Changes of brain structure and function in ADHD children

Examining Narcissistic Traits in Relation To Reactive and Proactive Aggression in Children At-Risk for Attention Deficit/Hyperactivity Disorder

The current study examined narcissistic traits in relation to proactive and reactive functions of aggression in a sample of children at-risk for attention-deficit/hyperactivity disorder (ADHD). Children ages 7-13 years (N = 110) were recruited from a pediatric ADHD assessment clinic. Caregivers completed the Antisocial Process Screening Device. Caregivers and teachers completed a measure of proactive and reactive aggression. In regression analyses controlling for ADHD and oppositional defiant disorder symptom severity and sex, narcissism was uniquely associated with higher caregiver-reported proactive aggression but not reactive aggression. Findings suggest that narcissism is uniquely related to proactive aggression in children at-risk for ADHD. Consideration of narcissistic traits may aid the prediction of behavioral issues and aggression in children and may be a potential intervention target. Future research should investigate if clinical interventions addressing narcissistic behaviors are effective for reducing proactive aggression in children.

White Matter Microstructural Abnormalities in Children with Familial vs. Non-Familial Attention-Deficit/Hyperactivity Disorder (ADHD)

Background: Attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent, heterogeneous neurodevelopmental disorder. Methods: This study presents, for the first time, a comprehensive investigation of white matter microstructural differences between familial ADHD (ADHD-F) and non-familial ADHD (ADHD-NF) using advanced diffusion tensor imaging analyses in a large community-based sample. Results: Children with ADHD-F exhibited significantly greater volume in the right anterior thalamic radiations and the left inferior fronto-occipital fasciculus compared to controls, and greater volume in the left inferior longitudinal fasciculus relative to ADHD-NF. The ADHD-NF group showed reduced fractional anisotropy in the left inferior longitudinal fasciculus compared to the controls. In both the ADHD-F and ADHD-NF groups, a greater volume of anterior thalamic radiation significantly contributed to reduced ADHD symptoms. Conclusions: Our findings suggest that white matter microstructural alterations along the frontal-thalamic pathways may play a critical role in hereditary factors among children with ADHD-F and significantly contribute to elevated inattentive and hyperactive/impulsive behaviors in the affected children.

Knowledge Distillation Guided Interpretable Brain Subgraph Neural Networks for Brain Disorder Exploration

The human brain is a highly complex neurological system that has been the subject of continuous exploration by scientists. With the help of modern neuroimaging techniques, there has been significant progress made in brain disorder analysis. There is an increasing interest about utilizing artificial intelligence techniques to improve the efficiency of disorder diagnosis in recent years. However, these methods rely only on neuroimaging data for disorder diagnosis and do not explore the pathogenic mechanism behind the disorder or provide an interpretable result toward the diagnosis decision. Furthermore, the scarcity of medical data limits the performance of existing methods. As the hot application of graph neural networks (GNNs) in molecular graphs and drug discovery due to its strong graph-structured data learning ability, whether GNNs can also play a huge role in the field of brain disorder analysis. Thus, in this work, we innovatively model brain neuroimaging data into graph-structured data and propose knowledge distillation (KD) guided brain subgraph neural networks to extract discriminative subgraphs between patient and healthy brain graphs to explain which brain regions and abnormal functional connectivities cause the disorder. Specifically, we introduce the KD technique to transfer the knowledge of pretrained teacher model to guide brain subgraph neural networks training and alleviate the problem of insufficient training data. And these discriminative subgraphs are conducive to learn better brain graph-level representations for disorder prediction. We conduct abundant experiments on two functional magnetic resonance imaging datasets, i.e., Parkinson's disease (PD) and attention-deficit/hyperactivity disorder (ADHD), and experimental results well demonstrate the superiority of our method over other brain graph analysis methods for disorder prediction accuracy. The interpretable experimental results given by our method are consistent with corresponding medical research, which is encouraging to provide a potential for deeper brain disorder study.

Neurobiology of attention-deficit hyperactivity disorder: historical challenges and emerging frontiers

Extensive investigations spanning multiple levels of inquiry, from genetic to behavioural studies, have sought to unravel the mechanistic foundations of attention-deficit hyperactivity disorder (ADHD), with the aspiration of developing efficacious treatments for this condition. Despite these efforts, the pathogenesis of ADHD remains elusive. In this Review, we reflect on what has been learned about ADHD while also providing a framework that may serve as a roadmap for future investigations. We emphasize that ADHD is a highly heterogeneous disorder with multiple aetiologies that necessitates a multifactorial dimensional phenotype, rather than a fixed dichotomous conceptualization. We highlight new findings that suggest a more brain-wide, 'global' view of the disorder, rather than the traditional localizationist framework, which asserts that a limited set of brain regions or networks underlie ADHD. Last, we underscore how underpowered studies that have aimed to associate neurobiology with ADHD phenotypes have long precluded the field from making progress. However, a new age of ADHD research with refined phenotypes, advanced methods, creative study designs and adequately powered investigations is beginning to put the field on a good footing. Indeed, the field is at a promising juncture to advance the neurobiological understanding of ADHD and fulfil the promise of clinical utility.

Functional imaging derived ADHD biotypes based on deep clustering: a study on personalized medication therapy guidance

Background

Attention deficit hyperactivity disorder (ADHD) is one prevalent neurodevelopmental disorder with childhood onset, however, there is no clear correspondence established between clinical ADHD subtypes and primary medications. Identifying objective and reliable neuroimaging markers for categorizing ADHD biotypes may lead to more individualized, biotype-guided treatment.

Methods

Here we proposed a graph convolution network for biological subtype detection (GCN-BSD) using both functional network connectivity (FNC) and non-imaging phenotypic data for ADHD biotype. We applied GCN-BSD to ADHD patients from the ABCD study as the discovery dataset and a validation ADHD dataset with longitudinal medication treatment from Peking University Sixth Hospital.

Findings

We identified two biotypes based on 1069 ADHD patients selected from Adolescent Brain and Cognitive Development (ABCD) study, which were validated on independent ADHD adolescents undergoing longitudinal medication treatment (n = 130). Interestingly, in addition to differences in cognitive performance and hyperactivity/impulsivity symptoms, biotype 1 demonstrated a significantly better recovery rate in psychosomatic problems score (p < 0.05, baseline symptom score adjusted) when treated with methylphenidate than with atomoxetine.

Interpretation

Our results suggested that such an imaging-driven, biotype-guided approaches hold promise for facilitating personalized treatment of ADHD and exploring possible boundaries through innovative deep learning algorithms to improve medication treatment effectiveness.

Funding

Science and Technology Innovation 2030 Major Projects, the National Natural Science Foundation of China, the Startup Funds for Talents at Beijing Normal University, China Postdoctoral Science Foundation, and the National Institutes of Health.

Distinct structural brain network properties in children with familial versus non-familial attention-deficit/hyperactivity disorder (ADHD)

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.

Abnormal brain activation during speech perception and production in children and adults with reading difficulty

Reading difficulty (RD) is associated with phonological deficits; however, it remains unknown whether the phonological deficits are different in children and adults with RD as reflected in foreign speech perception and production. In the current study, using functional Near-infrared spectroscopy (fNIRS), we found less difference between Chinese adults and Chinese children in the RD groups than the control groups in the activation of the right inferior frontal gyrus (IFG) and the dorsolateral prefrontal cortex (DLPFC) during Spanish speech perception, suggesting slowed development in these regions associated with RD. Furthermore, using multivariate pattern analysis (MVPA), we found that activation patterns in the left middle temporal gyrus (MTG), premotor, supplementary motor area (SMA), and IFG could serve as reliable markers of RD. We provide both behavioral and neurological evidence for impaired speech perception and production in RD readers which can serve as markers of RD.

