC activation versus controls, suggesting increased recruitment of executive control regions for accurate response inhibition. Studies relating these results to mood regulation in pediatric BD are warranted.
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Affiliation(s)
- Manpreet K. Singh
- Pediatric Bipolar Disorders Program, Stanford University School of Medicine, Stanford, California.,Center for Interdisciplinary Brain Sciences Research, Stanford University School of Medicine, Stanford, California
| | - Kiki D. Chang
- Pediatric Bipolar Disorders Program, Stanford University School of Medicine, Stanford, California
| | - Paul Mazaika
- Center for Interdisciplinary Brain Sciences Research, Stanford University School of Medicine, Stanford, California
| | - Amy Garrett
- Center for Interdisciplinary Brain Sciences Research, Stanford University School of Medicine, Stanford, California
| | - Nancy Adleman
- Center for Interdisciplinary Brain Sciences Research, Stanford University School of Medicine, Stanford, California
| | - Ryan Kelley
- Center for Interdisciplinary Brain Sciences Research, Stanford University School of Medicine, Stanford, California
| | - Meghan Howe
- Pediatric Bipolar Disorders Program, Stanford University School of Medicine, Stanford, California
| | - Allan Reiss
- Center for Interdisciplinary Brain Sciences Research, Stanford University School of Medicine, Stanford, California
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Sheridan MA, Hinshaw S, D’Esposito M. Stimulant medication and prefrontal functional connectivity during working memory in ADHD: a preliminary report. J Atten Disord 2010; 14:69-78. [PMID: 20576647 PMCID: PMC2935299 DOI: 10.1177/1087054709347444] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Recent theoretical and empirical work suggests that while unmedicated, children with ADHD have a deficit in subcortical processing that leads to greater and more varied prefrontal cortical (PFC) activation, compared to (a) age-matched control participants and (b) their own brain activity while on stimulant medication. This pattern has been described elsewhere as inefficient. METHOD Functional magnetic resonance imaging (fMRI) and functional connectivity analyses were used during a working memory task for five female adolescents with ADHD, aged 11 to 17 years, both on and off their usual dose of stimulant medication. RESULTS On medication, adolescents with ADHD demonstrated less PFC activation and less functional connectivity between frontal and subcortical regions compared to off medication. CONCLUSIONS Because of the small sample size, results are presented as preliminary findings which await replication in a larger sample. However, these findings lend support to the idea that remediation of inefficiencies in PFC function for individuals with ADHD by stimulant medication may be related, in part, to frontal-subcortical connectivity.
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Affiliation(s)
- Margaret A. Sheridan
- Robert Wood Johnson Foundation Health & Society Scholar at the Harvard School of Public Health in Harvard University,Developmental Medicine Center, Children’s Hospital Boston
| | - Stephen Hinshaw
- Department of Psychology, University of California, Berkeley
| | - Mark D’Esposito
- Corresponding Author: Helen Wills Neuroscience Institute; 132 Barker Hall, #3190; Berkeley, CA 94720-3190. Tel.:510-642-2593; fax: 510-642-3192,
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Differential engagement of cognitive and affective neural systems in pediatric bipolar disorder and attention deficit hyperactivity disorder. J Int Neuropsychol Soc 2010; 16:106-17. [PMID: 19849880 PMCID: PMC3169194 DOI: 10.1017/s1355617709991019] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This fMRI study investigates the neural bases of cognitive control of emotion processing in pediatric bipolar disorder (PBD) and attention deficit hyperactivity disorder (ADHD). Seventeen un-medicated PBD patients, 15 un-medicated ADHD patients, and 14 healthy controls (HC) (mean age = 13.78 +/- 2.47) performed an emotional valence Stroop Task, requiring them to match the color of an emotionally valenced word to the color of either of two adjacent circles. Both patient groups responded significantly slower than HC, but there were no group differences in accuracy. A voxel-wise analysis of variance on brain activation revealed a significant interaction of group by word valence [F(2,41) = 4.44; p = .02]. Similar group differences were found for negative and positive words. For negative versus neutral words, both patient groups exhibited greater activation in dorsolateral prefrontal cortex (DLPFC) and parietal cortex relative to HC. The PBD group exhibited greater activation in ventrolateral prefrontal cortex (VLPFC) and anterior cingulate cortex (ACC) relative to HC. The ADHD group exhibited decreased VLPFC activation relative to HC and the PBD group. During cognitive control of emotion processing, PBD patients deployed the VLPFC to a greater extent than HC. The ADHD patients showed decreased VLPFC engagement relative to both HC and PBD patients.
