ADHD: what have we learned from neuroimaging?

Author/s
Katya Rubia
Citation
Issue 2 Spring 2012
CEPiP.2012.1.16-21
Abstract

The last two decades of modern imaging techniques applied to research into attention deficit hyperactivity disorder (ADHD) have substantially expanded our knowledge of the underlying neural substrates of this condition and have shed light on the mechanism of action of the most common treatment of the disorder, stimulant medication. Studies have shown that ADHD is a multisystem disorder affecting several late developing fronto-cortical and fronto-subcortical pathways that mediate mature adult behaviour and cognition. Psychostimulants appear to modulate brain catecholamines and to have a normalising impact on some of the brain deficits in ADHD. The challenge lies in finding avenues to use neuroimaging techniques in clinical practice to aid diagnosis, treatment and prediction of response to treatment of ADHD.

Keywords: ADHD, fMRI, MRI, methylphenidate, psychostimulant medication, frontal lobes, basal ganglia, cerebellum, parieto-temporal regions

Cite as: Cutting Edge Psychiatry in Practice 2012, 2(1):16-21; https://doi.org/10.65031/qnen6841

References

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Association. AP, editor. Washington, DC.1994.    
  2. Biederman J, Mick E, Faraone SV. Age-dependent decline of symptoms of attention deficit hyperactivity disorder: impact of remission definition and symptom type. Am J Psychiatry2000 May;157(5):816-8. https://doi.org/10.1176/appi.ajp.157.5.816
  3. Polanczyk G, de Lima MS, Horta BL, Biederman J, Rohde LA. The worldwide prevalence of ADHD: A systematic review and metaregression analysis. American Journal of Psychiatry2007;164(6):942-8. https://doi.org/10.1176/ajp.2007.164.6.942
  4. Biederman J, Monuteaux MC, Mick E, Spencer T, Wilens TE, Silva JM, et al. Young adult outcome of attention deficit hyperactivity disorder: a controlled 10-year follow-up study. Psychol Med2006 Feb;36(2):167-79. https://doi.org/10.1017/s0033291705006410
  5. Packwood S, Hodgetts HM, Tremblay S. A multiperspective approach to the conceptualization of executive functions. Journal of Clinical and Experimental Neuropsychology2011;33(4):456-70. https://doi.org/10.1080/13803395.2010.533157
  6. Sowell ER, Thompson PM, Toga AW. Mapping changes in the human cortex throughout the span of life. Neuroscientist 2004 Aug;10(4):372-92. https://doi.org/10.1177/1073858404263960
  7. Luna B, Padmanabhan A, O’Hearn K. What has fMRI told us about the development of cognitive control through adolescence? Brain Cogn 2010;72(1):101-13. https://doi.org/10.1016/j.bandc.2009.08.005
  8. Rubia K. “Cool” inferior fronto-striatal dysfunction in Attention Deficit Hyperactivity Disorder (ADHD) versus “hot” ventromedial orbitofronto-limbic dysfunction in conduct disorder: a review. Biological Psychiatry2011;69:e69-e87. https://doi.org/10.1016/j.biopsych.2010.09.023
  9. Valera EM, Faraone SV, Murray KE, Seidman LJ. Meta-analysis of structural imaging findings in attention-deficit/ hyperactivity disorder. Biological Psychiatry 2007;61(12):1361-9. https://doi.org/10.1016/j.biopsych.2006.06.011
  10. Ellison-Wright I, Ellison-Wright Z, Bullmore E. Structural brain change in Attention Deficit Hyperactivity Disorder identified by meta-analysis. BMC Psychiatry 2008;8:51. https://doi.org/10.1186/1471-244x-8-51
  11. Nakao T, Radua C, Rubia K, Mataix-Cols D. Gray matter volume abnormalities in ADHD and the effects of stimulant medication: Voxel-based meta-analysis. American Journal of Psychiatry 2011;in press. https://doi.org/10.1176/appi.ajp.2011.11020281
  12. Castellanos FX, Lee PP, Sharp W, Jeffries NO, Greenstein DK, Clasen LS, et al. Developmental trajectories of brain volume abnormalities in children and adolescents with attention-deficit/hyperactivity disorder. Journal of the American Medical Association 2002 Oct 9;288(14):1740-8. https://doi.org/10.1001/jama.288.14.1740
