Skip to main content Accessibility help
×
Home
Hostname: page-component-78dcdb465f-nbrzn Total loading time: 1.981 Render date: 2021-04-17T05:38:38.626Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": false, "newCiteModal": false, "newCitedByModal": true }

Attending to adult ADHD: a review of the neurobiology behind adult ADHD

Published online by Cambridge University Press:  04 December 2017

L. Alexander
Affiliation:
Liaison Psychiatry, St Vincent’s University Hospital, Elm Park, Dublin, Ireland ADHD Clinic, Trinity College Dublin, Dublin, Ireland Department of Psychiatry, University College Dublin, Dublin, Ireland
N. Farrelly
Affiliation:
College Health Centre, Trinity College Dublin, Dublin, Ireland
Corresponding
E-mail address:

Abstract

Background

Attention deficit hyperactivity disorder (ADHD) is a common disorder in childhood, which progresses to adulthood in about a fifth of cases. For various reasons, adult ADHD is a disorder not comprehensively assessed by psychiatrists, not least because the biological underpinnings are only recently being unmasked.

Aims

This selective review targets psychiatrists without a background in neuroscience and aims to describe the neurobiological basis of ADHD.

Methods

In total, 40 articles from a PubMed search were selected for inclusion based on sample population and methodology (neuroimaging studies). Studies focussing on adult participants were selected preferentially for inclusion. Seminal articles relevant to childhood populations were included for the purpose of understanding general concepts around ADHD.

Results

The neuropathology of ADHD is not rooted in a single anatomical area, but in multiple parallel and intersecting pathways, which have demonstrated impaired functional connectivity in ADHD brains. Dysfunction in executive function, reward processing, attention networks and default networks play major roles in the neuropathology of this condition. Biological findings vary between individuals, with some showing greater dysfunction at cortical levels and others at subcortical levels, which is in keeping with its clinical heterogeneity.

Conclusion

Improved symptomatology in adulthood is linked to a number of factors. Maturation of the prefrontal cortex in early adulthood contributes to symptom attenuation in many cases, meaning that individuals with cortical dysfunction are more likely to grow out of symptoms, whereas individuals with subcortical dysfunction may be less likely to do so. There is emerging evidence for a similar but distinct disorder arising de novo in adulthood.

Type
Review Articles
Copyright
© College of Psychiatrists of Ireland 2017 

Access options

Get access to the full version of this content by using one of the access options below.

