RESUMEN
OBJECTIVES: A high incidence of attention-deficit hyperactivity disorder (ADHD) has been reported in chronic pain (ChP) patients. Furthermore, an association between ChP and muscular dysregulation has been reported in adults with ADHD. The present study investigated whether ADHD was more prevalent among psychiatric outpatients with ChP than those without ChP, and if there was an association between ChP, muscular dysregulation and characteristics of pain in patients with ADHD. METHODS: One-hundred and twenty-one individuals remitted to an outpatient psychiatry unit took part in this naturalistic epidemiological cross-sectional study. They were assessed with a pain self-report form (localization, intensity, and onset) and a test of muscle dysregulation (the Motor Function Neurological Assessment). Prevalence of ADHD among patients with ChP, as well as the qualitative characteristics of ChP within the ADHDgroup are reported. Both ChP and pain intensity correlated with muscular dysregulation through Spearman's rho analysis. Additionally, the relationship between various diagnostic categories (ADHD, affective disorders, anxiety, or personality disorders) and incidence of axial pain was evaluated in logistic regression. RESULTS: ADHD was significantly more prevalent in patients with ChP, than in patients without ChP. In the ADHD group, ChP and pain intensity was associated with muscular dysregulation, particularly with high muscle tone. ChP was more axial and widespread, than for the patients without ADHD, and started at an early age. ADHD diagnosis predicted axial pain, whereas affective-, anxiety-, or personality disorders did not. CONCLUSIONS: The study suggests that ChP in ADHD is associated with muscular dysregulation and is qualitatively different from ChP in psychiatric patients without ADHD. These findings may lead to further understanding of potential mechanisms involved in ADHD and ChP, and in turn to new treatment strategies for both disorders.
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Trastorno por Déficit de Atención con Hiperactividad , Dolor Crónico , Humanos , Trastorno por Déficit de Atención con Hiperactividad/fisiopatología , Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Dolor Crónico/fisiopatología , Dolor Crónico/epidemiología , Masculino , Femenino , Estudios Transversales , Adulto , Persona de Mediana Edad , Prevalencia , Dimensión del Dolor , Adulto JovenRESUMEN
OBJECTIVE: Diagnostic assessment of ADHD is challenging due to comorbid psychopathologies and symptoms overlapping with other psychiatric disorders. In this study, we investigate if a distinct pattern of neuromuscular dysregulation previously reported in ADHD, can help identifying ADHD in psychiatric patients with diverse and complex symptoms. METHOD: We explored the impact of neuromuscular dysregulation, as measured by The Motor Function Neurologic Assessment (MFNU), on the likelihood of being diagnosed with ADHD, affective disorder, anxiety disorder, or personality disorder among adults (n = 115) referred to a psychiatric outpatient clinic. RESULTS: Logistic regression revealed that neuromuscular dysregulation was significantly associated with ADHD diagnosis only (OR 1.15, p < .01), and not with affective-, anxiety-, or personality disorders. Sensitivity and specificity for ADHD at different MFNU scores is provided. CONCLUSIONS: A test of neuromuscular dysregulation may promote diagnostic accuracy in differentiating ADHD from other psychiatric disorders in patients with an overlapping symptom picture. This may have important implications for clinical practice. More studies are needed.
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Trastorno por Déficit de Atención con Hiperactividad , Humanos , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Trastorno por Déficit de Atención con Hiperactividad/fisiopatología , Masculino , Femenino , Adulto , Trastornos de Ansiedad/diagnóstico , Trastornos de la Personalidad/diagnóstico , Trastornos del Humor/diagnóstico , Examen Neurológico , Sensibilidad y Especificidad , Persona de Mediana Edad , Diagnóstico Diferencial , Enfermedades Neuromusculares/diagnóstico , Enfermedades Neuromusculares/fisiopatología , Adulto JovenRESUMEN
There is emerging evidence that the endocannabinoid system (ECS) plays a significant role in the pathophysiology of many psychiatric disorders, including attention deficit hyperactivity disorder (ADHD). Increasing evidence suggests that a number of neurobiological correlates between endogenous cannabinoid function and cognitive dysfunction are seen in ADHD, making the ECS a possible target for therapeutic interventions. Cannabis use and cannabis use disorder are more prevalent in individuals with ADHD, compared to the general population, and there is growing popular perception that cannabis is therapeutic for ADHD. However, the relationship between cannabis use and ADHD symptomology is poorly understood. Further understanding of the role of the ECS in ADHD pathophysiology and the molecular alterations that may be a target for treatment is needed. To further the science on this emerging area of research, this scoping review describes the preclinical and clinical evidence seeking to understand the relationship between the ECS and ADHD.