Optogenetic Inhibition of Rat Anterior Cingulate Cortex Impairs the Ability to Initiate and Stay on Task

Our prior research has identified neural correlates of cognitive control in the anterior cingulate cortex (ACC), leading us to hypothesize that the ACC is necessary for increasing attention as rats flexibly learn new contingencies during a complex reward-guided decision-making task. Here, we tested this hypothesis by using optogenetics to transiently inhibit the ACC, while rats of either sex performed the same two-choice task. ACC inhibition had a profound impact on behavior that extended beyond deficits in attention during learning when expected outcomes were uncertain. We found that ACC inactivation slowed and reduced the number of trials rats initiated and impaired both their accuracy and their ability to complete sessions. Furthermore, drift-diffusion model analysis suggested that free-choice performance and evidence accumulation (i.e., reduced drift rates) were degraded during initial learning-leading to weaker associations that were more easily overridden in later trial blocks (i.e., stronger bias). Together, these results suggest that in addition to attention-related functions, the ACC contributes to the ability to initiate trials and generally stay on task.

Dmd mdx mice have defective oligodendrogenesis, delayed myelin compaction and persistent hypomyelination

Duchenne muscular dystrophy (DMD) is caused by mutations in the DMD gene, resulting in the loss of dystrophin, a large cytosolic protein that links the cytoskeleton to extracellular matrix receptors in skeletal muscle. Aside from progressive muscle damage, many patients with DMD also have neurological deficits of unknown etiology. To investigate potential mechanisms for DMD neurological deficits, we assessed postnatal oligodendrogenesis and myelination in the Dmdmdx mouse model. In the ventricular-subventricular zone (V-SVZ) stem cell niche, we found that oligodendrocyte progenitor cell (OPC) production was deficient, with reduced OPC densities and proliferation, despite a normal stem cell niche organization. In the Dmdmdx corpus callosum, a large white matter tract adjacent to the V-SVZ, we also observed reduced OPC proliferation and fewer oligodendrocytes. Transmission electron microscopy further revealed significantly thinner myelin, an increased number of abnormal myelin structures and delayed myelin compaction, with hypomyelination persisting into adulthood. Our findings reveal alterations in oligodendrocyte development and myelination that support the hypothesis that changes in diffusion tensor imaging seen in patients with DMD reflect developmental changes in myelin architecture.

Cumulative Effects of Resting-State Connectivity Across All Brain Networks Significantly Correlate with Attention-Deficit Hyperactivity Disorder Symptoms

Identification of replicable neuroimaging correlates of attention-deficit hyperactivity disorder (ADHD) has been hindered by small sample sizes, small effects, and heterogeneity of methods. Given evidence that ADHD is associated with alterations in widely distributed brain networks and the small effects of individual brain features, a whole-brain perspective focusing on cumulative effects is warranted. The use of large, multisite samples is crucial for improving reproducibility and clinical utility of brain-wide MRI association studies. To address this, a polyneuro risk score (PNRS) representing cumulative, brain-wide, ADHD-associated resting-state functional connectivity was constructed and validated using data from the Adolescent Brain Cognitive Development (ABCD, N = 5,543, 51.5% female) study, and was further tested in the independent Oregon-ADHD-1000 case-control cohort (N = 553, 37.4% female). The ADHD PNRS was significantly associated with ADHD symptoms in both cohorts after accounting for relevant covariates (p < 0.001). The most predictive PNRS involved all brain networks, though the strongest effects were concentrated among the default mode and cingulo-opercular networks. In the longitudinal Oregon-ADHD-1000, non-ADHD youth had significantly lower PNRS (Cohen's d = -0.318, robust p = 5.5 × 10-4) than those with persistent ADHD (age 7-19). The PNRS, however, did not mediate polygenic risk for ADHD. Brain-wide connectivity was robustly associated with ADHD symptoms in two independent cohorts, providing further evidence of widespread dysconnectivity in ADHD. Evaluation in enriched samples demonstrates the promise of the PNRS approach for improving reproducibility in neuroimaging studies and unraveling the complex relationships between brain connectivity and behavioral disorders.

Common and distinct cortical thickness alterations in youth with autism spectrum disorder and attention-deficit/hyperactivity disorder

BACKGROUND

Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are neurodevelopmental disorders with overlapping behavioral features and genetic etiology. While brain cortical thickness (CTh) alterations have been reported in ASD and ADHD separately, the degree to which ASD and ADHD are associated with common and distinct patterns of CTh changes is unclear.

METHODS

We searched PubMed, Web of Science, Embase, and Science Direct from inception to 8 December 2023 and included studies of cortical thickness comparing youth (age less than 18) with ASD or ADHD with typically developing controls (TDC). We conducted a comparative meta-analysis of vertex-based studies to identify common and distinct CTh alterations in ASD and ADHD.

RESULTS

Twelve ASD datasets involving 458 individuals with ASD and 10 ADHD datasets involving 383 individuals with ADHD were included in the analysis. Compared to TDC, ASD showed increased CTh in bilateral superior frontal gyrus, left middle temporal gyrus, and right superior parietal lobule (SPL) and decreased CTh in right temporoparietal junction (TPJ). ADHD showed decreased CTh in bilateral precentral gyri, right postcentral gyrus, and right TPJ relative to TDC. Conjunction analysis showed both disorders shared reduced TPJ CTh located in default mode network (DMN). Comparative analyses indicated ASD had greater CTh in right SPL and TPJ located in dorsal attention network and thinner CTh in right TPJ located in ventral attention network than ADHD.

CONCLUSIONS

These results suggest shared thinner TPJ located in DMN is an overlapping neurobiological feature of ASD and ADHD. This alteration together with SPL alterations might be related to altered biological motion processing in ASD, while abnormalities in sensorimotor systems may contribute to behavioral control problems in ADHD. The disorder-specific thinner TPJ located in disparate attention networks provides novel insight into distinct symptoms of attentional deficits associated with the two neurodevelopmental disorders.

TRIAL REGISTRATION

PROSPERO CRD42022370620. Registered on November 9, 2022.

BH4 as a Therapeutic Target for ADHD: Relevance to Neurotransmitters and Stress-Driven Symptoms

Tetrahydrobiopterin (BH4) is a critical cofactor in a variety of metabolic pathways that have been linked to ADHD. There have been no previous studies utilizing BH4 as a supplement for ADHD. BH4 has been approved as a treatment for phenylketonuria (PKU). Individuals with PKU and ADHD appear to have low DA levels in common, suggesting that the hypodopaminergic state seen in both illnesses could be a relationship between the two. Clinical research involving supplementation of BH4 has shown low occurrence of adverse. In experiments, BH4 has also been found to have good blood-brain barrier permeability. BH4 also has the ability in scavenging ROS activity, which is an implication of stress and is seen in ADHD. BH4's significance in ADHD is reviewed in this paper because of its involvement in numerous neurodevelopmental metabolic pathways, and we anticipate that exogenous BH4 can be used to treat ADHD.

Correlation of Cognitive Reappraisal and the Microstructural Properties of the Forceps Minor: A Deductive Exploratory Diffusion Tensor Imaging Study

Cognitive reappraisal (CR) is a mechanism for emotion regulation, and the prefrontal cortex (PFC) plays a central role in the regulation of emotions. We tested the hypothesis of an association between CR function and microstructural properties of forceps minor (a commissural bundle within the PFC) in healthy subjects (HS). We analyzed a population of 65 young HS of a public dataset. The diffusion tensor imaging (DTI) sequence of every subject was analyzed to extract the derived shape (diameter and volume) and DTI metrics in terms of fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) of the forceps minor. The CR subscale of the German version of the Emotion Regulation Questionnaire (ERQ) was used for CR assessment. The Shapiro-Wilk test was applied to test the assumption of normality in all these parameters, adopting a statistical threshold at p < 0.05. Whenever appropriate a non-parametric two-tailed partial correlation analysis was applied to test for correlations between the CR ERQ score and the derived shape and DTI metrics, including age and sex as confounders, adopting a statistical threshold at p < 0.05. The non-parametric two-tailed partial correlation analysis revealed a mildly significant correlation with FA (ρ = 0.303; p = 0.016), a weakly significant negative correlation with MD (ρ = - 0.269; p = 0.033), and a mildly significant negative correlation with RD (ρ = - 0.305; p = 0.015). These findings suggest a correlation between DTI microstructural properties of forceps minor and CR.