  13. Shaw P, Eckstrand K, Sharp W, Blumenthal J, Lerch JP, Greenstein D, et al. Attention-deficit/hyperactivity disorder is characterized by a delay in cortical maturation. Proceedings of the National Academy of Sciences of the United States of America 2007 Dec 4;104(49):19649-54. https://doi.org/10.1073/pnas.0707741104
  14. Konrad K, Eickhoff SB. Is the ADHD Brain Wired Differently? A Review on Structural and Functional Connectivity in Attention Deficit Hyperactivity Disorder. Human Brain Mapping 2010;31(6):904-16. https://doi.org/10.1002/hbm.21058
  15. Cubillo A, R H, Smith A, V G, E T, Rubia K. Fronto-cortical and fronto-subcortical brain abnormalities in children and adults with ADHD: a review and evidence for fronto-striatal dysfunctions in adults with ADHD followed up from childhood during motivation and attention. Cortex 2011;in press. https://doi.org/10.1016/j.cortex.2011.04.007
  16. Cubillo A, Rubia K. Structural and functional brain imaging in adult Attention Deficit Hyperactivity Disorder (ADHD): a review. Expert Rev Neurother2010;10(4 ):603-20. https://doi.org/10.1586/ern.10.4
  17. Krause J. SPECT and PET of the dopamine transporter in attention-deficit/hyperactivity disorder. Expert Review of Neurotherapeutics2008;8(4):611-25. https://doi.org/10.1586/14737175.8.4.611
  18. Fusar-Poli P, Rubia K, Rossi G, Sartori G, Ballotin U. Dopamine transporter alterations in ADHD: pathophysiology or adaptation to psychostimulants? a meta-analysis, Am J Psychiatry 2011, under revision . https://doi.org/10.1176/appi.ajp.2011.11060940
  19. Shaw P, Sharp WS, Morrison M, Eckstrand K, Greenstein DK, Clasen LS, et al. Psychostimulant treatment and the developing cortex in attention deficit hyperactivity disorder. Am J Psychiatry2009 Jan;166(1):58-63. https://doi.org/10.1176/appi.ajp.2008.08050781
  20. Bledsoe J, Semrud-Clikeman M, Pliszka SR. A magnetic resonance imaging study of the cerebellar vermis in chronically treated and treatment-naive children with attention-deficit/hyperactivity disorder combined type. Biol Psychiatry2009 Apr 1;65(7):620-4. https://doi.org/10.1016/j.biopsych.2008.11.030
  21. Pliszka SR, Lancaster J, Liotti M, Semrud-Clikeman M. Volumetric MRI differences in treatment-naive vs chronically treated children with ADHD. Neurology2006 Sep 26;67(6):1023-7. https://doi.org/10.1212/01.wnl.0000237385.84037.3c
  22. Bush G, Spencer TJ, Holmes J, Shin LM, Valera EM, Seidman LJ, et al. Functional magnetic resonance imaging of methylphenidate and placebo in attention-deficit/hyperactivity disorder during the multi-source interference task. Arch Gen Psychiatry2008 Jan;65(1):102-14. https://doi.org/10.1001/archgenpsychiatry.2007.16
  23. Rubia K, Halari R, Christakou A, Taylor E. Impulsiveness as a timing disturbance: neurocognitive abnormalities in attention- deficit hyperactivity disorder during temporal processes and normalization with methylphenidate. Philos Trans R Soc Lond B Biol Sci2009 Jul 12;364(1525):1919-31. https://doi.org/10.1098/rstb.2009.0014
  24. Rubia K, Halari R, Cubillo A, Mohammad M, Taylor E. Methylphenidate normalises activation and functional connectivity deficits in attention and motivation networks in medication-naïve children with ADHD during a Rewarded Continuous Performance Task. Neuropharmacology 2009;57:640-52. https://doi.org/10.1016/j.neuropharm.2009.08.013
  25. Rubia K, Halari R, Cubillo A, Smith A, Mohammad M, Brammer M, et al. Methylphenidate normalises fronto-striatal underactivation during interference inhibition in medication-naive boys Neuropsychopharmacology 2011;in press. https://doi.org/10.1038/npp.2011.30
  26. Rubia K, Halari R, Taylor E, Brammer M. Methylphenidate normalises fronto-cingulate underactivation during error processing in children with Attention-Deficit Hyperactivity Disorder. Biol Psychiatry 2011;in press. https://doi.org/10.1016/j.biopsych.2011.04.018