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Trastorno por Déficit de Atención con Hiperactividad , Endocannabinoides , Trastorno por Déficit de Atención con Hiperactividad/fisiopatología , Trastorno por Déficit de Atención con Hiperactividad/metabolismo , Humanos , Endocannabinoides/metabolismo , Animales , Abuso de Marihuana/fisiopatología , Abuso de Marihuana/metabolismo , Uso de la Marihuana/metabolismoRESUMEN
Both cortical and cerebellar developmental differences have been implicated in attention-deficit/hyperactivity disorder (ADHD). Recently accumulating neuroimaging studies have highlighted hierarchies as a fundamental principle of brain organization, suggesting the importance of assessing hierarchy abnormalities in ADHD. A novel gradient-based resting-state functional connectivity analysis was applied to investigate the cerebro-cerebellar disturbed hierarchy in children and adolescents with ADHD. We found that the interaction of functional gradient between diagnosis and age was concentrated in default mode network (DMN) and visual network (VN). At the same time, we also found that the opposite gradient changes of DMN and VN caused the compression of the cortical main gradient in ADHD patients, implicating the co-occurrence of both low- (visual processing) and high-order (self-related thought) cognitive dysfunction manifesting in abnormal cerebro-cerebellar organizational hierarchy in ADHD. Our study provides a neurobiological framework to better understand the co-occurrence and interaction of both low-level and high-level functional abnormalities in the cortex and cerebellum in ADHD.
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Trastorno por Déficit de Atención con Hiperactividad , Cerebelo , Corteza Cerebral , Conectoma , Imagen por Resonancia Magnética , Red Nerviosa , Humanos , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico por imagen , Trastorno por Déficit de Atención con Hiperactividad/fisiopatología , Adolescente , Niño , Masculino , Cerebelo/diagnóstico por imagen , Cerebelo/fisiopatología , Femenino , Corteza Cerebral/diagnóstico por imagen , Corteza Cerebral/fisiopatología , Red Nerviosa/diagnóstico por imagen , Red Nerviosa/fisiopatología , Red en Modo Predeterminado/diagnóstico por imagen , Red en Modo Predeterminado/fisiopatologíaRESUMEN
Attention-deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with lifelong impairments. ADHD-related behaviors have been observed as early as toddlerhood for children who later develop ADHD. Children with ADHD have disrupted connectivity in neural circuitry involved in executive control of attention, including the prefrontal cortex (PFC) and dorsal attention network (DAN). It is not known if these alterations in connectivity can be identified before the onset of ADHD. Children (N = 51) 1.5-3 years old were assessed using functional near-infrared spectroscopy while engaging with a book. The relation between mother-reported ADHD-related behaviors and neural connectivity, computed using robust innovation-based correlation, was examined. Task engagement was high across the sample and unrelated to ADHD-related behaviors. Observed attention was associated with greater connectivity between the right lateral PFC and the right temporal parietal junction (TPJ). Children with greater ADHD-related behaviors had greater frontoparietal connectivity, particularly between the PFC bilaterally and the right TPJ. Toddlers at risk for developing ADHD may require increased frontoparietal connectivity to sustain attention. Future work is needed to examine early interventions that enhance developing attention and their effect on neural connectivity between the PFC and attention networks.
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Trastorno por Déficit de Atención con Hiperactividad , Atención , Lóbulo Parietal , Corteza Prefrontal , Espectroscopía Infrarroja Corta , Humanos , Femenino , Masculino , Trastorno por Déficit de Atención con Hiperactividad/fisiopatología , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico por imagen , Lóbulo Parietal/fisiopatología , Lóbulo Parietal/diagnóstico por imagen , Preescolar , Lactante , Atención/fisiología , Corteza Prefrontal/fisiopatología , Corteza Prefrontal/diagnóstico por imagen , Función Ejecutiva/fisiología , Red Nerviosa/fisiopatología , Red Nerviosa/diagnóstico por imagen , Conducta Infantil/fisiologíaRESUMEN
BACKGROUND: Sex differences in the symptomatology of adults with attention-deficit/hyperactivity disorder (ADHD) have often been overlooked when studying behavioral abnormalities. However, it is known that women exhibit considerably more stronger symptoms related to emotional competence than men. Since affective functions significantly influence the processing of risky decision-making and risk-engagement, we assume that risky behavior in ADHD is affected by sex differences. Therefore, we specifically investigated sex-specific effects on the interaction between emotionally induced changes in physiology and behavioral performance on a decision-making task. METHODS: Skin conductance responses of twenty-nine adults with ADHD (n = 16 male; n = 13 female) and thirty-three adults in the control group (n = 14 male; n = 19 female) were recorded during the performance in a modified version of the Balloon Analogue Risk Task (BART). Additional questionnaires were used to reveal insights in the self-assessment of emotional competence, risk perception, and feedback sensitivity. Emotional arousal and decision-making behavior were analyzed using linear mixed-effects models. RESULTS: Results showed different effects of sex on risk behaviors in controls and ADHD. In contrast to healthy controls, female adults with ADHD showed a significantly greater risk engagement in the BART compared to males with ADHD. This contrary sex relation was not observed in skin conductance responses and revealed a significantly different sex-dependent correlation of body response and behavioral task performance in ADHD. Comparisons with results from self-assessments furthermore indicate a reduced behavioral self-perception in women with ADHD, but not in men. CONCLUSION: In summary, we found an altered interaction between physiological activity and risky behavior in women with ADHD. Thus, the present study indicates a reduced sensitivity towards the own bodily responses in women with ADHD, which could consequently cause increased risky DM behavior in daily life. The current results suggest that more consideration needs to be given to sex-specific effects on physiological processes and behavior in adults with ADHD.