Characteristics of white matter structural connectivity in healthy adults with childhood maltreatment

Background: Childhood maltreatment (CM) is a common psychological stressor associated with multiple mental disorders. While CM is associated with vulnerability to depression and anxiety, little is known about the specific mechanism underlying this relationship.Objective: This study aimed to investigate the white matter (WM) of healthy adults with CM and their relationships with depression and anxiety to provide biological evidence for the development of mental disorders in subjects with childhood trauma.Methods: The CM group included 40 healthy adults with CM. The non-CM group included 40 healthy adults without CM. Diffusion tensor imaging (DTI) data were collected, and tract-based spatial statistics (TBSS) were applied to the whole brain to assess WM differences between the two groups; post-hoc fibre tractography was used to characterise the developmental differences; and mediation analysis was used to assess the relationships among the Child Trauma Questionnaire (CTQ) results, DTI indices, and depression and anxiety scores.Results: Relative to the non-CM group, the CM group revealed significantly lower fractional anisotropy (FA) in the right posterior corona radiata (PCR-R), right anterior corona radiata (ACR-R), left super corona radiata (SCR-L), anterior thalamic radiation (ATR), and right posterior limb of the internal capsule (PLIC-R). Additionally, shorter fibre bundles passed through the PCR-R, ACR-R, and ATR in the CM group compared with the non-CM group. Besides, the length of the ACR-R mediated the relationship between CM and trait anxiety.Conclusions: The alteration of white matter microstructure associated with childhood trauma in healthy adults may reflect biomarkers of childhood trauma. Besides, an alteration of WM microstructure in healthy adults with CM mediates the association between CM and trait anxiety, which may represent the vulnerability to developing mental disorders after childhood trauma experiences.

Resting-State Functional MRI and PET Imaging as Noninvasive Tools to Study (Ab)Normal Neurodevelopment in Humans and Rodents

Neurodevelopmental disorders (NDDs) are a group of complex neurologic and psychiatric disorders. Functional and molecular imaging techniques, such as resting-state functional magnetic resonance imaging (rs-fMRI) and positron emission tomography (PET), can be used to measure network activity noninvasively and longitudinally during maturation in both humans and rodent models. Here, we review the current knowledge on rs-fMRI and PET biomarkers in the study of normal and abnormal neurodevelopment, including intellectual disability (ID; with/without epilepsy), autism spectrum disorder (ASD), and attention deficit hyperactivity disorder (ADHD), in humans and rodent models from birth until adulthood, and evaluate the cross-species translational value of the imaging biomarkers. To date, only a few isolated studies have used rs-fMRI or PET to study (abnormal) neurodevelopment in rodents during infancy, the critical period of neurodevelopment. Further work to explore the feasibility of performing functional imaging studies in infant rodent models is essential, as rs-fMRI and PET imaging in transgenic rodent models of NDDs are powerful techniques for studying disease pathogenesis, developing noninvasive preclinical imaging biomarkers of neurodevelopmental dysfunction, and evaluating treatment-response in disease-specific models.

Anatomical connectivity in children with developmental dyscalculia: A graph theory study

Current theories postulate that numerical processing depends upon a brain circuit formed by regions and their connections; specialized in the representation and manipulation of the numerical properties of stimuli. It has been suggested that the damage of these network may cause Developmental Dyscalculia (DD): a persistent neurodevelopmental disorder that significantly interferes with academic performance and daily life activities that require mastery of mathematical notions and operations. However, most of the studies on the brain foundations of DD have focused on regions of interest associated with numerical processing, and have not addressed numerical cognition as a complex network phenomenon. The present study explored DD using a Graph Theory network approach. We studied the association between topological measures of integration and segregation of information processing in the brain proposed by Graph Theory; and individual variability in numerical performance in a group of 11 school-aged children with DD (5 of which presented with comorbidity with Developmental Dyslexia, the specific learning disorder for reading) and 17 typically developing peers. A statistically significant correlation was found between the Weber fraction (a measure of numerical representations' precision) and the Clustering Index (a measure of segregation of information processing) in the whole sample. The DD group showed significantly lower Characteristic Path Length (average shortest path length among all pairs of regions in the brain network) compared to controls. Also, differences in critical regions for the brain network performance (hubs) were found between groups. The presence of limbic hubs characterized the DD brain network while right Temporal and Frontal hubs found in controls were absent in the DD group. Our results suggest that the DD may be associated with alterations in anatomical brain connectivity that hinder the capacity to integrate and segregate numerical information.

Atypical Associations between Functional Connectivity during Pragmatic and Semantic Language Processing and Cognitive Abilities in Children with Autism

Autism Spectrum Disorder (ASD) is characterized by both atypical functional brain connectivity and cognitive challenges across multiple cognitive domains. The relationship between task-dependent brain connectivity and cognitive abilities, however, remains poorly understood. In this study, children with ASD and their typically developing (TD) peers engaged in semantic and pragmatic language tasks while their task-dependent brain connectivity was mapped and compared. A multivariate statistical approach revealed associations between connectivity and psychometric assessments of relevant cognitive abilities. While both groups exhibited brain-behavior correlations, the nature of these associations diverged, particularly in the directionality of overall correlations across various psychometric categories. Specifically, greater disparities in functional connectivity between the groups were linked to larger differences in Autism Questionnaire, BRIEF, MSCS, and SRS-2 scores but smaller differences in WASI, pragmatic language, and Theory of Mind scores. Our findings suggest that children with ASD utilize distinct neural communication patterns for language processing. Although networks recruited by children with ASD may appear less efficient than those typically engaged, they could serve as compensatory mechanisms for potential disruptions in conventional brain networks.

White matter alterations in Attention-Deficit/Hyperactivity Disorder (ADHD): a systematic review of 129 diffusion imaging studies with meta-analysis

Aberrant anatomical brain connections in attention-deficit/hyperactivity disorder (ADHD) are reported inconsistently across diffusion weighted imaging (DWI) studies. Based on a pre-registered protocol (Prospero: CRD42021259192), we searched PubMed, Ovid, and Web of Knowledge until 26/03/2022 to conduct a systematic review of DWI studies. We performed a quality assessment based on imaging acquisition, preprocessing, and analysis. Using signed differential mapping, we meta-analyzed a subset of the retrieved studies amenable to quantitative evidence synthesis, i.e., tract-based spatial statistics (TBSS) studies, in individuals of any age and, separately, in children, adults, and high-quality datasets. Finally, we conducted meta-regressions to test the effect of age, sex, and medication-naïvety. We included 129 studies (6739 ADHD participants and 6476 controls), of which 25 TBSS studies provided peak coordinates for case-control differences in fractional anisotropy (FA)(32 datasets) and 18 in mean diffusivity (MD)(23 datasets). The systematic review highlighted white matter alterations (especially reduced FA) in projection, commissural and association pathways of individuals with ADHD, which were associated with symptom severity and cognitive deficits. The meta-analysis showed a consistent reduced FA in the splenium and body of the corpus callosum, extending to the cingulum. Lower FA was related to older age, and case-control differences did not survive in the pediatric meta-analysis. About 68% of studies were of low quality, mainly due to acquisitions with non-isotropic voxels or lack of motion correction; and the sensitivity analysis in high-quality datasets yielded no significant results. Findings suggest prominent alterations in posterior interhemispheric connections subserving cognitive and motor functions affected in ADHD, although these might be influenced by non-optimal acquisition parameters/preprocessing. Absence of findings in children may be related to the late development of callosal fibers, which may enhance case-control differences in adulthood. Clinicodemographic and methodological differences were major barriers to consistency and comparability among studies, and should be addressed in future investigations.