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Solanto MV, Schulz KP, Fan J, Tang CY, Newcorn JH. Event-related FMRI of inhibitory control in the predominantly inattentive and combined subtypes of ADHD. J Neuroimaging 2009; 19:205-12. [PMID: 19594667 DOI: 10.1111/j.1552-6569.2008.00289.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE To examine the neurophysiological basis for the pronounced differences in hyperactivity and impulsiveness that distinguish the predominantly inattentive type of attention-deficit/hyperactivity disorder (ADHD-PI) from the combined type of the disorder (ADHD-C). METHODS Event-related brain responses to a go/no-go test of inhibitory control were measured with functional magnetic resonance imaging (fMRI) in 11 children with ADHD-C and 9 children with ADHD-PI, aged 7 to 13 years, who were matched for age, sex, and intelligence. RESULTS There were no significant group differences in task performance. Children with ADHD-C and ADHD-PI activated overlapping regions of right inferior frontal gyrus, right superior temporal lobe, and left inferior parietal lobe during inhibitory control. However, the magnitude of the activation in the temporal and parietal regions, as well as in the bilateral middle frontal gyrus, was greater in children with ADHD-PI than those with ADHD-C. Conversely, children with ADHD-C activated bilateral medial occipital lobe to a greater extent than children with ADHD-PI. CONCLUSIONS The results provide preliminary evidence that phenotypic differences between the ADHD-C and ADHD-PI subtypes are associated with differential activation of regions that have previously been implicated in the pathophysiology of ADHD and are thought to mediate executive and attentional processes.
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Affiliation(s)
- Mary V Solanto
- Department of Psychiatry, Mount Sinai School of Medicine, New York, New York 10029, USA.
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31
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Cherkasova MV, Hechtman L. Neuroimaging in attention-deficit hyperactivity disorder: beyond the frontostriatal circuitry. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2009; 54:651-64. [PMID: 19835672 DOI: 10.1177/070674370905401002] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To review the findings of structural and functional neuroimaging studies in attention-deficit hyperactivity disorder (ADHD), with a focus on abnormalities reported in brain regions that lie outside the frontostriatal circuitry, which is currently believed to play a central role in the pathophysiology of ADHD. METHODS Relevant publications were found primarily by searching the MEDLINE and PubMed databases using the keywords ADHD and the abbreviations of magnetic resonance imaging (MRI), functional MRI, positron emission tomography, and single photon emission computed tomography. The reference lists of the articles found through the databases were then reviewed for the purpose of finding additional articles. RESULTS There is now substantial evidence of structural and functional alterations in regions outside the frontostriatal circuitry in ADHD, most notably in the cerebellum and the parietal lobes. CONCLUSIONS Although there is compelling evidence suggesting that frontostriatal dysfunction may be central to the pathophysiology of ADHD, the neuroimaging findings point to distributed neural substrates rather than a single one. More research is needed to elucidate the nature of contributions of nonfrontostriatal regions to the pathophysiology of ADHD.
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Vaidya CJ, Stollstorff M. Cognitive neuroscience of Attention Deficit Hyperactivity Disorder: current status and working hypotheses. ACTA ACUST UNITED AC 2009; 14:261-7. [PMID: 19072750 DOI: 10.1002/ddrr.40] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Cognitive neuroscience studies of Attention Deficit Hyperactivity Disorder (ADHD) suggest multiple loci of pathology with respect to both cognitive domains and neural circuitry. Cognitive deficits extend beyond executive functioning to include spatial, temporal, and lower-level "nonexecutive" functions. Atypical functional anatomy extends beyond frontostriatal circuits to include posterior cortices, limbic regions, and the cerebellum. Pathophysiology includes dopaminergic as well as noradrenergic neurotransmitter systems. We review the major insights gained from functional brain imaging studies in ADHD and discuss working hypotheses regarding their neurochemical underpinnings.