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Trastorno por Déficit de Atención con Hiperactividad , Toma de Decisiones , Respuesta Galvánica de la Piel , Asunción de Riesgos , Humanos , Femenino , Masculino , Trastorno por Déficit de Atención con Hiperactividad/fisiopatología , Trastorno por Déficit de Atención con Hiperactividad/psicología , Adulto , Toma de Decisiones/fisiología , Respuesta Galvánica de la Piel/fisiología , Factores Sexuales , Emociones/fisiología , Adulto Joven , Caracteres SexualesRESUMEN
Reinforcement sensitivity is a hypothesized attention-deficit/hyperactivity disorder (ADHD) intermediate phenotype but its role in transgenerational transmission of ADHD-linked psychopathology risk is largely unknown. We examined, in a carefully phenotyped, N = 123 sample of adolescents (Mage = 15.27 years, SD = 0.984; 61.78% boys), whether (1) parental psychopathology is differentially associated with fMRI-indexed neural response to reward receipt and (2) both maternal and paternal psychopathology are associated with neural response to reward; across adolescents at-risk for and not at-risk for ADHD. Indices of parental psychopathology were differentially associated with adolescent offspring neural response to reward such that across measures, parental psychopathology was negatively or not associated with offspring superior frontal gyrus (SFG) response to reward receipt in adolescents at-risk for ADHD, but parental psychopathology was positively associated with offspring SFG response in adolescents not at-risk. Further, across measures, greater maternal psychopathology was associated with blunted adolescent SFG response to reward in adolescents at-risk for ADHD whereas greater maternal externalizing problems were linked to enhanced adolescent SFG response in adolescents not at-risk. Across measures, paternal psychopathology was not associated with adolescent response to reward, in either group. ADHD risk confers differential reward-related susceptibility to the effects of parental psychopathology. Results also show this association is nonspecific in terms of parental psychopathology type but is specific to maternal psychopathology.
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Trastorno por Déficit de Atención con Hiperactividad , Hijo de Padres Discapacitados , Imagen por Resonancia Magnética , Recompensa , Humanos , Trastorno por Déficit de Atención con Hiperactividad/fisiopatología , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico por imagen , Adolescente , Femenino , Masculino , Hijo de Padres Discapacitados/estadística & datos numéricos , MadresRESUMEN
Evidence suggests aerobic exercise has beneficial effects on cognitive performance in adults with attention-deficit hyperactivity disorder (ADHD). The underlying mechanisms might depend on mechanisms of exercise-mediated brain physiology. The study aims to investigate the effects of acute aerobic exercise on cortical excitability and cognitive performance, and the correlation between these phenomena in adults with ADHD. Twenty-six drug-naïve ADHD adults, and twenty-six age-, and gender-matched healthy controls were assessed with respect to cortical excitability and cognitive performance before and after acute aerobic exercise (a single session for 30 min) or a control intervention. The results show significantly enhanced intracortical facilitation (ICF) and decreased short intracortical inhibition (SICI) after aerobic exercise in healthy subjects. In contrast, SICI was significantly enhanced following acute aerobic exercise in ADHD. In ADHD, furthermore inhibitory control and motor learning were significantly improved after the acute aerobic exercise intervention. Alterations of SICI induced by aerobic exercise, and inhibitory control and motor learning improvement were significantly positively correlated in the ADHD group. Aerobic exercise had partially antagonistic effects in healthy controls, and ADHD patients. Furthermore, aerobic exercise-induced cognition-enhancing effects in ADHD depend on specific alterations of brain physiology, which differ from healthy humans.