References

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th edn. American Psychiatric Publishing: Arlington, VA.Google Scholar
Agnew-Blais, JC, Polanczyk, GV, Danese, A, Wertz, J, Moffitt, TE, Arseneault, L (2016). Evaluation of the persistence, remission, and emergence of attention-deficit/hyperactivity disorder in young adulthood. JAMA Psychiatry 73, 713720.CrossRefGoogle ScholarPubMed
Asherson, P, Chen, W, Craddock, B, Taylor, E (2007). Adult attention-deficit hyperactivity disorder: recognition and treatment in general adult psychiatry. British Journal of Psychiatry 190, 45.CrossRefGoogle ScholarPubMed
Asherson, P, Young, AH, Eich-Höchli, D, Moran, P, Porsdal, V, Deberdt, W (2014). Differential diagnosis, comorbidity, and treatment of attention-deficit/hyperactivity disorder in relation to bipolar disorder or borderline personality disorder in adults. Current Medical Research and Opinion 30, 16571672.CrossRefGoogle ScholarPubMed
Barkley, RA, Cox, D (2007). A review of driving risks and impairments associated with attention-deficit/hyperactivity disorder and the effects of stimulant medication on driving performance. Journal of Safety Research 38, 113128.CrossRefGoogle ScholarPubMed
Biederman, J, Mick, E, Faraone, SV (2000). Age-dependent decline of symptoms of attention deficit hyperactivity disorder: impact of remission definition and symptom type. American Journal of Psychiatry 157, 816818.CrossRefGoogle ScholarPubMed
Bitsakou, P, Psychogiou, L, Thompson, M, Sonuga-Barke, EJ (2009). Delay aversion in attention deficit/hyperactivity disorder: an empirical investigation of the broader phenotype. Neuropsychologia 47, 446456.CrossRefGoogle ScholarPubMed
Bush, G (2010). Attention-deficit/hyperactivity disorder and attention networks. Neuropsychopharmacology 35, 278300.CrossRefGoogle ScholarPubMed
Castellanos, FX (2015). Is adult-onset ADHD a distinct entity? American Journal of Psychiatry 172, 929931.CrossRefGoogle ScholarPubMed
Castellanos, FX, Aoki, Y (2016). Intrinsic functional connectivity in attention-deficit/hyperactivity disorder: a science in development. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging 1, 253261.Google ScholarPubMed
Castellanos, FX, Margulies, DS, Kelly, C, Uddin, LQ, Ghaffari, M, Kirsch, A, Shaw, D, Shehzad, Z, DI Martino, A, Biswal, B, Sonuga-Barke, EJ, Rotrosen, J, Adler, LA, Milham, MP (2008). Cingulate-precuneus interactions: a new locus of dysfunction in adult attention-deficit/hyperactivity disorder. Biological Psychiatry 63, 332337.CrossRefGoogle ScholarPubMed
Castellanos, FX, Proal, E (2012). Large-scale brain systems in ADHD: beyond the prefrontal-striatal model. Trends in Cognitive Science 16, 1726.CrossRefGoogle ScholarPubMed
Chandra, S, Biederman, J, Faraone, SV (2016). Assessing the validity of the age at onset criterion for diagnosing ADHD in DSM-5. Journal of Attention Disorders, Feb 27. pii: 1087054716629717. [Epub ahead of print].CrossRefGoogle ScholarPubMed
Cook, J, Knight, E, Hume, I, Qureshi, A (2014). The self-esteem of adults diagnosed with attention-deficit/hyperactivity disorder (ADHD): a systematic review of the literature. Attention Deficit and Hyperactivity Disorders 6, 249268.CrossRefGoogle ScholarPubMed
Cortese, S, Kelly, C, Chabernaud, C, Proal, E, DI Martino, A, Milham, MP, Castellanos, FX (2012). Toward systems neuroscience of ADHD: a meta-analysis of 55 fMRI studies. American Journal of Psychiatry 169, 10381055.CrossRefGoogle ScholarPubMed
Dickstein, SG, Bannon, K, Castellanos, FX, Milham, MP (2006). The neural correlates of attention deficit hyperactivity disorder: an ALE meta-analysis. Journal of Child Psychology and Psychiatry 47, 10511062.CrossRefGoogle ScholarPubMed
Dixon, ML, Christoff, K (2014). The lateral prefrontal cortex and complex value-based learning and decision making. Neuroscience & Biobehavioral Reviews 45, 918.CrossRefGoogle ScholarPubMed
Faraone, SV, Biederman, J, Mick, E (2006). The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies. Psychological Medicine 36, 159165.CrossRefGoogle ScholarPubMed