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Affiliation(s)
- Chandan J Vaidya
- Department of Psychology, Georgetown University, Washington, DC 20057, USA.
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Converging methods in studying attention-deficit/hyperactivity disorder: what can we learn from neuroimaging and genetics? Dev Psychopathol 2009; 20:1133-43. [PMID: 18838034 DOI: 10.1017/s0954579408000539] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This paper discusses how converging methods may form a powerful tool in unraveling the neurobiology of attention-deficit/hyperactivity disorder (ADHD). Integrating findings from multiple disciplines can inform us on how different neurobiological and cognitive mechanisms tie together in both typical and atypical development. Examples are discussed of this approach: combining family and genetic approaches with anatomical neuroimaging illustrates how mapping familial effects can bring us closer to understanding the neurobiology of ADHD. Functional neuroimaging has convincingly linked cognitive problems in this disorder with frontostriatal functioning, but also shows that other systems may be involved in some of the symptoms of ADHD. Combining these findings has suggested new avenues for investigation, such as the role of frontocerebellar networks. Furthermore, findings may have practical applications: this paper discusses an example of how converging evidence of striatal dysregulation in ADHD suggests possible directions for treatment that are now being explored in functional imaging studies.
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Integrating functional brain neuroimaging and developmental cognitive neuroscience in child psychiatry research. J Am Acad Child Adolesc Psychiatry 2008; 47:1273-88. [PMID: 18827719 PMCID: PMC2627505 DOI: 10.1097/chi.0b013e318185d2d1] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To provide an overview of clinical research aiming to develop a mechanistic understanding of brain dysfunction in child psychiatric disorders. METHOD Technological, conceptual, and translational approaches relevant to the investigation of brain function in pediatric psychiatric illnesses are explored. Research in the area of pediatric bipolar disorder is used as a prototypic model illustrating the use of complementary techniques of functional magnetic neuroimaging and neurocognitive studies to identify abnormalities in neural circuitry function. RESULTS Studies of bipolar youths indicate impairment in cognitive and affective neural systems and in the interface of these two circuits. This evolving field paves a future pathway for identifying diagnostic biomarkers for the disorder, providing tools for monitoring response to pharmacotherapy, examining illness-associated alterations in developmental trajectory, and facilitating the use of animal research for guiding the development of novel treatment strategies. CONCLUSIONS Studies of brain function in child psychiatry are establishing a platform of knowledge and methods that offer promise for revolutionizing both models of illness pathophysiology and future diagnostic and therapeutic practice.
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Interference Control in Children with Attention Deficit/Hyperactivity Disorder. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2008; 37:293-303. [DOI: 10.1007/s10802-008-9277-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Halperin JM, Trampush JW, Miller CJ, Marks DJ, Newcorn JH. Neuropsychological outcome in adolescents/young adults with childhood ADHD: profiles of persisters, remitters and controls. J Child Psychol Psychiatry 2008; 49:958-66. [PMID: 18573145 PMCID: PMC2646044 DOI: 10.1111/j.1469-7610.2008.01926.x] [Citation(s) in RCA: 183] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND This study examined neuropsychological functioning in a longitudinal sample of adolescents/young adults with attention deficit/hyperactivity disorder (ADHD) and controls as a function of the persistence of ADHD. We hypothesized that measures of executive processes would parallel adolescent clinical status, with ADHD-persisters, but not remitters, differing significantly from controls. In contrast, persisters and remitters were hypothesized to perform similarly, and different from controls, on tasks requiring less effortful processing. METHODS Ninety-eight participants diagnosed with ADHD in childhood were reevaluated approximately 10 years later. Eighty-five never-ADHD controls similar in age, IQ, and sex distribution served as a comparison group. Participants were administered a psychiatric interview and neuropsychological test battery. RESULTS Those with childhood ADHD demonstrated broad neuropsychological deficits relative to controls. When the group with childhood ADHD was subdivided based on adolescent ADHD status, compared to controls, both persisters and remitters showed deficient perceptual sensitivity and response variability, and increased ankle movements recorded by a solid-state actigraph. Only persisters differed from controls on several measures of more effortful executive processes. CONCLUSIONS Findings provide preliminary support to the hypothesis that ADHD is associated with early-appearing and enduring subcortical dysfunction, while recovery over the course of development is associated with improvements in executive control functions.