Two neurosubtypes of ADHD different from the clinical phenotypes

Clinical and etiological variability of attention deficit hyperactivity disorder (ADHD) presents an obstacle to understand the disorder. The aim of this study was to disentangle the heterogeneity of ADHD using neuroimaging and a semi-supervised machine learning algorithm. We collected brain structural and functional magnetic resonance imaging (MRI) data and clinical profiles of 183 children with ADHD and 396 neurotypical controls from 7 independent sites. We also used an external validation set with 750 subjects. We adopted a semi-supervised clustering method to subtype ADHD by regional volumetric measures of gray matter, white matter, and fractional amplitude of low frequency fluctuation (fALFF). In addition, split sample test, leave-one-site-out test and external validation were applied to evaluate the reproducibility and stability of ADHD subtypes. Two stable and reproducible neurosubtypes of ADHD were disclosed, which were proved by the split-sample test and leave-one-site-out validation. The structural and functional patterns of ADHD subtypes were also stable in the external validation set. The current two neurosubtypes differed in clinical manifestations and volumetric gray matter, white matter volume and fALFF patterns. The current neurosubtypes of ADHD which were different from clinical phenotypes could facilitate understanding the underlying neuropathological and neurobiological mechanism of the disorder.

White matter microstructure and connectivity changes after surgery in male adults with obstructive sleep apnea: recovery or reorganization?

Study objectives

Obstructive sleep apnea (OSA) is a prevalent clinical problem significantly affecting cognitive functions. Surgical treatment is recommended for those unable to use continuous positive airway pressure. We aimed to investigate the therapeutic effect of upper airway surgery on the white matter (WM) microstructure and brain connectivity in patients with OSA.

Methods

Twenty-one male patients with moderate-to-severe OSA were recruited for multi-level upper airway surgery. Overnight polysomnography (PSG), neuropsychiatric tests, and brain MRI scans were acquired before and 6.1 ± 0.8 months after surgery. Nineteen male patients with untreated OSA were also included as a reference group. We calculated the longitudinal changes of diffusion tensor imaging (DTI) parameters, including fractional anisotropy (ΔFA) and mean/axial/radial diffusivity (ΔMD/AD/RD). We also assessed changes in network properties based on graph theory.

Results

Surgically treated patients showed improvement in PSG parameters and verbal memory after surgery. Globally, ΔFA was significantly higher and ΔRD was lower in the surgery group than in the untreated group. Especially ΔFA of the tracts involved in the limbic system was higher after surgery. In network analysis, higher Δbetweenness and lower Δclustering coefficients were observed in the surgical group than in the untreated group. Finally, the improvement of verbal memory after surgery positively correlated with ΔFA in superior thalamic radiation (p = 0.021), fronto aslant tracts (p = 0.027), and forceps minor tracts (p = 0.032).

Conclusion

Surgical treatment of OSA can alleviate alterations in WM integrity and disruptions in local networks, particularly for the tracts involved in the limbic system. These findings may further explain the cognitive improvement observed after the treatment of OSA.

Methylphenidate as a treatment option for substance use disorder: a transdiagnostic perspective

A transition in viewing mental disorders from conditions defined as a set of unique characteristics to one of the quantitative variations on a collection of dimensions allows overlap between disorders. The overlap can be utilized to extend to treatment approaches. Here, we consider the overlap between attention-deficit/hyperactivity disorder and substance use disorder to probe the suitability to use methylphenidate as a treatment for substance use disorder. Both disorders are characterized by maladaptive goal-directed behavior, impaired cognitive control, hyperactive phasic dopaminergic neurotransmission in the striatum, prefrontal hypoactivation, and reduced frontal cortex gray matter volume/density. In addition, methylphenidate has been shown to improve cognitive control and normalize associated brain activation in substance use disorder patients and clinical trials have found methylphenidate to improve clinical outcomes. Despite the theoretical basis and promising, but preliminary, outcomes, many questions remain unanswered. Most prominent is whether all patients who are addicted to different substances may equally profit from methylphenidate treatment.

Lack of functional brain connectivity was associated with poor inhibition in children with attention-deficit/hyperactivity disorder using near-infrared spectroscopy

Objectives

The present study aimed to evaluate the characteristics of functional brain connectivity in the resting state in children with attention deficit hyperactivity disorder (ADHD) and to assess the association between the connectivity and inhibition function using near-infrared spectroscopy (NIRS).

Methods

In total, 34 children aged 6-13 diagnosed with ADHD were recruited from Hangzhou Seventh People's Hospital. In comparison, 37 healthy children were recruited from a local primary school as controls matched by age and sex. We used NIRS to collect information on brain images. The Stroop test assessed inhibition function. We compared the differences in functional brain connectivity in two groups by analyzing the resting-state brain network. Pearson partial correlation analysis was applied to evaluate the correlation between functional brain connectivity and inhibition in all the children.

Results

Compared with the control group, results of NIRS images analysis showed that children with ADHD had significantly low functional brain connectivity in regions of the orbitofrontal cortex, left dorsolateral prefrontal cortex, left pre-motor and supplementary motor cortex, inferior prefrontal gyrus, and right middle temporal gyrus (p = 0.006). Inhibition function of children with ADHD was negatively correlated with functional brain connectivity (p = 0.009), while such correlation was not found in the control group.

Conclusion

The present study demonstrated that children with ADHD had relatively low connectivity in several brain regions measured at the resting state. Our results supported the evidence that lack of functional brain connectivity was associated with impaired inhibition function in children with ADHD.

Neurocognitive and cerebellar function in ADHD, autism and spinocerebellar ataxia

The cerebellum plays a major role in balance, motor control and sensorimotor integration, but also in cognition, language, and emotional regulation. Several neuropsychiatric disorders such as attention deficit-hyperactivity disorder (ADHD), autism spectrum disorder (ASD), as well as neurological diseases such as spinocerebellar ataxia type 3 (SCA3) are associated with differences in cerebellar function. Morphological abnormalities in different cerebellar subregions produce distinct behavioral symptoms related to the functional disruption of specific cerebro-cerebellar circuits. The specific contribution of the cerebellum to typical development may therefore involve the optimization of the structure and function of cerebro-cerebellar circuits underlying skill acquisition in multiple domains. Here, we review cerebellar structural and functional differences between healthy and patients with ADHD, ASD, and SCA3, and explore how disruption of cerebellar networks affects the neurocognitive functions in these conditions. We discuss how cerebellar computations contribute to performance on cognitive and motor tasks and how cerebellar signals are interfaced with signals from other brain regions during normal and dysfunctional behavior. We conclude that the cerebellum plays a role in many cognitive functions. Still, more clinical studies with the support of neuroimaging are needed to clarify the cerebellum's role in normal and dysfunctional behavior and cognitive functioning.

The shared white matter developmental trajectory anomalies of attention-deficit/hyperactivity disorder and autism spectrum disorders: A meta-analysis of diffusion tensor imaging studies

Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) show common brain area abnormalities, which may contribute to the high shared co-occurrence symptoms and comorbidity of the two disorders. However, neuroanatomic anomalies in neurodevelopmental disorders may change over the course of development, and the developmental variation of these two disorders is unclear. Our study conducted a systematic literature search of PubMed, Web of Science, and EMBASE databases to identify disorder-shared abnormalities of white matter (WM) from childhood to adulthood in ADHD and ASD. 28 ADHD and 23 ASD datasets were included in this meta-analysis and were analysed by AES-SDM to detect differences in fractional anisotropy in patients compared to typically developing individuals. Our main findings reveal the variable WM developmental trajectories in ADHD and ASD respectively, and the two disorders showed overlapping corpus callosum tract abnormalities in their development from children to adults. Furthermore, the overlapping abnormalities of the corpus callosum tract increased with age, which may be related to their gradually increasing shared symptoms and comorbidity in these two disorders.

A generalizable connectome-based marker of in-scan sustained attention in neurodiverse youth

Difficulty with attention is an important symptom in many conditions in psychiatry, including neurodiverse conditions such as autism. There is a need to better understand the neurobiological correlates of attention and leverage these findings in healthcare settings. Nevertheless, it remains unclear if it is possible to build dimensional predictive models of attentional state in a sample that includes participants with neurodiverse conditions. Here, we use 5 datasets to identify and validate functional connectome-based markers of attention. In dataset 1, we use connectome-based predictive modeling and observe successful prediction of performance on an in-scan sustained attention task in a sample of youth, including participants with a neurodiverse condition. The predictions are not driven by confounds, such as head motion. In dataset 2, we find that the attention network model defined in dataset 1 generalizes to predict in-scan attention in a separate sample of neurotypical participants performing the same attention task. In datasets 3-5, we use connectome-based identification and longitudinal scans to probe the stability of the attention network across months to years in individual participants. Our results help elucidate the brain correlates of attentional state in youth and support the further development of predictive dimensional models of other clinically relevant phenotypes.

