“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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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. "

    Full-text · Article · Feb 2016 · Clinical Psychopharmacology and Neuroscience
    • "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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    ABSTRACT: Background: Ineffective decision making is a major source of everyday functional impairment and reduced quality of life for young people with mental disorders. However, very little is known about what distinguishes decision making by individuals with different disorders or the neuropsychological processes or brain systems underlying these. This is the focus of the current review. Scope and methodology: We first propose a neuroeconomic model of the decision-making process with separate stages for the prechoice evaluation of expected utility of future options; choice execution and postchoice management; the appraisal of outcome against expectation; and the updating of value estimates to guide future decisions. According to the proposed model, decision making is mediated by neuropsychological processes operating within three domains: (a) self-referential processes involved in autobiographical reflection on past, and prospection about future, experiences; (b) executive functions, such as working memory, inhibition, and planning, that regulate the implementation of decisions; and (c) processes involved in value estimation and outcome appraisal and learning. These processes are underpinned by the interplay of multiple brain networks, especially medial and lateralized cortical components of the default mode network, dorsal corticostriatal circuits underpinning higher order cognitive and behavioral control, and ventral frontostriatal circuits, connecting to brain regions implicated in emotion processing, that control valuation and learning processes. Findings and conclusion: Based on clinical insights and considering each of the decision-making stages in turn, we outline disorder-specific hypotheses about impaired decision making in four childhood disorders: attention-deficit/hyperactivity disorder (ADHD), conduct disorder (CD), depression, and anxiety. We hypothesize that decision making in ADHD is deficient (i.e. inefficient, insufficiently reflective, and inconsistent) and impulsive (biased toward immediate over delayed alternatives). In CD, it is reckless and insensitive to negative consequences. In depression, it is disengaged, perseverative, and pessimistic, while in anxiety, it is hesitant, risk-averse, and self-deprecating. A survey of current empirical indications related to these disorder-specific hypotheses highlights the limited and fragmentary nature of the evidence base and illustrates the need for a major research initiative in decision making in childhood disorders. The final section highlights a number of important additional general themes that need to be considered in future research.
    Full-text · Article · Dec 2015 · Journal of Child Psychology and Psychiatry
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