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

  • L. Alexander (a1) (a2) (a3) and N. Farrelly (a4)
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.

Copyright
Corresponding author
*Address for correspondence: Dr L. Alexander, Department of Psychiatry, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland. (Email: lalexander30@gmail.com)
References
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American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th edn. American Psychiatric Publishing: Arlington, VA.
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.
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.
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.
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.
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.
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.
Bush, G (2010). Attention-deficit/hyperactivity disorder and attention networks. Neuropsychopharmacology 35, 278300.
Castellanos, FX (2015). Is adult-onset ADHD a distinct entity? American Journal of Psychiatry 172, 929931.
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.
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.
Castellanos, FX, Proal, E (2012). Large-scale brain systems in ADHD: beyond the prefrontal-striatal model. Trends in Cognitive Science 16, 1726.
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].
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.
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.
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.
Dixon, ML, Christoff, K (2014). The lateral prefrontal cortex and complex value-based learning and decision making. Neuroscience & Biobehavioral Reviews 45, 918.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Mills, KL, Goddings, AL, Clasen, LS, Giedd, JN, Blakemore, SJ (2014). The developmental mismatch in structural brain maturation during adolescence. Developmental Neuroscience 36, 147160.
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.
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.
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.
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.
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.
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.
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.
Raichle, ME (2015). The brain’s default mode network. Annual Review of Neuroscience 38, 433447.
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.
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.
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.
Volkow, ND, Wang, GJ, Tomasi, D, Kollins, SH, Wigal, TL, Newcorn, JH, Telang, FW, Fowler, JS, Logan, J, Wong, CT, Swanson, JM (2012). Methylphenidate-elicited dopamine increases in ventral striatum are associated with long-term symptom improvement in adults with attention deficit hyperactivity disorder. Journal of Neuroscience 32, 841849.
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