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Affiliation(s)
- Jeffrey M. Halperin
- Department of Psychology, Queens College of the City University of New York, Flushing, New York, USA, Neuropsychology Doctoral Subprogram, Graduate Center of the City University of New York, New York, USA, Department of Psychiatry, Mount Sinai School of Medicine, New York, USA
| | - Joey W. Trampush
- Neuropsychology Doctoral Subprogram, Graduate Center of the City University of New York, New York, USA
| | - Carlin J. Miller
- Department of Psychology, University of Windsor, Ontario, Canada
| | - David J. Marks
- Department of Psychiatry, Mount Sinai School of Medicine, New York, USA
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Imaging genetics in ADHD: a focus on cognitive control. Neurosci Biobehav Rev 2008; 33:674-89. [PMID: 18789356 DOI: 10.1016/j.neubiorev.2008.08.009] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Revised: 07/18/2008] [Accepted: 08/17/2008] [Indexed: 01/17/2023]
Abstract
This paper evaluates neuroimaging of cognitive control as an endophenotype for investigating the role of dopamine genes in ADHD. First, this paper reviews both data-driven and theory-driven approaches from genetics and neuroimaging. Several viable candidate genes have been implicated in ADHD, including the dopamine DRD4 and DAT1 genes. Neuroimaging studies have resulted in a good understanding of the neurobiological basis of deficits in cognitive control in this disorder. Second, this paper discusses imaging genetics in ADHD. Papers to date have taken one of two approaches: whereas early papers investigated the effects of one or two candidate genes on many brain areas, later papers constrained regions of interest by gene expression patterns. These papers have largely focused on cognitive control and the dopamine circuits involved in this ability. The results show that neuroimaging of cognitive control is useful as an endophenotype in investigating dopamine gene effects in ADHD. Other avenues of investigation are suggested by a combination of data- and theory-driven approaches in both genetics and neuroimaging.
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Borges JL, Trentini CM, Bandeira DR, Dell'Aglio DD. Avaliação neuropsicológica dos transtornos psicológicos na infância: um estudo de revisão. PSICO-USF 2008. [DOI: 10.1590/s1413-82712008000100015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Este artigo apresenta uma revisão da literatura sobre a avaliação neuropsicológica dos déficits cognitivos associados aos transtornos psicológicos na infância e adolescência, com base em pesquisas publicadas no período de 2000 a 2006. Foi realizado um levantamento abrangendo publicações nacionais e internacionais indexadas nas bases de dados Medline, SciELo e PsycInfo. Os resultados indicaram um aumento da produção científica na área da avaliação neuropsicológica do transtorno de déficit de atenção e hiperatividade, autismo, transtornos de humor e transtorno de conduta. Observou-se a presença de poucos estudos nacionais, indicando a necessidade de pesquisas na área de avaliação neuropsicológica no Brasil.
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Mayes SD, Calhoun SL. Learning, attention, writing, and processing speed in typical children and children with ADHD, autism, anxiety, depression, and oppositional-defiant disorder. Child Neuropsychol 2008; 13:469-93. [PMID: 17852125 DOI: 10.1080/09297040601112773] [Citation(s) in RCA: 193] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Learning, attention, graphomotor, and processing speed scores were analyzed in 149 typical control children and 886 clinical children with normal intelligence. Nonsignificant differences were found between control children and children with anxiety, depression, and oppositional-defiant disorder. Control children performed better than children with ADHD and autism in all areas. Children with ADHD and autism did not differ, except that children with ADHD had greater learning problems. Attention, graphomotor, and speed weaknesses were likely to coexist, the majority of children with autism and ADHD had weaknesses in all three areas, and these scores contributed significantly to the prediction of academic achievement.