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Trastorno por Déficit de Atención con Hiperactividad , Cognición , Ejercicio Físico , Estimulación Magnética Transcraneal , Humanos , Trastorno por Déficit de Atención con Hiperactividad/fisiopatología , Trastorno por Déficit de Atención con Hiperactividad/rehabilitación , Trastorno por Déficit de Atención con Hiperactividad/terapia , Masculino , Femenino , Ejercicio Físico/fisiología , Adulto , Adulto Joven , Cognición/fisiología , Potenciales Evocados Motores/fisiología , Excitabilidad Cortical/fisiología , ElectromiografíaRESUMEN
Early intervention is imperative for young children with attention-deficit/hyperactivity disorder (ADHD) who manifest heterogeneous neurocognitive deficits. The study investigated the functional connectivity and complexity of brain activity among young children with ADHD exhibiting a fast cognitive processing speed (ADHD-F, n = 26), with ADHD exhibiting a slow cognitive processing speed (ADHD-S, n = 17), and typically developing children (n = 35) using wireless electroencephalography (EEG) during rest and task conditions. During rest, compared with the typically developing group, the ADHD-F group displayed lower long-range intra-hemispheric connectivity, while the ADHD-S group had lower frontal beta inter-hemispheric connectivity. During task performance, the ADHD-S group displayed lower frontal beta inter-hemispheric connectivity than the typically developing group. The ADHD-S group had lower frontal inter-hemispheric connectivity in broader frequency bands than the ADHD-F group, indicating ADHD heterogeneity in mental processing speed. Regarding complexity, the ADHD-S group tended to show lower frontal entropy estimators than the typically developing group during the task condition. These findings suggest that the EEG profile of brain connectivity and complexity can aid the early clinical diagnosis of ADHD, support subgrouping young children with ADHD based on cognitive processing speed heterogeneity, and may contain specific novel neural biomarkers for early intervention planning.
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Trastorno por Déficit de Atención con Hiperactividad , Electroencefalografía , Humanos , Trastorno por Déficit de Atención con Hiperactividad/fisiopatología , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico por imagen , Masculino , Femenino , Niño , Preescolar , Encéfalo/fisiopatología , Encéfalo/diagnóstico por imagen , Cognición/fisiología , Conectoma , Velocidad de ProcesamientoRESUMEN
Epilepsy is one of the most common neurological disorders in children. Diagnosing epilepsy in children can be very challenging, especially as it often coexists with neurodevelopmental conditions like autism and ADHD. Functional brain networks obtained from neuroimaging and electrophysiological data in wakefulness and sleep have been shown to contain signatures of neurological disorders, and can potentially support the diagnosis and management of co-occurring neurodevelopmental conditions. In this work, we use electroencephalography (EEG) recordings from children, in restful wakefulness and sleep, to extract functional connectivity networks in different frequency bands. We explore the relationship of these networks with epilepsy diagnosis and with measures of neurodevelopmental traits, obtained from questionnaires used as screening tools for autism and ADHD. We explore differences in network markers between children with and without epilepsy in wake and sleep, and quantify the correlation between such markers and measures of neurodevelopmental traits. Our findings highlight the importance of considering the interplay between epilepsy and neurodevelopmental traits when exploring network markers of epilepsy.
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Encéfalo , Electroencefalografía , Epilepsia , Trastornos del Neurodesarrollo , Sueño , Vigilia , Humanos , Epilepsia/fisiopatología , Niño , Sueño/fisiología , Masculino , Encéfalo/fisiopatología , Encéfalo/diagnóstico por imagen , Femenino , Vigilia/fisiología , Trastornos del Neurodesarrollo/fisiopatología , Adolescente , Red Nerviosa/fisiopatología , Preescolar , Trastorno por Déficit de Atención con Hiperactividad/fisiopatologíaRESUMEN
Children with attention-deficit hyperactivity disorder (ADHD) have difficulties in social interactions. Studying brain activity during social interactions is difficult with conventional artificial stimuli. This pioneering study examined the neural correlates of social perception in children with ADHD and matched controls using naturalistic stimuli. We presented 20 children with ADHD and 20 age-and-sex-matched controls with tailored movies featuring high- or low-level social interactions while recording electroencephalographic signals. Both groups exhibited synchronized gamma-band oscillations, but controls demonstrated greater inter-subject correlations. Additionally, the difference in inter-subject correlations between high- and low-interaction movies was significantly larger in controls compared to ADHD patients. Between 55 and 75 Hz comparing viewing high interaction movies with low interaction moves, controls had a significantly larger weighting in the right parietal lobe, while ADHD patients had a significantly smaller weighting in the left occipital lobe. These findings reveal distinct spatiotemporal neural signatures in social interaction processing among children with ADHD and controls using naturalistic stimuli. These neural markers offer potential for group differentiation and assessing intervention efficacy, advancing our understanding ADHD-related social interaction mechanisms.
