Original Investigation |

Attention Network Hypoconnectivity With Default and Affective Network Hyperconnectivity in Adults Diagnosed With Attention-Deficit/Hyperactivity Disorder in Childhood

Hazel McCarthy, MSc1,2; Norbert Skokauskas, MD, PhD1,3; Aisling Mulligan, MB3,4; Gary Donohoe, PhD1,2; Diane Mullins, MD, MRCPsych, MSc, MMEd1; John Kelly, MB1; Katherine Johnson, PhD1,5; Andrew Fagan, PhD2,6; Michael Gill, MRCPsych, MD1,2,7; James Meaney, MB6; Thomas Frodl, MD, MA1,2,6,8
[+] Author Affiliations
1Neuroimaging Group, Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
2Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
3Department of Child and Adolescent Psychiatry, Children’s University Hospital, Dublin, Ireland
4Mater Child and Adolescent Mental Health Service, Dublin, Ireland
5School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
6Centre for Advanced Medical Imaging, St James’s Hospital, Dublin, Ireland
7Neuropsychiatric Genetics Research Group, Department of Psychiatry, Trinity Centre for Health Sciences, St James’s Hospital, Dublin, Ireland
8Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
JAMA Psychiatry. 2013;70(12):1329-1337. doi:10.1001/jamapsychiatry.2013.2174.
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Importance  The neurobiological underpinnings of attention-deficit/hyperactivity disorder (ADHD) and particularly those associated with the persistence of ADHD into adulthood are not yet well understood. The correlation patterns in spontaneous neural fluctuations at rest are known as resting-state functional connectivity (RSFC) and could characterize ADHD-specific connectivity changes.

Objective  To determine the specific location of possible ADHD-related differences in RSFC between adults diagnosed as having ADHD in childhood and control subjects.

Design  Using resting-state functional magnetic resonance imaging, we calculated and compared functional connectivity from attention, affective, default, and cognitive control networks involved in the psychopathology of ADHD between the ADHD and control groups.

Setting  University psychiatric service and magnetic resonance imaging research center.

Participants  Sixteen drug-free adults (5 women and 11 men; mean age, 24.5 years) diagnosed with combined-type ADHD in childhood and 16 healthy controls matched for age (mean age, 24.4 years), sex, handedness, and educational level recruited from the community.

Intervention  Functional magnetic resonance imaging.

Main Outcomes and Measures  Connectivity data from ventral and dorsal attention, affective, default, and cognitive control networks and ADHD symptoms derived from ADHD-specific rating instruments.

Results  Adults with ADHD showed significantly decreased RSFC within the attention networks and increased RSFC within the affective and default mode and the right lateralized cognitive control networks compared with healthy controls (P < .01, familywise error for whole-brain cluster correction). Lower RSFC in the ventral and dorsal attention network was significantly correlated with higher levels of ADHD symptoms (P < .001).

Conclusions and Relevance  These RSFC findings might underpin a biological basis for adult ADHD and are functionally related to persistent inattention, disturbance in cognitive control, and emotional dysregulation in adults with ADHD. These findings need to be understood in the context of all aspects of brain function in ADHD.

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Figure 1.
Functional Magnetic Resonance Imaging of Bilateral Affective Regions

Participants with attention-deficit/hyperactivity disorder displayed greater resting-state functional connectivity between the anterior cingulate cortex (ACC) and superior parietal and cerebellar areas than did control subjects. A, Left ACC (x = 18, y = −50, z = 64). B, Right ACC (x = 34, y = −76, z = −30). Values next to the images indicate the sections in axial view.

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Figure 2.
Functional Magnetic Resonance Imaging of the Ventral Attention Network

In control subjects, the ventral attention network showed more significant resting-state functional connectivity bilaterally than did participants with attention-deficit/hyperactivity disorder. A, Left temporoparietal junction and left middle temporal gyrus (x = −62, y = −4, z = −8). B, Left ventral frontal cortex (VFC) and left inferior operculum (x = −30, y = 6, z = 30). C, Right VFC and left precentral gyrus (x = −50, y = 2, z = 28). Values next to the images indicate the sections in axial view.

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