“Cool” Inferior Frontostriatal Dysfunction in Attention-Deficit/Hyperactivity Disorder Versus “Hot” Ventromedial Orbitofrontal-Limbic Dysfunction in Conduct Disorder: A Review

Department of Child Psychiatry/Medical Research Council Center for Social, Genetic and Developmental Psychiatry, Institute of Psychiatry, London, United Kingdom.
Biological psychiatry (Impact Factor: 10.26). 11/2010; 69(12):e69-87. DOI: 10.1016/j.biopsych.2010.09.023
Source: PubMed


Attention-deficit/hyperactivity disorder (ADHD) and conduct disorder overlap behaviorally, clinically, and cognitively. An important question of potential future clinical relevance is whether these two overlapping disorders are mediated by similar or distinct underlying brain substrates. This article reviews the modern neuroimaging literature on brain structure, function, and connectivity in both disorders, shaping out commonalities and differences. Findings show that ADHD is characterized predominantly by abnormalities in inferior frontal, striatal, parietotemporal, and cerebellar regions and networks that mediate "cool"-cognitive, i.e., inhibitory, attention and timing functions associated with the disorder. Conduct disorder, by contrast, has consistently been associated with abnormalities of the "hot" paralimbic system that regulates motivation and affect, comprising lateral orbital and ventromedial prefrontal cortices, superior temporal lobes, and underlying limbic structures, most prominently the amygdala. Direct comparisons in functional imaging show that these associations of cool inferior fronto-striato-cerebellar dysfunction in ADHD and of hot orbitofrontal-paralimbic dysfunction in conduct disorder are disorder-specific. There is, hence, evidence for dissociated underlying pathophysiologies for these two disorders that may have implications for future anatomy-based differential diagnosis and prevention and intervention.