Longitudinal Changes of Resting-State Networks in Children With Attention-Deficit/Hyperactivity Disorder and Typically Developing Children

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent childhood neurodevelopmental disorder. Given the profound brain changes that occur across childhood and adolescence, it is important to identify functional networks that exhibit differential developmental patterns in children with ADHD. This study sought to examine whether children with ADHD exhibit differential developmental trajectories in functional connectivity compared with typically developing children using a network-based approach.

METHODS

This longitudinal neuroimaging study included 175 participants (91 children with ADHD and 84 control children without ADHD) between ages 9 and 14 and up to 3 waves (173 total resting-state scans in children with ADHD and 197 scans in control children). We adopted network-based statistics to identify connected components with trajectories of development that differed between groups.

RESULTS

Children with ADHD exhibited differential developmental trajectories compared with typically developing control children in networks connecting cortical and limbic regions as well as between visual and higher-order cognitive regions. A pattern of reduction in functional connectivity between corticolimbic networks was seen across development in the control group that was not present in the ADHD group. Conversely, the ADHD group showed a significant decrease in connectivity between predominantly visual and higher-order cognitive networks that was not displayed in the control group.

CONCLUSIONS

Our findings show that the developmental trajectories in children with ADHD are characterized by a subnetwork involving different trajectories predominantly between corticolimbic regions and between visual and higher-order cognitive network connections. These findings highlight the importance of examining the longitudinal maturational course to understand the development of functional connectivity networks in children with ADHD.

Abnormal Reactivity of Brain Oscillations to Visual Search Target in Children With Attention-Deficit/Hyperactivity Disorder

BACKGROUND

Previous studies have shown that impaired goal-directed alpha lateralization and functional disconnection within attention networks during the cue period are significant features of attention-deficit/hyperactivity disorder (ADHD). This study aimed to explore the role of brain oscillations in the visual search process, focusing on target-induced posterior alpha lateralization, midfrontal theta synchronization, and their functional connection in children with ADHD.

METHODS

Electroencephalograms were recorded from typically developing (TD) children (n = 72) and children with ADHD (n = 96) while they performed a visual search task.

RESULTS

Both the TD and ADHD groups showed significant midfrontal theta event-related synchronization (ERS) and posterior alpha lateralization. Compared with TD children, children with ADHD showed significantly lower theta ERS and higher target-induced alpha lateralization. TD children showed a positive trial-based correlation between theta ERS and alpha lateralization and a negative correlation between theta ERS and reaction time variability. However, all these correlations were absent in children with ADHD.

CONCLUSIONS

Abnormal brain oscillations in children with ADHD indicate insufficient executive control function and the compensation of attention networks for attention deficits in visual selective attention. Cross-frequency disconnection reflects the common deficiency of executive control in the gating of target information. Our findings provide novel evidence for interpreting the features of brain oscillations during stimulus-driven selective attention in children with ADHD.

Brain White Matter Structural Alteration in Hemifacial Spasm: A Diffusion Tensor Imaging Study

OBJECTIVE

To analyze the changes in the white matter structure of the whole brain in hemifacial spasm (HFS) patients by using the tract-based spatial statistics (TBSS) method.

MATERIALS AND METHODS

29 HFS patients without anxiety and depression and 29 healthy controls with matching age, sex, and education were selected. All subjects received a 3.0T magnetic resonance (MR) brain diffusion tensor imaging scan. Tract-based spatial statistics method was used to analyze the changes in white matter structure in the whole brain and obtained the cerebral white matter fibrous areas exhibiting significant intergroup differences. The fractional anisotropy (FA), mean diffusivity, axial diffusivity, and radial diffusivity of these areas were abstracted. Analyzed the correlation between these diffusion metrics and clinical variables (disease duration, spasm severity).

RESULTS

Compared with the healthy controls group, the HFS group exhibited significantly lower FA in the forceps minor, bilateral anterior thalamic radiation, and right superior longitudinal fasciculus ( P <0.05, threshold-free cluster enhancement corrected). Cohen grading scale of HFS patients was negatively correlated with FA of forceps minor.

CONCLUSION

Based on TBSS analysis, the injury of white matter fiber tracts in HFS patients was found, including forceps minor, bilateral anterior thalamic radiation, and right superior longitudinal fasciculus. The changes of FA values in forceps minor were negatively correlated with the Cohen grading scale, suggesting that the alteration of white matter fiber in the genu-of-corpus-callosum-cortex circuit plays an important role in the neuro-pathological mechanism of HFS. Combined with previous research, it is also necessary to further explore the change of the superior longitudinal fasciculus in the future.

The Effect of Meditation-Based Mind-Body Interventions on Symptoms and Executive Function in People With ADHD: A Meta-Analysis of Randomized Controlled Trials

OBJECTIVE

This study aims to perform a systematic review and meta-analysis of the effect of MBIs (Mindfulness, Tai Chi, Yoga, and Qigong) on symptoms and executive function (EF) in ADHD.

METHOD

PubMed, Web of Science, the Cochrane Library, PsycINFO, CINAHL, Embase, and CNKI databases were searched to collect randomized controlled trials (RCTs) on the effects of MBIs on symptoms and EF in ADHD. Data extraction and methodological quality evaluation were conducted by two researchers, and a meta-analysis was conducted by Stata SE.

RESULTS

The pooled meta-analyses of MBIs revealed a positive and small effect on inattention (g = -0.26), hyperactivity/impulsivity (g = -0.19), and EF (g = -0.35).

CONCLUSION

Results suggest that MBIs have a significant improvement relative to the control condition. Although some results show that symptoms are affected by age, interventions, and total time of moderators, while EF is not affected by age and measurement, it needs to be supported by more research evidence. (J. of Att. Dis. XXXX; XX(X) XX-XX).

Distinct and shared white matter abnormalities when ADHD is comorbid with ASD: A preliminary diffusion tensor imaging study

Attention deficit/hyperactivity disorder (ADHD), a common neurodevelopmental disorder, is the most frequent comorbid condition seen in children with autism spectrum disorder (ASD). This high comorbidity between ADHD and ASD worsens symptom manifestations and complicates disease treatment and prognosis. It remains unclear whether individuals suffering with both ADHD and ASD, compared to individuals with ADHD only, share overlapping neural correlates associated with ADHD neuropathology, or exhibit a distinct neuropathological profile. Answering this question is critical to the understanding of treatment outcomes for the challenging comorbid ADHD symptoms. To identify the shared and the differentiated neural correlates of the comorbidity mechanisms of ADHD with ASD, we use diffusion tensor imaging (DTI) to characterize white-matter microstructure integrity in youth diagnosed with ADHD+ASD and youth with ADHD-only (excluding both the diagnosis and symptoms of ASD) compared with a healthy control group. Results show that the ADHD-only cohort exhibits impaired microstructural integrity (lower fractional anisotropy, FA) in the callosal-cingulum (CC-CG) tracts compared to the control cohort. The ADHD+ASD comorbid cohort shows impaired FA in an overlapping region within the CC-CG tracts and, additionally, shows impaired FA in the frontolimbic tracts including the uncinate fasciculus and anterior thalamic radiation. Across all participants, FA in the CC-CG showed a significantly negative relationship with the degree of ADHD symptom severity. Findings of this study suggest a specific role of CC-CG underlying ADHD neuropathology and symptom manifestations, and when comorbid with ASD a shared ADHD profile with a shift toward an anterior-brain, frontal impact. Results of this study may facilitate future targeted therapeutics and assist in diagnostic precision for individuals suffering with differing levels of comorbid ADHD with ASD, and ultimately contribute to improve prognostication and outcomes for these two highly prevalent and comorbid neurodevelopmental disorders.