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Trastorno por Déficit de Atención con Hiperactividad , Electroencefalografía , Interacción Social , Humanos , Trastorno por Déficit de Atención con Hiperactividad/fisiopatología , Trastorno por Déficit de Atención con Hiperactividad/psicología , Masculino , Niño , Femenino , Biomarcadores , Ritmo Gamma/fisiología , Estudios de Casos y Controles , Encéfalo/fisiopatología , AdolescenteRESUMEN
BACKGROUND: Attention-Deficit/Hyperactivity Disorder (ADHD) is a multifaceted neurodevelopmental psychiatric condition that typically emerges during childhood but often persists into adulthood, significantly impacting individuals' functioning, relationships, productivity, and overall quality of life. However, the current diagnostic process exhibits limitations that can significantly affect its overall effectiveness. Notably, its face-to-face and time-consuming nature, coupled with the reliance on subjective recall of historical information and clinician subjectivity, stand out as key challenges. To address these limitations, objective measures such as neuropsychological evaluations, imaging techniques and physiological monitoring of the Autonomic Nervous System functioning, have been explored. METHODS: The main aim of this study was to investigate whether physiological data (i.e., Electrodermal Activity, Heart Rate Variability, and Skin Temperature) can serve as meaningful indicators of ADHD, evaluating its utility in distinguishing adult ADHD patients. This observational, case-control study included a total of 76 adult participants (32 ADHD patients and 44 healthy controls) who underwent a series of Stroop tests, while their physiological data was passively collected using a multi-sensor wearable device. Univariate feature analysis was employed to identify the tests that triggered significant signal responses, while the Informative k-Nearest Neighbors (KNN) algorithm was used to filter out less informative data points. Finally, a machine-learning decision pipeline incorporating various classification algorithms, including Logistic Regression, KNN, Random Forests, and Support Vector Machines (SVM), was utilized for ADHD patient detection. RESULTS: Results indicate that the SVM-based model yielded the optimal performance, achieving 81.6% accuracy, maintaining a balance between the experimental and control groups, with sensitivity and specificity of 81.4% and 81.9%, respectively. Additionally, integration of data from all physiological signals yielded the best results, suggesting that each modality captures unique aspects of ADHD. CONCLUSIONS: This study underscores the potential of physiological signals as valuable diagnostic indicators of adult ADHD. For the first time, to the best of our knowledge, our findings demonstrate that multimodal physiological data collected via wearable devices can complement traditional diagnostic approaches. Further research is warranted to explore the clinical applications and long-term implications of utilizing physiological markers in ADHD diagnosis and management.
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Trastorno por Déficit de Atención con Hiperactividad , Respuesta Galvánica de la Piel , Aprendizaje Automático , Humanos , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Trastorno por Déficit de Atención con Hiperactividad/fisiopatología , Femenino , Masculino , Adulto , Estudios de Casos y Controles , Respuesta Galvánica de la Piel/fisiología , Frecuencia Cardíaca/fisiología , Máquina de Vectores de Soporte , Dispositivos Electrónicos Vestibles , Test de Stroop , Adulto Joven , Sensibilidad y EspecificidadRESUMEN
For a long time, clinical knowledge and first-person reports have pointed to individual differences in the dynamics of spontaneous thoughts, in particular in the extreme case of psychiatric conditions (e.g. racing thoughts in Attention Deficit / Hyperactivity Disorder, ADHD; rumination in depression). We used a novel procedure to investigate this individual variability by combining verbal fluency tasks and introspective reports of thought content. Our goal was twofold. First, we tested the hypothesis that a greater segmentation of the stream of thoughts would be associated with trait inattention, in line with subjective reports of ADHD patients. Second, we tested whether the segmentation of the stream of thoughts increased with an increased tendency for exploratory behavior, following recent theoretical claims on the mechanisms underpinning the generation of spontaneous thoughts. Our results support both hypotheses, shedding light on the factors contributing to the individual variability in the dynamics of the stream of thought.
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Atención , Pensamiento , Humanos , Masculino , Pensamiento/fisiología , Femenino , Adulto , Atención/fisiología , Adulto Joven , Conducta Exploratoria/fisiología , Individualidad , Adolescente , Trastorno por Déficit de Atención con Hiperactividad/fisiopatologíaRESUMEN
Stimulants represent the first line pharmacological treatment for attention-deficit/hyperactivity disorder (ADHD) and are among the most prescribed psychopharmacological treatments. Their mechanism of action at synaptic level has been extensively studied. However, it is less clear how their mechanism of action determines clinically observed benefits. To help bridge this gap, we provide a comprehensive review of stimulant effects, with an emphasis on nuclear medicine and magnetic resonance imaging (MRI) findings. There is evidence that stimulant-induced modulation of dopamine and norepinephrine neurotransmission optimizes engagement of task-related brain networks, increases perceived saliency, and reduces interference from the default mode network. An acute administration of stimulants may reduce brain alterations observed in untreated individuals in fronto-striato-parieto-cerebellar networks during tasks or at rest. Potential effects of prolonged treatment remain controversial. Overall, neuroimaging has fostered understanding on stimulant mechanism of action. However, studies are often limited by small samples, short or no follow-up, and methodological heterogeneity. Future studies should address age-related and longer-term effects, potential differences among stimulants, and predictors of treatment response.