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Affiliation(s)
- Susan Dickerson Mayes
- Department of Psychiatry, Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, USA.
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Abstract
Functional MRI (fMRI) research in attention-deficit/hyperactivity disorder (ADHD) is a fast developing and very complex field. Every study appears to show differences in patterns of brain activation between cases and controls, but the interpretation of such differences is not as straightforward as it may seem. We present here a systematic review of the fMRI literature in ADHD; areas covered include executive functions, reward processing, the effects of methylphenidate, comorbidity and spontaneous brain activity in the resting state. To facilitate the interpretation of research in this area, we discuss important conceptual issues, such as the need to take group differences in performance into account or to consider the role of errors. We present common themes that emerge from these studies and we discuss possible reasons for the many discrepancies that were observed. Finally, based on existing literature and current advancements in fMRI research, we discuss the role that fMRI could play in the future as a diagnostic tool or in treatment outcome predictions, and we make predictions for the future directions of research in this field.
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Affiliation(s)
- Yannis Paloyelis
- MRC Social Genetic Developmental Psychiatry (SGDP) Centre (P080), Institute of Psychiatry, De Crespigny Park London, UK, SE5 8AF Tel: 02078480748 Fax: 02078480866
| | - Mitul A. Mehta
- Centre for Neuroimaging Sciences Box 089, Institute of Psychiatry De Crespigny Park London SE5 8AF Tel: 020 3228 3053 Fax: 020 3228 2116
| | - Jonna Kuntsi
- MRC Social Genetic Developmental Psychiatry (SGDP) Centre (P080), Institute of Psychiatry, De Crespigny Park London, UK, SE5 8AF
| | - Philip Asherson
- MRC Social Genetic Developmental Psychiatry (SGDP) Centre (P080), Institute of Psychiatry, De Crespigny Park London, UK, SE5 8AF Tel: 0207 848 0078 (office) 0207 848 5363 (administration) Fax: 0207 848 0866
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Durston S, Konrad K. Integrating genetic, psychopharmacological and neuroimaging studies: A converging methods approach to understanding the neurobiology of ADHD. DEVELOPMENTAL REVIEW 2007. [DOI: 10.1016/j.dr.2007.05.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Vance A, Silk TJ, Casey M, Rinehart NJ, Bradshaw JL, Bellgrove MA, Cunnington R. Right parietal dysfunction in children with attention deficit hyperactivity disorder, combined type: a functional MRI study. Mol Psychiatry 2007; 12:826-32, 793. [PMID: 17471290 DOI: 10.1038/sj.mp.4001999] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Attention deficit hyperactivity disorder, combined type (ADHD-CT) is associated with spatial working memory deficits. These deficits are known to be subserved by dysfunction of neural circuits involving right prefrontal, striatal and parietal brain regions. This study determines whether decreased right prefrontal, striatal and parietal activation with a mental rotation task shown in adolescents with ADHD-CT is also evident in children with ADHD-CT. A cross-sectional study of 12 pre-pubertal, right-handed, 8-12-year-old boys with ADHD-CT and 12 pre-pubertal, right-handed, performance IQ-matched, 8-12-year-old healthy boys, recruited from local primary schools, was completed. Participants underwent functional magnetic resonance imaging while performing a mental rotation task that requires spatial working memory. The two groups did not differ in their accuracy or response times for the mental rotation task. The ADHD-CT group showed significantly less activation in right parieto-occipital areas (cuneus and precuneus, BA 19), the right inferior parietal lobe (BA 40) and the right caudate nucleus. Our findings with a child cohort confirm previous reports of right striatal-parietal dysfunction in adolescents with ADHD-CT. This dysfunction suggests a widespread maturational deficit that may be developmental stage independent.
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Affiliation(s)
- A Vance
- Academic Child Psychiatry Unit, Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Murdoch Children's Research Institute, Parkville, VIC, Australia.