The Mediatory Role of Executive Functioning on the Association Between Sleep and Both Everyday Memory and ADHD Symptoms in Children and Youth With Down Syndrome

People with Down syndrome (DS) commonly experience challenges with sleep, executive functioning, everyday memory, and symptoms of attention deficit hyperactivity disorder (ADHD). A path analysis was conducted to determine if executive function mediated the relationship between sleep problems and both everyday memory and ADHD symptoms. Parents of 96 children and youth with DS completed questionnaires related to sleep, executive functioning, everyday memory, and ADHD symptoms. Results showed that executive functioning fully mediated the relation between sleep and both everyday memory and ADHD symptoms. Implications for education and intervention for children and youth with DS are discussed.

Distinct Thalamic and Frontal Neuroanatomical Substrates in Children with Familial vs. Non-Familial Attention-Deficit/Hyperactivity Disorder (ADHD)

Attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent, inheritable, and heterogeneous neurodevelopmental disorder. Children with a family history of ADHD are at elevated risk of having ADHD and persisting its symptoms into adulthood. The objective of this study was to investigate the influence of having or not having positive family risk factor in the neuroanatomy of the brain in children with ADHD. Cortical thickness-, surface area-, and volume-based measures were extracted and compared in a total of 606 participants, including 132, 165, and 309 in groups of familial ADHD (ADHD-F), non-familial ADHD (ADHD-NF), and typically developed children, respectively. Compared to controls, ADHD probands showed significantly reduced gray matter surface area in the left cuneus. Among the ADHD subgroups, ADHD-F showed significantly increased gray matter volume in the right thalamus and significantly thinner cortical thickness in the right pars orbitalis. Among ADHD-F, an increased volume of the right thalamus was significantly correlated with a reduced DSM-oriented t-score for ADHD problems. The findings of this study may suggest that a positive family history of ADHD is associated with the structural abnormalities in the thalamus and inferior frontal gyrus; these anatomical abnormalities may significantly contribute to the emergence of ADHD symptoms.

Gut microbiome and attention deficit/hyperactivity disorder: a systematic review

BACKROUND

This systematic review aims to examine the associations between features of gut microbiome and Attention Deficit/Hyperactivity Disorder (ADHD) risk or severity in children, adolescents and young adults.

METHODS

Eligible studies were identified in PubMed and Google Scholar databases until December 31, 2020.

RESULTS

The search identified a total of 1197 items, of which 11 were included in this systematic review. The findings regarding alpha, beta diversity, bacterial phyla, orders and families were inconclusive. At the genus level an increased abundance of Odoribacter (two studies) and Eggerthella (two studies) was found in ADHD; on the contrary, decreased abundance of Faecalibacterium (three studies) was noted, whereas one study suggested its inverse association with ADHD severity and hyperactivity. One study indicated that Bacteroides species also correlated with levels of hyperactivity and impulsivity. At the species level, a lower abundance of Faecalibacterium prausnitzii, but higher of Odoribacter splanchnicus and Bacteroides uniformis was reported.

CONCLUSIONS

This systematic review highlights associations between gut microbiome features and ADHD. Potential mechanisms differ by microorganism and include effects on neurotransmitter production, dopamine metabolism, modulation of inflammation and neurodevelopment through the release of cytokines.

IMPACT

The existence of correlations between features of gut microbiome and ADHD manifestation or its severity in children, adolescents and young adults. Associations between gut microbiome features and ADHD are highlighted. Potential mechanisms seem to differ by microorganism and include effects on neurotransmitter production, dopamine metabolism, modulation of inflammation and neurodevelopment through the release of cytokines. As correlations between gut microbiome features and ADHD seem to exist, additional studies are needed for further investigation.

Association between attention-deficit/hyperactivity disorder symptom severity and white matter integrity moderated by in-scanner head motion

Attention-deficit/hyperactivity disorder (ADHD) is a common and debilitating neurodevelopmental disorder associated with various negative life impacts. The manifestation of ADHD is very heterogeneous, and previous investigations on neuroanatomical alterations in ADHD have yielded inconsistent results. We investigated the mediating effect of in-scanner head motion and ADHD hyperactivity severity on motion-corrected fractional anisotropy (FA) using diffusion tensor imaging in the currently largest sample (n = 739) of medication-naïve children and adolescents (age range 5-22 years). We used automated tractography to examine whole-brain and mean FA of the tracts most frequently reported in ADHD; corpus callosum forceps major and forceps minor, left and right superior-longitudinal fasciculus, and left and right corticospinal tract (CST). Associations between FA and hyperactivity severity appeared when in-scanner head motion was not accounted for as mediator. However, causal mediation analysis revealed that these effects are fully mediated through in-scanner head motion for whole-brain FA, the corpus callosum forceps minor, and left superior-longitudinal fasciculus. Direct effect of hyperactivity severity on FA was only found for the left CST. This study illustrates the crucial role of in-scanner head motion in the identification of white matter integrity alterations in ADHD and shows how neglecting irremediable motion artifacts causes spurious findings. When the mediating effect of in-scanner head motion on FA is accounted for, an association between hyperactivity severity and FA is only present for the left CST; this may play a crucial role in the manifestation of hyperactivity and impulsivity symptoms in ADHD.

Trait-like white matter abnormalities in current and remitted depression

Microstructural alterations to white matter (WM) have been implicated in the onset and recurrence of major depressive disorder (MDD). The present study aimed to identify trait-like WM abnormality in current and remitted depression, as well as changes to WM that could be specifically related to the state of clinical remission. Diffusion tensor imaging data were collected from 60 patients with medication-naive first episode current depression (cMDD), 41 patients with medication-naive remitted depression (rMDD), and 62 demographically-matched healthy control participants (HCs). Tract-based spatial statistics (TBSS) applied to the whole brain were used to detect microstructural differences of WM among the three groups. TBSS analyses showed that, compared with HCs, both the cMDD and rMDD groups exhibited significantly reduced FA values in the genus and body of the corpus callosum, and superior and anterior corona radiata, with no significant differences between the cMDD and rMDD groups. FA values in the corpus callosum were negatively correlated with the duration of illness in the rMDD group. Reduced WM integrity in the corpus callosum and corona radiata might reflect the trait markers of MDD, and could constitute a neuroanatomical marker of MDD.

Resting-State fMRI Whole Brain Network Function Plasticity Analysis in Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) is a common mental disorder in children, which is related to inattention and hyperactivity. These symptoms are associated with abnormal interactions of brain networks. We used resting-state functional magnetic resonance imaging (rs-fMRI) based on the graph theory to explore the topology property changes of brain networks between an ADHD group and a normal group. The more refined AAL_1024 atlas was used to construct the functional networks with high nodal resolution, for detecting more subtle changes in brain regions and differences among groups. We compared altered topology properties of brain network between the groups from multilevel, mainly including modularity at mesolevel. Specifically, we analyzed the similarities and differences of module compositions between the two groups. The results found that the ADHD group showed stronger economic small-world network property, while the clustering coefficient was significantly lower than the normal group; the frontal and occipital lobes showed smaller node degree and global efficiency between disease statuses. The modularity results also showed that the module number of the ADHD group decreased, and the ADHD group had short-range overconnectivity within module and long-range underconnectivity between modules. Moreover, modules containing long-range connections between the frontal and occipital lobes disappeared, indicating that there was lack of top-down control information between the executive control region and the visual processing region in the ADHD group. Our results suggested that these abnormal regions were related to executive control and attention deficit of ADHD patients. These findings helped to better understand how brain function correlates with the ADHD symptoms and complement the fewer modularity elaboration of ADHD research.

Neuroprotection in late life attention-deficit/hyperactivity disorder: A review of pharmacotherapy and phenotype across the lifespan

For decades, psychostimulants have been the gold standard pharmaceutical treatment for attention-deficit/hyperactivity disorder (ADHD). In the United States, an astounding 9% of all boys and 4% of girls will be prescribed stimulant drugs at some point during their childhood. Recent meta-analyses have revealed that individuals with ADHD have reduced brain volume loss later in life (>60 y.o.) compared to the normal aging brain, which suggests that either ADHD or its treatment may be neuroprotective. Crucially, these neuroprotective effects were significant in brain regions (e.g., hippocampus, amygdala) where severe volume loss is linked to cognitive impairment and Alzheimer's disease. Historically, the ADHD diagnosis and its pharmacotherapy came about nearly simultaneously, making it difficult to evaluate their effects in isolation. Certain evidence suggests that psychostimulants may normalize structural brain changes typically observed in the ADHD brain. If ADHD itself is neuroprotective, perhaps exercising the brain, then psychostimulants may not be recommended across the lifespan. Alternatively, if stimulant drugs are neuroprotective, then this class of medications may warrant further investigation for their therapeutic effects. Here, we take a bottom-up holistic approach to review the psychopharmacology of ADHD in the context of recent models of attention. We suggest that future studies are greatly needed to better appreciate the interactions amongst an ADHD diagnosis, stimulant treatment across the lifespan, and structure-function alterations in the aging brain.

