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Specific cognitive–neurophysiological processes predict impulsivity in the childhood attention-deficit/hyperactivity disorder combined subtype

Published online by Cambridge University Press:  25 January 2016

A. Bluschke ,
V. Roessner  and
C. Beste
A. Bluschke
Affiliation:
Department of Child and Adolescent Psychiatry, Faculty of Medicine of the TU Dresden, Cognitive Neurophysiology, Dresden, Germany
V. Roessner
Affiliation:
Department of Child and Adolescent Psychiatry, Faculty of Medicine of the TU Dresden, Cognitive Neurophysiology, Dresden, Germany
C. Beste*
Affiliation:
Department of Child and Adolescent Psychiatry, Faculty of Medicine of the TU Dresden, Cognitive Neurophysiology, Dresden, Germany
*
*Address for correspondence: C. Beste, Department of Child and Adolescent Psychiatry, Faculty of Medicine of the TU Dresden, Cognitive Neurophysiology, Schubertstrasse 42, D-01309 Dresden, Germany. (Email: christian.beste@uniklinikum-dresden.de)
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Abstract

Background

Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent neuropsychiatric disorders in childhood. Besides inattention and hyperactivity, impulsivity is the third core symptom leading to diverse and serious problems. However, the neuronal mechanisms underlying impulsivity in ADHD are still not fully understood. This is all the more the case when patients with the ADHD combined subtype (ADHD-C) are considered who are characterized by both symptoms of inattention and hyperactivity/impulsivity.

Method

Combining high-density electroencephalography (EEG) recordings with source localization analyses, we examined what information processing stages are dysfunctional in ADHD-C (n = 20) compared with controls (n = 18).

Results

Patients with ADHD-C made more impulsive errors in a Go/No-go task than healthy controls. Neurophysiologically, different subprocesses from perceptual gating to attentional selection, resource allocation and response selection processes are altered in this patient group. Perceptual gating, stimulus-driven attention selection and resource allocation processes were more pronounced in ADHD-C, are related to activation differences in parieto-occipital networks and suggest attentional filtering deficits. However, only response selection processes, associated with medial prefrontal networks, predicted impulsive errors in ADHD-C.

Conclusions

Although the clinical picture of ADHD-C is complex and a multitude of processing steps are altered, only a subset of processes seems to directly modulate impulsive behaviour. The present findings improve the understanding of mechanisms underlying impulsivity in patients with ADHD-C and might help to refine treatment algorithms focusing on impulsivity.

Keywords

Attention-deficit/hyperactivity disordercombined subtypeelectroencephalographyimpulsivityresponse inhibition
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 6 , April 2016 , pp. 1277 - 1287
Copyright
Copyright © Cambridge University Press 2016 

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