Norepinephrine and acetylcholine mediation of the components of reflexive attention: implications for attention deficit disorders.

Attention deficit hyperactivity disorders (ADHD) create major learning barriers for children and significant social and legal handicaps for adults worldwide. Important advances in the genetic basis of the disease have been made, but reliable, biological, diagnostic markers remain elusive. This review takes the position that future progress in treating the core symptom of attention deficits requires a clearer understanding of the neuroscience of attention in normal individuals. Two important achievements in this direction have been the development of tasks that identify activity in the orienting, alerting and conflict networks, and the identification of neurotransmitters that mediate these components. The proven ability of these tasks to identify and characterize response components of "normal" attention argues that they could be used advantageously with patient populations. The categorization of neurotransmitter abnormalities in those with ADHD could clarify whether attention deficits occur within or across attention networks. To realize these goals, we evaluate laboratory studies of attention in humans and animals that address the underlying neurotransmitter systems, primarily norepinephrine and acetylcholine. We propose that key facts about deficits in reflexive and voluntary attention may be understood by a model that includes deficits in brain norepinephrine release and its effects on cholinergic activity in the parietal cortex.