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Abstract
OBJECTIVE The remarkable persistence of disablement in chronic traumatic brain injury and the dearth of accommodation define the condition as a disorder of adaptation. This construct is extended to explain exceptional recoveries after postacute treatment. METHOD Nine severely injured graduates of holistic cognitive rehabilitation were selected for their exceptional postmorbid academic, vocational, and social accomplishments. RESULTS In interviews, they attributed their successes to continuing reliance on, and ongoing elaboration and modification of, cognitive compensation strategies. Unlike their disabled cohorts, they implement a deliberate procedure for self-corrective self-management that minimizes the functional impact of their permanent deficits.
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Affiliation(s)
- Larry E Schutz
- Department of Speech Sciences and Communication Disorders, University of Central Florida, Orlando, FL 32828, USA.
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Boellner SW, Earl CQ, Arora S. Modafinil in children and adolescents with attention-deficit/hyperactivity disorder: a preliminary 8-week, open-label study. Curr Med Res Opin 2006; 22:2457-65. [PMID: 17257460 DOI: 10.1185/030079906x148300] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE In a 4-week, double-blind, placebo-controlled study, the attention-promoting agent modafinil improved symptoms of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents and was well tolerated. To assess the continued efficacy of modafinil and obtain additional safety data, an 8-week, open-label study was conducted as an extension to the double-blind study. METHOD Two hundred and twenty children and young adolescents (age range, 6-14 years) with ADHD who had completed 4 weeks of the double-blind period or had withdrawn for reasons other than an adverse event were enrolled. Patients received individually titrated doses of modafinil (100-400 mg), administered once daily or as a divided dose. Patients visited the clinic at open-label weeks 2, 4, and 8 for assessments of efficacy. Efficacy was assessed using the parent- or clinician-completed ADHD Rating Scale-IV (ADHD-RS-IV) Home Version, the parent-completed Conners' ADHD/DSM-IV Scale Parent Version (CADS-P), and the clinician-rated Clinical Global Impression of Improvement (CGI-I) scale. Adverse events were monitored. RESULTS Modafinil improved symptoms on all ADHD rating scales and subscales during the open-label extension. Mean change (baseline to final visit) in Total score on the ADHD-RS-IV was -14.6 (95% CI: -16.40 to -12.70); and -7.6 (95% CI: -8.65 to -6.62) and -6.9 (95% CI: -7.90 to -5.94) in the Inattention and Hyperactivity-impulsivity scores, respectively. The mean Total score [SD] on the CADS-P decreased from baseline (74.4 [10.3]) to the final visit (63.2 [13.1]) (change: -11.2, 95% CI: -13.08 to -9.65). Fifty-three percent of patients were rated as much or very much improved on the CGI-I. Insomnia (13%) and headache (10%) were the most common adverse events. No clinically meaningful changes were observed in physical examination findings, electrocardiography, blood pressure, pulse, or body temperature. Clinically significant changes (increase or decrease) in body weight of 7% or more were observed for 30 patients (14%), with decreases (mean, 3.2 kg) reported for 22 patients (10%) and increases (mean, 3.7 kg) reported for eight patients (4%). CONCLUSION Modafinil remained efficacious and well tolerated in children with ADHD, improving ADHD symptoms and overall clinical condition during the open-label study. Limitations of the study include open-label dosing and lack of a placebo control.
