Michael C Stevens1, Godfrey D Pearlson2, Vince D Calhoun3, Katie L Bessette4. 1. Olin Neuropsychiatry Research Center, the Institute of Living, Hartford, Connecticut; Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut. Electronic address: Michael.Stevens@hhchealth.org. 2. Olin Neuropsychiatry Research Center, the Institute of Living, Hartford, Connecticut; Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut. 3. Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut; Mind Research Network, University of New Mexico, Albuquerque, New Mexico; Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, New Mexico. 4. Olin Neuropsychiatry Research Center, the Institute of Living, Hartford, Connecticut; Department of Psychology, University of Illinois Chicago, Chicago, Illinois.
Abstract
BACKGROUND: A challenge facing clinical neuroscientists is how best to synthesize diverse and sometimes inconsistent evidence for neuropsychological deficits and brain system dysfunction found in psychiatric disorders into models that guide etiological and treatment research. Multiple-pathway models suggest that psychiatric symptoms might arise from pathophysiology in different neural systems. This study tested dual-pathway model predictions for attention-deficit/hyperactivity disorder (ADHD) that reward and executive function cognitive deficits should be related to abnormalities in corresponding functionally specialized neural systems. METHODS: Behavioral inhibition and preference for immediate rewards were assessed in N = 251 adolescent boys and girls ages 12 to 18 diagnosed with DSM-IV combined-subtype ADHD or non-ADHD control subjects. Following taxometric analyses of test performance, the resulting subgroups were compared on a functional magnetic resonance imaging monetary incentive delay task probing reward anticipation and go/no-go task of motor response inhibition. RESULTS: Three ADHD subgroups were identified consistent with different proposed pathways-ADHD with executive function/motor inhibition deficits, ADHD with both executive and reward deficits, and ADHD with relatively normal test performance. Each cognitive domain mapped to different ADHD brain dysfunction features as expected. However, no brain abnormalities were found common to all ADHD subgroups despite the fact they had nearly identical ADHD-related clinical characteristics. CONCLUSIONS: The results suggest that combined-subtype ADHD is a collection of discrete disorders for which a comparable behavioral end point arises through different neurobiological pathways. The findings raise caution about applying common cause, single-deficit conceptual models to individual ADHD patients and should prompt researchers to consider biologically defined, multifactorial etiological models for other psychiatric diagnoses.
BACKGROUND: A challenge facing clinical neuroscientists is how best to synthesize diverse and sometimes inconsistent evidence for neuropsychological deficits and brain system dysfunction found in psychiatric disorders into models that guide etiological and treatment research. Multiple-pathway models suggest that psychiatric symptoms might arise from pathophysiology in different neural systems. This study tested dual-pathway model predictions for attention-deficit/hyperactivity disorder (ADHD) that reward and executive function cognitive deficits should be related to abnormalities in corresponding functionally specialized neural systems. METHODS: Behavioral inhibition and preference for immediate rewards were assessed in N = 251 adolescent boys and girls ages 12 to 18 diagnosed with DSM-IV combined-subtype ADHD or non-ADHD control subjects. Following taxometric analyses of test performance, the resulting subgroups were compared on a functional magnetic resonance imaging monetary incentive delay task probing reward anticipation and go/no-go task of motor response inhibition. RESULTS: Three ADHD subgroups were identified consistent with different proposed pathways-ADHD with executive function/motor inhibition deficits, ADHD with both executive and reward deficits, and ADHD with relatively normal test performance. Each cognitive domain mapped to different ADHD brain dysfunction features as expected. However, no brain abnormalities were found common to all ADHD subgroups despite the fact they had nearly identical ADHD-related clinical characteristics. CONCLUSIONS: The results suggest that combined-subtype ADHD is a collection of discrete disorders for which a comparable behavioral end point arises through different neurobiological pathways. The findings raise caution about applying common cause, single-deficit conceptual models to individual ADHDpatients and should prompt researchers to consider biologically defined, multifactorial etiological models for other psychiatric diagnoses.
Authors: Nenad Vasic; Michael M Plichta; Robert C Wolf; Andreas J Fallgatter; Zrinka Sosic-Vasic; Georg Grön Journal: J Atten Disord Date: 2012-06-01 Impact factor: 3.256
Authors: Du Lei; Mingying Du; Min Wu; Taolin Chen; Xiaoqi Huang; Xiaoxia Du; Feng Bi; Graham J Kemp; Qiyong Gong Journal: Neuropsychology Date: 2015-05-04 Impact factor: 3.295
Authors: Dina R Dajani; Catherine A Burrows; Mary Beth Nebel; Stewart H Mostofsky; Kathleen M Gates; Lucina Q Uddin Journal: Brain Connect Date: 2019-11
Authors: Jacqueline F Saad; Kristi R Griffiths; Michael R Kohn; Taylor A Braund; Simon Clarke; Leanne M Williams; Mayuresh S Korgaonkar Journal: Front Hum Neurosci Date: 2022-06-09 Impact factor: 3.473
Authors: Danielle S Kroll; Dana E Feldman; Szu-Yung Ariel Wang; Rui Zhang; Peter Manza; Corinde E Wiers; Nora D Volkow; Gene-Jack Wang Journal: J Neurol Sci Date: 2020-08-19 Impact factor: 3.181
Authors: Michael I Demidenko; Alexander S Weigard; Karthikeyan Ganesan; Hyesue Jang; Andrew Jahn; Edward D Huntley; Daniel P Keating Journal: Brain Behav Date: 2021-03-22 Impact factor: 2.708
Authors: Theodore A Henderson; Muriel J van Lierop; Mary McLean; John Michael Uszler; John F Thornton; Yin-Hui Siow; Dan G Pavel; Joe Cardaci; Phil Cohen Journal: Front Psychiatry Date: 2020-04-15 Impact factor: 4.157
Authors: Santosh K Yadav; Ajaz A Bhat; Sheema Hashem; Sabah Nisar; Madeeha Kamal; Najeeb Syed; Mohamed-Ramzi Temanni; Rakesh K Gupta; Saddat Kamran; Muhammad Waqar Azeem; Amit K Srivastava; Puneet Bagga; Sanjeev Chawla; Ravinder Reddy; Michael P Frenneaux; Khalid Fakhro; Mohammad Haris Journal: Transl Psychiatry Date: 2021-06-05 Impact factor: 6.222