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Trastorno por Déficit de Atención con Hiperactividad , Encéfalo , Estimulantes del Sistema Nervioso Central , Red Nerviosa , Humanos , Trastorno por Déficit de Atención con Hiperactividad/tratamiento farmacológico , Trastorno por Déficit de Atención con Hiperactividad/fisiopatología , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico por imagen , Estimulantes del Sistema Nervioso Central/farmacología , Encéfalo/efectos de los fármacos , Encéfalo/diagnóstico por imagen , Encéfalo/metabolismo , Encéfalo/fisiopatología , Red Nerviosa/efectos de los fármacos , Red Nerviosa/diagnóstico por imagen , Red Nerviosa/fisiopatología , Neuronas/efectos de los fármacosRESUMEN
BACKGROUND: Youth with attention-deficit/hyperactivity disorder (ADHD) exhibit increased effort aversion, likely due to deficits in anticipatory dopamine firing. Previous research has shown that transcranial direct current stimulation (tDCS) targeting the right prefrontal cortex can enhance activity in dopaminergic meso-striatal regions. However, the extent to which this specific tDCS configuration effectively modulates effort behavior in anticipation of rewards in ADHD remains uncertain. HYPOTHESIS: We expected an increase of effort maintenance and invigoration during and following our tDCS set-up compared to sham in subjects with ADHD. METHODS: Twenty-four children and adolescents with ADHD (mean age: 11.6 years; 95 % CI [10.7, 12.4]) received 2 mA and sham tDCS for 20 min each. The anode was positioned over the ventromedial prefrontal cortex (PFC), while the cathode was placed over the right dorsolateral PFC, generating an electrical field with maximal strength in the right PFC. During and after the tDCS sessions, participants performed a button-pressing task aimed at earning delayed monetary rewards. Primary outcomes were effort maintenance (frequency of button presses) and invigoration (slopes of button presses), measuring motor task performance. RESULTS: We observed a significant increase in effort maintenance both during (b = 2.66; p < 0.001) and after tDCS (b = 2.04; p= .007) compared to sham. No significant difference was found for invigoration during stimulation, while after bonferroni correction (p = 0.025) a non-significant decrease was found after tDCS compared to sham (b = -5.18; p = 0.041). CONCLUSION: tDCS targeting the ventromedial PFC (anodal) and right dorsolateral PFC (cathodal) increases effort maintenance in children and adolescents with ADHD.
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Trastorno por Déficit de Atención con Hiperactividad , Corteza Prefrontal , Estimulación Transcraneal de Corriente Directa , Humanos , Estimulación Transcraneal de Corriente Directa/métodos , Trastorno por Déficit de Atención con Hiperactividad/terapia , Trastorno por Déficit de Atención con Hiperactividad/fisiopatología , Masculino , Femenino , Niño , Adolescente , Corteza Prefrontal/fisiología , Corteza Prefrontal/fisiopatología , Recompensa , Desempeño Psicomotor/fisiologíaRESUMEN
Attention-deficit/hyperactivity disorder (ADHD) is among the most prevalent, inheritable, and heterogeneous childhood-onset neurodevelopmental disorders. Children with a hereditary background of ADHD have heightened risk of having ADHD and persistent impairment symptoms into adulthood. These facts suggest distinct familial-specific neuropathological substrates in ADHD that may exist in anatomical components subserving attention and cognitive control processing pathways during development. The objective of this study is to investigate the topological properties of the gray matter (GM) structural brain networks in children with familial ADHD (ADHD-F), non-familial ADHD (ADHD-NF), as well as matched controls. A total of 452 participants were involved, including 132, 165 and 155 in groups of ADHD-F, ADHD-NF and typically developed children, respectively. The GM structural brain network was constructed for each group using graph theoretical techniques with cortical and subcortical structures as nodes and correlations between volume of each pair of the nodes within each group as edges, while controlled for confounding factors using regression analysis. Relative to controls, children in both ADHD-F and ADHD-NF groups showed significantly higher nodal global and nodal local efficiencies in the left caudal middle frontal gyrus. Compared to controls and ADHD-NF, children with ADHD-F showed distinct structural network topological patterns associated with right precuneus (significantly higher nodal global efficiency and significantly higher nodal strength), left paracentral gyrus (significantly higher nodal strength and trend toward significantly higher nodal local efficiency) and left putamen (significantly higher nodal global efficiency and trend toward significantly higher nodal local efficiency). Our results for the first time in the field provide evidence of familial-specific structural brain network alterations in ADHD, that may contribute to distinct clinical/behavioral symptomology and developmental trajectories in children with ADHD-F.