The metacontrol hypothesis as diagnostic framework of OCD and ADHD: A dimensional approach based on shared neurobiological vulnerability

Obsessive-compulsive disorder (OCD) and attention-deficit hyperactivity disorder (ADHD) are multi-faceted neuropsychiatric conditions that in many aspects appear to be each other's antipodes. We suggest a dimensional approach, according to which these partially opposing disorders fall onto a continuum that reflects variability regarding alterations of cortico-striato-thalamo-cortical (CSTC) circuits and of the processing of neural noise during cognition. By using theoretical accounts of human cognitive metacontrol, we develop a framework according to which OCD can be characterized by a chronic bias towards exaggerated cognitive persistence, equivalent to a high signal-to-noise ratio (SNR)-which facilitates perseverative behaviour but impairs mental flexibility. In contrast, ADHD is characterized by a chronic bias towards inflated cognitive flexibility, equivalent to a low SNR-which increases behavioural variability but impairs the focusing on one goal and on relevant information. We argue that, when pharmacology is not feasible, novel treatments of these disorders may involve methods to manipulate the signal-to-noise ratio via non-invasive brain stimulation techniques, in order to normalize the situational imbalance between cognitive persistence and cognitive flexibility.

Identify aberrant white matter microstructure in ASD, ADHD and other neurodevelopmental disorders: A meta-analysis of diffusion tensor imaging studies

BACKGROUND

Neurodevelopmental disorders (NDDs) usually present overlapping symptoms. Abnormal white matter (WM) microstructure has been found in these disorders. Identification of common and unique neural abnormalities across NDDs could provide further insight into the underlying pathophysiological mechanisms.

METHODS

We performed a voxel-based meta-analysis of whole-brain diffusion tensor imaging (DTI) studies in autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD) and other NDDs. A systematic literature search was conducted through March 2020 to identify studies that compared measures of WM microstructure between patients with NDDs and neurotypical controls. Peak voxel coordinates were meta-analyzed via anisotropic effect size-signed differential mapping (AES-SDM) as well as activation likelihood estimation (ALE).

RESULTS

Our final sample included a total of 4137 subjects from 66 studies across five NDDs. Fractional anisotropy (FA) reductions were found in the splenium of the CC in ADHD, and the genu and splenium of CC in ASD. And mean diffusivity (MD) increases were shown in posterior thalamic radiation in ASD. No consistent abnormalities were detected in specific learning disorder, motor disorder or communication disorder. Significant differences between child/adolescent and adult patients were found within the CC across NDDs, reflective of aberrant neurodevelopmental processes in NDDs.

CONCLUSIONS

The current study demonstrated atypical WM patterns in ASD, ADHD and other NDDs. Microstructural abnormalities in the splenium of the CC were possibly shared among ASD and ADHD.

White matter microstructure in children and adolescents with ADHD

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A systematic review of diffusion MRI studies in children and adolescents with ADHD.

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46 studies included, encompassing multiple diffusion MRI techniques.

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Reduced white matter microstructure was reported in several studies.

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Mixed evidence linking white matter differences with specific cognitive processes.

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Common limitations included sample size, head motion and medication status.

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder. Advances in diffusion magnetic resonance imaging (MRI) acquisition sequences and analytic techniques have led to growing body of evidence that abnormal white matter microstructure is a core pathophysiological feature of ADHD. This systematic review provides a qualitative assessment of research investigating microstructural organisation of white matter amongst children and adolescents with ADHD. This review included 46 studies in total, encompassing multiple diffusion MRI imaging techniques and analytic approaches, including whole-brain, region of interest and connectomic analyses. Whole-brain and region of interest analyses described atypical organisation of white matter microstructure in several white matter tracts: most notably in frontostriatal tracts, corpus callosum, superior longitudinal fasciculus, cingulum bundle, thalamic radiations, internal capsule and corona radiata. Connectomic analyses, including graph theory approaches, demonstrated global underconnectivity in connections between functionally specialised networks. Although some studies reported significant correlations between atypical white matter microstructure and ADHD symptoms or other behavioural measures there was no clear pattern of results. Interestingly however, many of the findings of disrupted white matter microstructure were in neural networks associated with key neuropsychological functions that are atypical in ADHD. Limitations to the extant research are outlined in this review and future studies in this area should carefully consider factors such as sample size, sex balance, head motion and medication status.

Functional near-infrared spectroscopy in developmental psychiatry: a review of attention deficit hyperactivity disorder

Research has linked executive function (EF) deficits to many of the behavioral symptoms of attention deficit hyperactivity disorder (ADHD). Evidence of the involvement of EF impairment in ADHD is corroborated by accumulating neuroimaging studies, specifically functional magnetic resonance imaging (fMRI) studies. However, in recent years, functional near-infrared spectroscopy (fNIRS) has become increasingly popular in ADHD research due to its portability, high ecological validity, resistance to motion artifacts, and cost-effectiveness. While numerous studies throughout the past decade have used fNIRS to examine alterations in neural correlates of EF in ADHD, a qualitative review of the reliability of these findings compared with those reported using gold-standard fMRI measurements does not yet exist. The current review aims to fill this gap in the literature by comparing the results generated from a qualitative review of fNIRS studies (children and adolescents ages 6-16 years old) to a meta-analysis of comparable fMRI studies and examining the extent to which the results of these studies align in the context of EF impairment in ADHD. The qualitative analysis of fNIRS studies of ADHD shows a consistent hypoactivity in the right prefrontal cortex in multiple EF tasks. The meta-analysis of fMRI data corroborates altered activity in this region and surrounding areas during EF tasks in ADHD compared with typically developing controls. These findings indicate that fNIRS is a promising functional brain imaging technology for examining alterations in cortical activity in ADHD. We also address the disadvantages of fNIRS, including limited spatial resolution compared with fMRI.

Sex differences in microstructural alterations in the corpus callosum tracts in drug-naïve children with ADHD

Widespread alterations in the corpus callosum (CC) microstructure and organization have been found in children with attention-deficit/hyperactivity disorder (ADHD); however, few studies have investigated the diffusion characteristics and volume of transcallosal fiber tracts defined by specific cortical projections in ADHD, which is important for identifying distinct functional interhemispheric connection abnormalities. In the current study, an automated fiber-tract quantification (AFQ) approach based on diffusion tensor imaging identified seven CC tracts according to their cortical projections and estimated diffusion parameters and volume among 76 drug-naïve ADHD patients (53 boys and 23 girls) and 37 typically developing children (TDC) (20 boys and 17 girls) matched for age, IQ, and handedness. We found significantly lower fractional anisotropy (FA) in the occipital and superior parietal tracts and higher mean diffusivity (MD) in the posterior, superior parietal and anterior frontal tracts in children with ADHD compared with TDC. In addition, lower FA and higher radial diffusivity (RD) in the occipital callosal tract were significantly associated with higher hyperactivity and impulsivity performance in ADHD. In addition, sex-by-diagnosis interactions were observed in the occipital, posterior and superior parietal tracts. Girls with ADHD showed decreased FA and volume in the occipital tract, which were significantly associated with increased impulsivity performance and poor response control, and increased MD in the posterior and superior parietal callosal tracts, which were significantly associated with increased inattention performance, whereas boys with ADHD merely showed decreased volume in the frontal tract. Our results elucidated that sex-specific alterations in the CC tracts potentially underlie ADHD symptomatology and further suggested a differential contribution of abnormalities in different CC tracts to impulsivity and inattention among girls with ADHD.