Fassbender, C, Schweitzer, JB (2006). Is there evidence for neural compensation in attention deficit hyperactivity disorder? A review of the functional neuroimaging literature. Clinical Psychological Reviews 26, 445465.CrossRefGoogle ScholarPubMed
Fassbender, C, Zhang, H, Buzy, WM, Cortes, CR, Mizuiri, D, Beckett, L, Schweitzer, JB (2009). A lack of default network suppression is linked to increased distractibility in ADHD. Brain Research 1273, 114128.CrossRefGoogle ScholarPubMed
Francx, W, Oldehinkel, M, Oosterlaan, J, Heslenfeld, D, Hartman, CA, Hoekstra, PJ, Franke, B, Beckmann, CF, Buitelaar, JK, Mennes, M (2015). The executive control network and symptomatic improvement in attention-deficit/hyperactivity disorder. Cortex 73, 6272.CrossRefGoogle ScholarPubMed
Hoogman, M, Bralten, J, Hibar, DP, Mennes, M, Zwiers, MP, Schweren, LS, Van Hulzen, KJ, Medland, SE, Shumskaya, E, Jahanshad, N, Zeeuw, P, Szekely, E, Sudre, G, Wolfers, T, Onnink, AM, Dammers, JT, Mostert, JC, Vives-Gilabert, Y, Kohls, G, Oberwelland, E, Seitz, J, Schulte-Rüther, M, Ambrosino, S, Doyle, AE, Høvik, MF, Dramsdahl, M, Tamm, L, Van Erp, TG, Dale, A, Schork, A, Conzelmann, A, Zierhut, K, Baur, R, Mccarthy, H, Yoncheva, YN, Cubillo, A, Chantiluke, K, Mehta, MA, Paloyelis, Y, Hohmann, S, Baumeister, S, Bramati, I, Mattos, P, Tovar-Moll, F, Douglas, P, Banaschewski, T, Brandeis, D, Kuntsi, J, Asherson, P, Rubia, K, Kelly, C, Martino, AD, Milham, MP, Castellanos, FX, Frodl, T, Zentis, M, Lesch, KP, Reif, A, Pauli, P, Jernigan, TL, Haavik, J, Plessen, KJ, Lundervold, AJ, Hugdahl, K, Seidman, LJ, Biederman, J, Rommelse, N, Heslenfeld, DJ, Hartman, CA, Hoekstra, PJ, Oosterlaan, J, Polier, GV, Konrad, K, Vilarroya, O, Ramos-Quiroga, JA, Soliva, JC, Durston, S, Buitelaar, JK, Faraone, SV, Shaw, P, Thompson, PM, Franke, B (2017). Subcortical brain volume differences in participants with attention deficit hyperactivity disorder in children and adults: a cross-sectional mega-analysis. Lancet Psychiatry 4, 310319.Google Scholar
Kappel, V, Lorenz, RC, Streifling, M, Renneberg, B, Lehmkuhl, U, Ströhle, A, Salbach-Andrae, H, Beck, A (2015). Effect of brain structure and function on reward anticipation in children and adults with attention deficit hyperactivity disorder combined subtype. Social Cognitive and Affective Neuroscience 10, 945951.CrossRefGoogle ScholarPubMed
Kessler, D, Angstadt, M, Sripada, C (2016). Growth charting of brain connectivity networks and the identification of attention impairment in youth. JAMA Psychiatry 73, 481489.CrossRefGoogle ScholarPubMed
Kooij, SJ, Bejerot, S, Blackwell, A, Caci, H, Casas-Brugué, M, Carpentier, PJ, Edvinsson, D, Fayyad, J, Foeken, K, Fitzgerald, M, Gaillac, V, Ginsberg, Y, Henry, C, Krause, J, Lensing, MB, Manor, I, Niederhofer, H, Nunes-Filipe, C, Ohlmeier, MD, Oswald, P, Pallanti, S, Pehlivanidis, A, Ramos-Quiroga, JA, Rastam, M, Ryffel-Rawak, D, Stes, S, Asherson, P (2010). European consensus statement on diagnosis and treatment of adult ADHD: the European network adult ADHD. BMC Psychiatry 10, 67.CrossRefGoogle ScholarPubMed
Lampe, K, Konrad, K, Kroener, S, Fast, K, Kunert, HJ, Herpertz, SC (2007). Neuropsychological and behavioural disinhibition in adult ADHD compared to borderline personality disorder. Psychological Medicine 37, 17171729.CrossRefGoogle ScholarPubMed
Lara, C, Fayyad, J, De Graaf, R, Kessler, RC, Aguilar-Gaxiola, S, Angermeyer, M, Demytteneare, K, De Girolamo, G, Haro, JM, Jin, R, Karam, EG, Lépine, JP, Mora, ME, Ormel, J, Posada-Villa, J, Sampson, N (2009). Childhood predictors of adult attention-deficit/hyperactivity disorder: results from the World Health Organization World Mental Health Survey Initiative. Biological Psychiatry 65, 4654.CrossRefGoogle ScholarPubMed
Marchant, BK, Reimherr, FW, Robison, D, Robison, RJ, Wender, PH (2013). Psychometric properties of the Wender-Reimherr Adult Attention Deficit Disorder Scale. Psychological Assessment 25, 942950.CrossRefGoogle ScholarPubMed
Mills, KL, Goddings, AL, Clasen, LS, Giedd, JN, Blakemore, SJ (2014). The developmental mismatch in structural brain maturation during adolescence. Developmental Neuroscience 36, 147160.CrossRefGoogle ScholarPubMed