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Trastorno por Déficit de Atención con Hiperactividad , Encéfalo , Sustancia Gris , Imagen por Resonancia Magnética , Humanos , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico por imagen , Trastorno por Déficit de Atención con Hiperactividad/fisiopatología , Trastorno por Déficit de Atención con Hiperactividad/patología , Niño , Masculino , Femenino , Encéfalo/diagnóstico por imagen , Encéfalo/patología , Imagen por Resonancia Magnética/métodos , Sustancia Gris/patología , Sustancia Gris/diagnóstico por imagen , Red Nerviosa/diagnóstico por imagen , Red Nerviosa/fisiopatología , Red Nerviosa/patología , Adolescente , Vías Nerviosas/fisiopatología , Vías Nerviosas/diagnóstico por imagen , Mapeo Encefálico/métodosRESUMEN
Impulsivity is a broad construct that often refers to one of several distinct behaviors and can be measured with self-report questionnaires and behavioral paradigms. Several psychiatric conditions are characterized by one or more forms of impulsive behavior, most notably the impulsive/hyperactive subtype of attention-deficit/hyperactivity disorder (ADHD), mood disorders, and substance use disorders. Monoaminergic neurotransmitters are known to mediate impulsive behaviors and are implicated in various psychiatric conditions. However, growing evidence suggests that glutamate, the major excitatory neurotransmitter of the mammalian brain, regulates important functions that become dysregulated in conditions like ADHD. The purpose of the current review is to discuss clinical and preclinical evidence linking glutamate to separate aspects of impulsivity, specifically motor impulsivity, impulsive choice, and affective impulsivity. Hyperactive glutamatergic activity in the corticostriatal and the cerebro-cerebellar pathways are major determinants of motor impulsivity. Conversely, hypoactive glutamatergic activity in frontal cortical areas and hippocampus and hyperactive glutamatergic activity in anterior cingulate cortex and nucleus accumbens mediate impulsive choice. Affective impulsivity is controlled by similar glutamatergic dysfunction observed for motor impulsivity, except a hyperactive limbic system is also involved. Loss of glutamate homeostasis in prefrontal and nucleus accumbens may contribute to motor impulsivity/affective impulsivity and impulsive choice, respectively. These results are important as they can lead to novel treatments for those with a condition characterized by increased impulsivity that are resistant to conventional treatments.
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Ácido Glutámico , Conducta Impulsiva , Humanos , Conducta Impulsiva/fisiología , Animales , Ácido Glutámico/metabolismo , Encéfalo/metabolismo , Trastorno por Déficit de Atención con Hiperactividad/metabolismo , Trastorno por Déficit de Atención con Hiperactividad/fisiopatología , Trastorno por Déficit de Atención con Hiperactividad/psicologíaRESUMEN
BACKGROUND: Home-based transcranial direct current stimulation (Hb-tDCS) is a non-invasive brain stimulation technique that utilizes low-intensity electric currents delivered via scalp electrodes to modulate brain activity. It holds significant promise for addressing inattention in adults with attention-deficit/hyperactivity disorder (ADHD). However, its effectiveness varies among individuals, and predicting outcomes remains uncertain, partially due to the influence of individual differences in ADHD-related brain anatomy. METHODS: We analyzed data from a subsample, composed by twenty-nine adult patients with ADHD, of the Treatment of Inattention Symptoms in Adult Patients with ADHD (TUNED) trial. Fourteen patients underwent active anodal right cathodal left dorsolateral prefrontal cortex (DLPFC) Hb-tDCS for 4 weeks and fifteen received sham-related tDCS intervention. Inattention outcome was evaluated at both baseline and endpoint (4th week). Baseline structural measures of the DLPFC, anterior cingulate cortex (ACC) and subcortical structures, previously associated with ADHD, were quantified. Several linear mixed models, with a three-way interaction between the fixed predictors brain volume or thickness, time, and treatment were calculated. Multiple comparison corrections were applied using the Benjamini-Hochberg method. RESULTS: Baseline volume of the left DLPFC regions middle frontal gyrus (t (25) = 3.33, p-adjusted = 0.045, Cohen's d = 1.33, 95% CI = [0.45, 2.19]), inferior frontal gyrus (orbital part) (t (25) = 3.10, p-adjusted = 0.045, Cohen's d = 1.24, 95% CI = [0.37, 2.08]), and of the left ACC supragenual (t (25) = 3.15, p-adjusted = 0.045, Cohen's d = 1.26, 95% CI = [0.39, 2.11]) presented significant association with the inattentive score improvement only in the active tDCS group. More specifically, the smaller these regions were, the more the symptoms improved following anodal right cathodal left DLPFC Hb-tDCS. CONCLUSION: Hb-tDCS was associated with greater improvement in brain areas related to attention regulation. Brain MRI can be potentially used to predict clinical response to tDCS in ADHD adults.
Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad , Imagen por Resonancia Magnética , Estimulación Transcraneal de Corriente Directa , Humanos , Trastorno por Déficit de Atención con Hiperactividad/terapia , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico por imagen , Trastorno por Déficit de Atención con Hiperactividad/fisiopatología , Trastorno por Déficit de Atención con Hiperactividad/patología , Masculino , Femenino , Adulto , Adulto Joven , Encéfalo/diagnóstico por imagen , Encéfalo/fisiopatología , Giro del Cíngulo/diagnóstico por imagen , Giro del Cíngulo/fisiopatología , Corteza Prefontal Dorsolateral/fisiología , Corteza Prefontal Dorsolateral/diagnóstico por imagenRESUMEN
BACKGROUND: In attention-deficit/hyperactivity disorder (ADHD), poor inhibitory control is one of the main characteristics, with oculomotor inhibition impairments being considered a potential biomarker of the disorder. While auditory white noise has demonstrated the ability to enhance working memory in this group, visual white noise is still unexplored and so are the effects of both types of white noise stimulation on oculomotor inhibition. OBJECTIVE: This crossover study aims to explore the impact of auditory and visual white noise on oculomotor inhibition in children with ADHD and typically developing (TD) children. The study will investigate the impact of different noise levels (25% and 50% visual, 78 dB auditory), and performance will be evaluated both with and without noise stimulation. We hypothesize that exposure to white noise will improve performance in children with ADHD and impair the performance for TD children. METHODS: Memory-guided saccades and prolonged fixations, known for their sensitivity in detecting oculomotor disinhibition in ADHD, will be used to assess performance. Children diagnosed with ADHD, withdrawing from medication for 24 hours, and TD children without psychiatric disorders were recruited for the study. RESULTS: Data collection was initiated in October 2023 and ended in February 2024. A total of 97 participants were enrolled, and the first results are expected between September and November 2024. CONCLUSIONS: This study will examine whether cross-modal sensory stimulation can enhance executive function, specifically eye movement control, in children with ADHD. In addition, the study will explore potential differences between auditory and visual noise effects in both groups. Our goal is to identify implications for understanding how noise can be used to improve cognitive performance. TRIAL REGISTRATION: ClinicalTrials.gov NCT06057441; https://clinicaltrials.gov/study/NCT06057441. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/56388.
Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad , Estudios Cruzados , Ruido , Humanos , Niño , Trastorno por Déficit de Atención con Hiperactividad/fisiopatología , Ruido/efectos adversos , Femenino , Masculino , Estimulación Acústica , Adolescente , Movimientos Oculares/fisiologíaRESUMEN
To investigate changes in brain network organization and possible neurobehavioral similarities to attention-deficit hyperactivity disorder (ADHD), we measured changes in brain resting-state functional connectivity (rs-fMRI) and cognitive domains in patients with resistance to thyroid hormone ß (RTHß) and compared them with those in healthy control subjects. In this prospective case-control study, twenty-one participants with genetically confirmed RTHß were matched with 21 healthy controls. The Adult ADHD Self-Report Scale (ASRS-v1.1) and ADHD Rating Scale-IV were used to assess self-reported symptoms of ADHD. A voxel-wise and atlas-based approach was used to identify changes in the brain networks. The RTHß group reported behavioral symptoms similar to those of ADHD. We found evidence of weaker network integration of the lingual and fusiform gyri in the RTHß group, which was mainly driven by weaker connectivity to the bilateral insula and supplementary motor cortex. Functional connectivity between regions of the default mode network (angular gyrus/middle temporal gyrus) and regions of the cognitive control network (bilateral middle frontal gyrus) was increased in RTHß patients compared to healthy controls. Increased connectivity between regions of the default mode network and the dorsolateral prefrontal cortex is frequently reported in ADHD and is interpreted to be associated with deficits in attention. Our finding of weaker connectivity of the lingual gyrus to the bilateral insula (salience network) in RTHß patients has also been reported previously in ADHD and may reflect decreased habituation to visual stimuli and increased distractibility. Overall, our observations support the notion of neuropsychological similarities between RTHß and ADHD.