Alterations in Structural and Functional Connectivity in ADHD: Implications for Theories of ADHD

Attention-Deficit/Hyperactivity Disorder (ADHD) is increasingly viewed as a disorder of brain connectivity. We review connectivity-based theories of ADHD including the default mode network (DMN) interference and multiple network hypotheses. We outline the main approaches used to study brain connectivity in ADHD: diffusion tensor imaging and resting-state functional connectivity. We discuss the basic principles underlying these methods and the main analytical approaches used and consider what the findings have told us about connectivity alterations in ADHD. The most replicable finding in the diffusion tensor imaging literature on ADHD is lower fractional anisotropy in the corpus callosum, a key commissural tract which connects the brain's hemispheres. Meta-analyses of resting-state functional connectivity studies have failed to identify spatial convergence across studies, with the exception of meta-analyses focused on specific networks which have reported within-network connectivity alterations in the DMN and between the DMN and the fronto-parietal control and salience networks. Overall, methodological heterogeneity between studies and differences in sample characteristics are major barriers to progress in this area. In addition, females, adults and medication-naïve/unmedicated individuals are under-represented in connectivity studies, comorbidity needs to be assessed more systematically, and longitudinal research is needed to investigate whether ADHD is characterized by maturational delays in connectivity.

Convergent selective signaling impairment exposes the pathogenicity of latrophilin-3 missense variants linked to inheritable ADHD susceptibility

Latrophilin-3 (Lphn3; also known as ADGRL3) is a member of the adhesion G Protein Coupled Receptor subfamily, which participates in the stabilization and maintenance of neuronal networks by mediating intercellular adhesion through heterophilic interactions with transmembrane ligands. Polymorphisms modifying the Lphn3 gene are associated with attention-deficit/hyperactivity disorder (ADHD) in children and its persistence into adulthood. How these genetic alterations affect receptor function remains unknown. Here, we conducted the functional validation of distinct ADHD-related Lphn3 variants bearing mutations in the receptor's adhesion motif-containing extracellular region. We found that all variants tested disrupted the ability of Lphn3 to stabilize intercellular adhesion in a manner that was distinct between ligands classes, but which did not depend on ligand-receptor interaction parameters, thus pointing to altered intrinsic receptor signaling properties. Using G protein signaling biosensors, we determined that Lphn3 couples to Gαi1, Gαi2, Gαs, Gαq, and Gα13. However, all ADHD-related receptor variants consistently lacked intrinsic as well as ligand-dependent Gα13 coupling efficiency while maintaining unaltered coupling to Gαi, Gαs, and Gαq. Consistent with these alterations, actin remodeling functions as well as actin-relevant RhoA signaling normally displayed by the constitutively active Lphn3 receptor were impeded by select receptor variants, thus supporting additional signaling defects. Taken together, our data point to Gα13 selective signaling impairments as representing a disease-relevant pathogenicity pathway that can be inherited through Lphn3 gene polymorphisms. This study highlights the intricate interplay between Lphn3 GPCR functions and the actin cytoskeleton in modulating neurodevelopmental cues related to ADHD etiology.

Promising Developments in the Use of Induced Pluripotent Stem Cells in Research of ADHD

Although research using animal models, peripheral and clinical biomarkers, multimodal neuroimaging techniques and (epi)genetic information has advanced our understanding of Attention-Deficit Hyperactivity Disorder (ADHD), the aetiopathology of this neurodevelopmental disorder has still not been elucidated. Moreover, as the primary affected tissue is the brain, access to samples is problematic. Alternative models are therefore required, facilitating cellular and molecular analysis. Recent developments in stem cell research have introduced the possibility to reprogram somatic cells from patients, in this case ADHD, and healthy controls back into their pluripotent state, meaning that they can then be differentiated into any cell or tissue type. The potential to translate patients' somatic cells into stem cells, and thereafter to use 2- and 3-dimensional (2D and 3D) neuronal cells to model neurodevelopmental disorders and/or test novel drug therapeutics, is discussed in this chapter.

Congenital Hypothyroidism and Brain Development: Association With Other Psychiatric Disorders

Thyroid hormones play an important role in brain development, and thyroid hormone insufficiency during the perinatal period results in severe developmental delays. Perinatal thyroid hormone deficiency is clinically known as congenital hypothyroidism, which is caused by dysgenesis of the thyroid gland or low iodine intake. If the disorder is not diagnosed or not treated early, the neuronal architecture is perturbed by thyroid hormone insufficiency, and neuropathological findings, such as abnormal synapse formation, defects in neuronal migration, and impairment of myelination, are observed in the brains of such patients. Furthermore, the expression of psychiatric disorder-related molecules, especially parvalbumin, is significantly decreased by thyroid hormone insufficiency during the perinatal period. Animal experiments using hypothyroidism models display decreased parvalbumin expression and abnormal brain architecture, and these experimental results show reproducibility and stability. These basic studies reinforce the results of epidemiological studies, suggesting the relevance of thyroid dysfunction in psychiatric disorders. In this review, we discuss the disruption of brain function associated with congenital hypothyroidism from the perspective of basic and clinical research.

Regional Topological Aberrances of White Matter- and Gray Matter-Based Functional Networks for Attention Processing May Foster Traumatic Brain Injury-Related Attention Deficits in Adults

Traumatic brain injury (TBI) is highly prevalent in adults. TBI-related functional brain alterations have been linked with common post-TBI neurobehavioral sequelae, with unknown neural substrates. This study examined the systems-level functional brain alterations in white matter (WM) and gray matter (GM) for visual sustained-attention processing, and their interactions and contributions to post-TBI attention deficits. Task-based functional MRI data were collected from 42 adults with TBI and 43 group-matched normal controls (NCs), and analyzed using the graph theoretic technique. Global and nodal topological properties were calculated and compared between the two groups. Correlation analyses were conducted between the neuroimaging measures that showed significant between-group differences and the behavioral symptom measures in attention domain in the groups of TBI and NCs, respectively. Significantly altered nodal efficiencies and/or degrees in several WM and GM nodes were reported in the TBI group, including the posterior corona radiata (PCR), posterior thalamic radiation (PTR), postcentral gyrus (PoG), and superior temporal sulcus (STS). Subjects with TBI also demonstrated abnormal systems-level functional synchronization between the PTR and STS in the right hemisphere, hypo-interaction between the PCR and PoG in the left hemisphere, as well as the involvement of systems-level functional aberrances in the PCR in TBI-related behavioral impairments in the attention domain. The findings of the current study suggest that TBI-related systems-level functional alterations associated with these two major-association WM tracts, and their anatomically connected GM regions may play critical role in TBI-related behavioral deficits in attention domains.

Differential structure-function network coupling in the inattentive and combined types of attention deficit hyperactivity disorder

The heterogeneous presentation of inattentive and hyperactive-impulsive core symptoms in attention deficit hyperactivity disorder (ADHD) warrants further investigation into brain network connectivity as a basis for subtype divisions in this prevalent disorder. With diffusion and resting-state functional magnetic resonance imaging data from the Healthy Brain Network database, we analyzed both structural and functional network efficiency and structure-functional network (SC-FC) coupling at the default mode (DMN), executive control (ECN), and salience (SAN) intrinsic networks in 201 children diagnosed with the inattentive subtype (ADHD-I), the combined subtype (ADHD-C), and typically developing children (TDC) to characterize ADHD symptoms relative to TDC and to test differences between ADHD subtypes. Relative to TDC, children with ADHD had lower structural connectivity and network efficiency in the DMN, without significant group differences in functional networks. Children with ADHD-C had higher SC-FC coupling, a finding consistent with diminished cognitive flexibility, for all subnetworks compared to TDC. The ADHD-C group also demonstrated increased SC-FC coupling in the DMN compared to the ADHD-I group. The correlation between SC-FC coupling and hyperactivity scores was negative in the ADHD-I, but not in the ADHD-C group. The current study suggests that ADHD-C and ADHD-I may differ with respect to their underlying neuronal connectivity and that the added dimensionality of hyperactivity may not explain this distinction.