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    • "First, children with ODD perform more poorly than controls on " hot " EF tasks such as computerized gambling tasks (Luman, Sergeant, Knol, & Oosterlaan, 2010; Matthys, van Goozen, Snoek, & Van Engeland, 2004). Second , Hobson, Scott, and Rubia (2011) found that ODD/conduct disorder (CD) symptoms, but not ADHD symptoms, were related to poor performance on a " hot " EF task (i.e., Iowa Gambling Task). Finally, a recent study comparing neuropsychological performance on a " hot " EF task (i.e., Balloon Analog Risk Task) found that children with ADHD + ODD displayed riskier behavior than children with ADHD alone (Humphreys & Lee, 2011). "
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    ABSTRACT: While neuropsychological deficits in both “hot” and “cool” executive functions (EFs) have been documented among individuals with attention-deficit/hyperactivity disorder (ADHD), these EF deficits are not universal across all individuals with this diagnosis. One potential moderator of executive dysfunction may be the presence of comorbid oppositional defiant disorder (ODD). This study examined the association between “hot” and “cool” EFs and comorbid ODD in children with ADHD. Thirty-three children with ADHD and comorbid ODD (ADHD+ODD), 67 with ADHD without ODD (ADHD-ODD), and 30 typically developing controls participated. Children were 7–12 years of age. “Cool” EFs were assessed with a spatial span task and a card sorting test. “Hot” EFs were assessed using a delay discounting task and a gambling task. ADHD-ODD and ADHD+ODD groups performed more poorly on “cool” EF tasks than controls, but did not differ from each other. Furthermore, the number of ADHD symptoms, but not ODD symptoms, was associated with “cool” EF scores. The three groups did not differ on “hot” EF tasks and the number of ADHD or ODD symptoms was unrelated to “hot” EF scores. In sum, children with ADHD presented with “cool” EF deficits which appear to be unrelated to ODD comorbidity. However, “hot” EF deficits were not present among children with ADHD, irrespective of comorbid ODD status. ( JINS , 2015, 21 , 584–595)
    Journal of the International Neuropsychological Society 09/2015; 21(8):584-595. DOI:10.1017/S1355617715000752 · 2.96 Impact Factor
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    • "Previous structural imaging studies consistently report abnormal morphometry (Nakao, Radua, Rubia, & Mataix-Cols, 2011) and developmental trajectories (Shaw et al., 2012) in the prefrontal, cingulate and parietal structures in ADHD. Both qualitative review (Rubia, 2011) and meta-analyses (Cortese et al., 2012; Hart, Radua, Nakao, Mataix-Cols, Rubia, 2013) on task-fMRI document hypoactivation of the components within the FPCN in ADHD across tasks. Rs-fMRI studies using various analytic methods also suggest involvement of the FPCN in ADHD (Cao et al., 2006; Posner et al., 2013; Qiu et al., 2011; Wang et al., 2009; Zang et al., 2007). "
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    ABSTRACT: The frontoparietal control network, anatomically and functionally interposed between the dorsal attention network and default mode network, underpins executive control functions. Individuals with attention-deficit/hyperactivity disorder (ADHD) commonly exhibit deficits in executive functions, which are mainly mediated by the frontoparietal control network. Involvement of the frontoparietal control network based on the anterior prefrontal cortex in neurobiological mechanisms of ADHD has yet to be tested. We used resting-state functional MRI and seed-based correlation analyses to investigate functional connectivity of the frontoparietal control network in a sample of 25 children with ADHD (7–14 years; mean 9.94±1.77 years; 20 males), and 25 age-, sex-, and performance IQ-matched typically developing (TD) children. All participants had limited in-scanner head motion. Spearman’s rank correlations were used to test the associations between altered patterns of functional connectivity with clinical symptoms and executive functions, measured by the Conners’ Continuous Performance Test and Spatial Span in the Cambridge Neuropsychological Test Automated Battery. Compared with TD children, children with ADHD demonstrated weaker connectivity between the right anterior prefrontal cortex (PFC) and the right ventrolateral PFC, and between the left anterior PFC and the right inferior parietal lobule. Furthermore, this aberrant connectivity of the frontoparietal control network in ADHD was associated with symptoms of impulsivity and opposition-defiance, as well as impaired response inhibition and attentional control. The findings support potential integration of the disconnection model and the executive dysfunction model for ADHD. Atypical frontoparietal control network may play a pivotal role in the pathophysiology of ADHD. ( JINS , 2015, 21 , 271–284)
    Journal of the International Neuropsychological Society 04/2015; 21(04):1-14. DOI:10.1017/S135561771500020X · 2.96 Impact Factor
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    • "The question remains as to how orbital-ventral medial dysfunction can lead to both internalizing anxiety-OCD and externalizing conduct disorders. Again, circuit balance theory can be extended to consider these possibilities, with circuit underactivity found in conduct disorder (e.g., Rubia, 2011) and circuit overactivity related to anxiety and obsessive-compulsive symptoms (e.g., Stern et al., 2012). There may be a lateralizing effect as well here and in other conditions, with the left FSC dysfunction or underactivation leading to depressive symptoms (Grimm et al., 2009) and ADHD symptoms related to right FSC dysfunction or underactivation (Arnsten & Rubia, 2012; Bush, 2011), which would be consistent with hemispheric studies of emotion and behavior (Beraha et al., 2012; Holtgraves & Felton, 2011). "
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    ABSTRACT: Attention to self and environment form the basis of effective social exchange and relationships. Although implicit in this basic social competency is the ability to be self-aware and responsive to the circumstances of others, many neuropsychologists have yet to understand or measure its basic functions, let alone recognize the brain-behavior relationships that govern this area. Several years ago, interest in "emotional intelligence" rose to the forefront of popular psychology, but we are still unraveling the cortical, subcortical, and neurocellular interactions that produce this nebulous construct, and we are determining how dysfunctional frontal-subcortical and cortico-cerebellar circuitry can lead to aberrant social dynamics and ultimately psychopathology when maladaptive patterns become routinized. In this article, we explore the orbital-ventral medial circuitry thought to govern emotional attention, personal self-regulation, social concern and exchange, and affective aspects of interpersonal relationships. Our examination notes both the dearth of and need for neuropsychological research on the biological basis and measurement of executive regulation of emotional attention, behavioral regulation, and social competence. We conclude with a call for development of neuropsychological measures and methods that can foster differential diagnosis and targeted treatment strategies for children with orbital-ventral medial circuit dysfunction.
    03/2015; 4(2):1-10. DOI:10.1080/21622965.2015.1005486
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