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Dickstein SG, Bannon K, Castellanos FX, Milham MP. The neural correlates of attention deficit hyperactivity disorder: an ALE meta-analysis. J Child Psychol Psychiatry 2006; 47:1051-62. [PMID: 17073984 DOI: 10.1111/j.1469-7610.2006.01671.x] [Citation(s) in RCA: 471] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Attention deficit/hyperactivity disorder (ADHD) is one of the most prevalent and commonly studied forms of psychopathology in children and adolescents. Causal models of ADHD have long implicated dysfunction in fronto-striatal and frontal-parietal networks supporting executive function, a hypothesis that can now be examined systematically using functional neuroimaging. The present work provides an objective, unbiased statistically-based meta-analysis of published functional neuroimaging studies of ADHD. METHODS A recently developed voxel-wise quantitative meta-analytic technique known as activation likelihood estimation (ALE) was applied to 16 neuroimaging studies examining and contrasting patterns of neural activity in patients with ADHD and healthy controls. Voxel-wise results are reported using a statistical threshold of p < .05, corrected. Given the large number of studies examining response inhibition, additional meta-analyses focusing specifically on group differences in the neural correlates of inhibition were included. RESULTS Across studies, significant patterns of frontal hypoactivity were detected in patients with ADHD, affecting anterior cingulate, dorsolateral prefrontal, and inferior prefrontal cortices, as well as related regions including basal ganglia, thalamus, and portions of parietal cortex. When focusing on studies of response inhibition alone, a more limited set of group differences were observed, including inferior prefrontal cortex, medial wall regions, and the precentral gyrus. In contrast, analyses focusing on studies of constructs other than response inhibition revealed a more extensive pattern of hypofunction in patients with ADHD than those of response inhibition. CONCLUSIONS To date, the most consistent findings in the neuroimaging literature of ADHD are deficits in neural activity within fronto-striatal and fronto-parietal circuits. The distributed nature of these results fails to support models emphasizing dysfunction in any one frontal sub-region. While our findings are suggestive of the primacy of deficits in frontal-based neural circuitry underlying ADHD, we discuss potential biases in the literature that need to be addressed before such a conclusion can be fully embraced.
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Halperin JM, Schulz KP. Revisiting the role of the prefrontal cortex in the pathophysiology of attention-deficit/hyperactivity disorder. Psychol Bull 2006; 132:560-81. [PMID: 16822167 DOI: 10.1037/0033-2909.132.4.560] [Citation(s) in RCA: 287] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Most neural models for the pathophysiology of attention-deficit/hyperactivity disorder (ADHD) have centered on the prefrontal cortex and its interconnections with the striatum and other subcortical structures. However, research only partially supports these models, and they do not correspond with the development of the prefrontal cortex and its interrelated neurocircuitry. The neural and functional development of the prefrontal cortex more closely parallels recovery from ADHD as indicated by the developmental remission of symptomatology. The authors hypothesize that ADHD is due to noncortical dysfunction that manifests early in ontogeny, remains static throughout the lifetime, and is not associated with the remission of symptomatology. Data supporting this neurodevelopmental model of prefrontal cortex function in ADHD are reviewed. Research and treatment implications are discussed.
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Affiliation(s)
- Jeffrey M Halperin
- Department of Psychology, Queens College of the City University of New York, Flushing, NY 11367, USA.
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Mitterschiffthaler MT, Ettinger U, Mehta MA, Mataix-Cols D, Williams SCR. Applications of functional magnetic resonance imaging in psychiatry. J Magn Reson Imaging 2006; 23:851-61. [PMID: 16652410 DOI: 10.1002/jmri.20590] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
While the use of MRI techniques has become a cornerstone of the neurology clinic, the application of such methods in psychiatry was rather limited until the advent of functional magnetic resonance imaging (fMRI). Over the past decade fMRI has superseded radionuclide-imaging techniques and blossomed into a widely used psychiatric research tool. This review focuses on the neurobiological findings from fMRI research in three less well-documented psychiatric disorders: attention deficit hyperactivity disorder (ADHD), depression, and obsessive-compulsive disorder (OCD). Although there was some disparity in early findings, greater standardization of image acquisition, analysis, and paradigms, and improved clinical classification are leading to a greater convergence of observations from different laboratories. fMRI is also beginning to realize its potential as an important mediator between genes and phenotypes, and may thus contribute to a better understanding of the pathophysiology of major neuropsychiatric diseases. The role of fMRI in the objective assessment of therapeutic intervention and early prediction of response to treatment is also discussed.
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Affiliation(s)
- Martina T Mitterschiffthaler
- Centre for Neuroimaging Sciences, Department of Clinical Neuroscience, Institute of Psychiatry, King's College London, London, UK
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