Article

“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

ABSTRACT

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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Available from: Katya Rubia, Dec 10, 2015
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    • "The T-scores in all sections in the medication-on condition were lower than in the medication-off condition (all p<0.01). Regarding Response Time, the main effect of the section was significant (GG: F[), and section (F[2,80]=4.40, p=0.01, η 2 =0.02) were significant. "

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    • "A latent structure of externalizing behavior in which multiple first-order factors (attention-deficit/hyperactivity disorder, oppositional defiant disorder, conduct disorder, substance use disorderss, and antisocial personality disorder) load on a single higher order factor (externalizing liability). 3. Some (e.g., Rubia, 2011) have suggested different central nervous system substrates for ADHD (frontostriatal) versus CD (ventromedial prefrontal). Although we acknowledge that ventromedial prefrontal cortex dysfunction , a likely neural substrate of emotion dysregulation (e.g., Goldsmith, Pollak, & Davidson, 2008), plays a role in the progression of ADHD to CD, we believe it emerges over time through PersonÂEnvironment transactions that can only be understood in developmental context (e.g., Beauchaine & Gatzke-Kopp, 2012; Beauchaine et al., 2007). "

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    • "Disruptions in brain regions such as the amygdala and anterior insula that are involved in the processing of valence and emotional and motivational salience are implicated in CD. Structural and functional changes in frontal and temporal regions have also been reported (Baker, Clanton, Rogers, & De Brito, 2015; Fairchild et al., 2011 Fairchild et al., , 2013 Fairchild et al., , 2015 Hyatt, Haney-Caron, & Stevens, 2012; Rubia, 2011). Treatment options include parenting interventions and multisystemic therapy (NICE 2013). "
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