Moffitt, TE, Houts, R, Asherson, P, Belsky, DW, Corcoran, DL, Hammerle, M, Harrington, H, Hogan, S, Meier, MH, Polanczyk, GV, Poulton, R, Ramrakha, S, Sugden, K, Williams, B, Rohde, LA, Caspi, A (2015). Is adult ADHD a childhood-onset neurodevelopmental disorder? Evidence from a four-decade longitudinal cohort study. American Journal of Psychiatry 172, 967977.CrossRefGoogle ScholarPubMed
Mostert, JC, Onnink, AM, Klein, M, Dammers, J, Harneit, A, Schulten, T, Van Hulzen, KJ, Kan, CC, Slaats-Willemse, D, Buitelaar, JK, Franke, B, Hoogman, M (2015). Cognitive heterogeneity in adult attention deficit/hyperactivity disorder: a systematic analysis of neuropsychological measurements. European Neuropsychopharmacology 25, 20622074.CrossRefGoogle ScholarPubMed
O’malley, GK, Mchugh, L, Mac Giollabhui, N, Bramham, J (2016). Characterizing adult attention-deficit/hyperactivity-disorder and comorbid borderline personality disorder: ADHD symptoms, psychopathology, cognitive functioning and psychosocial factors. European Psychiatry 31, 2936.CrossRefGoogle ScholarPubMed
Oosterlaan, J, Sergeant, JA (1998). Response inhibition and response re-engagement in attention-deficit/hyperactivity disorder, disruptive, anxious and normal children. Behavioural Brain Research 94, 3343.CrossRefGoogle ScholarPubMed
Ortiz, N, Parsons, A, Whelan, R, Brennan, K, Agan, ML, O’connell, R, Bramham, J, Garavan, H (2015). Decreased frontal, striatal and cerebellar activation in adults with ADHD during an adaptive delay discounting task. Acta Neurobiologiae Experimentalis (Wars) 75, 326338.Google ScholarPubMed
Peterson, BS, Potenza, MN, Wang, Z, Zhu, H, Martin, A, Marsh, R, Plessen, KJ, Yu, S (2009). An FMRI study of the effects of psychostimulants on default-mode processing during Stroop task performance in youths with ADHD. American Journal of Psychiatry 166, 12861294.CrossRefGoogle ScholarPubMed
Posner, J, Park, C, Wang, Z (2014). Connecting the dots: a review of resting connectivity MRI studies in attention-deficit/hyperactivity disorder. Neuropsychology Review 24, 315.CrossRefGoogle ScholarPubMed
Raichle, ME (2015). The brain’s default mode network. Annual Review of Neuroscience 38, 433447.CrossRefGoogle ScholarPubMed
Rubia, K (2007). Neuro-anatomic evidence for the maturational delay hypothesis of ADHD. Proceedings of the National Academy of Sciences of the United States of America 104, 1966319664.CrossRefGoogle ScholarPubMed
Sripada, CS, Kessler, D, Angstadt, M (2014). Lag in maturation of the brain’s intrinsic functional architecture in attention-deficit/hyperactivity disorder. Proceedings of the National Academy of Sciences of the United States of America 111, 1425914264.CrossRefGoogle ScholarPubMed
Tripp, G, Wickens, JR (2008). Research review: dopamine transfer deficit: a neurobiological theory of altered reinforcement mechanisms in ADHD. Journal of Child Psychology and Psychiatry 49, 691704.CrossRefGoogle ScholarPubMed
Volkow, ND, Wang, GJ, Tomasi, D, Kollins, SH, Wigal, TL, Newcorn, JH, Telang, FW, Fowler, JS, Logan, J, Wong, CT, Swanson, JM (2012). Methylphenidate-elirefd dopamine increases in ventral striatum are associated with long-term symptom improvement in adults with attention deficit hyperactivity disorder. Journal of Neuroscience 32, 841849.CrossRefGoogle ScholarPubMed

Altmetric attention score

Full text views

Full text views reflects PDF downloads, PDFs sent to Google Drive, Dropbox and Kindle and HTML full text views.

Total number of HTML views: 196
Total number of PDF views: 659 *
View data table for this chart

* Views captured on Cambridge Core between 04th December 2017 - 17th April 2021. This data will be updated every 24 hours.

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Attending to adult ADHD: a review of the neurobiology behind adult ADHD
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Attending to adult ADHD: a review of the neurobiology behind adult ADHD
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Attending to adult ADHD: a review of the neurobiology behind adult ADHD
Available formats
×
×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *