Neural substrates of decision making in adults with attention deficit hyperactivity disorder.

Full Abstract

OBJECTIVE:
The characteristics of attention deficit hyperactivity disorder (ADHD) include abnormalities in reward responsivity that may interfere with decision making. The study examined reward responsivity in ADHD by comparing the neural correlates of decision making in adults with childhood-onset ADHD and in healthy adults.

METHOD:
The neural correlates of performance on a decision-making task and a control task were compared in 10 adults with ADHD and 12 age-matched healthy volunteers by using [(15)O]H(2)O positron emission tomography. The decision-making task tested the ability to weigh short-term rewards against long-term losses. The control task matched all components of the decision-making task except for the decision-making process and related contingency.

RESULTS:
The ventral and dorsolateral prefrontal cortex and the insula were activated during performance of the decision-making task in both the ADHD and healthy groups; however, activation in the ADHD group was less extended and did not involve other regions, such as anterior cingulate and hippocampus, that subserve emotion/memory processes. Direct comparison of data from the ADHD subjects and the healthy volunteers suggested that the healthy subjects engaged the hippocampal and insular regions more than did the ADHD subjects and that the ADHD subjects recruited the caudal part of the right anterior cingulate more than did the healthy subjects.

CONCLUSIONS:
The findings suggest that the neural circuits engaged during decision making differ in subjects with ADHD and healthy comparison subjects. This difference may explain observed deficits in motivated behaviors in ADHD. A better understanding of the nature of these deficits could ultimately be applied to refine treatment strategies for ADHD.

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Author information

Author/s: Ernst, Monique (M); Kimes, Alane S (AS); London, Edythe D (ED); Matochik, John A (JA); Eldreth, Dana (D); Tata, Satya (S); Contoreggi, Carlo (C); Leff, Michelle (M); Bolla, Karen (K);

Affiliation: Intramural Research program, NIMH, Natioanl Institute on Drug Abuse, Baltimore, MD, USA. ernstm(-atsign-)intra.nimh.nih.gov

Grants: DA-11426 (Agency:NIDA NIH HHS) ; RR-02719 (Agency:NCRR NIH HHS)

Journal and publication information

Publication Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.

Journal: The American journal of psychiatry (Am J Psychiatry), published in United States. (Language: eng)

Reference: 2003-Jun; vol 160 (issue 6) : pp 1061-70

Dates: Created 2003/06/02; Completed 2003/07/23; Revised 2007/11/14;

PMID: 12777263, status: MEDLINE (last retrieval date: 12/26/2008)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Adult
Attention Deficit Disorder with Hyperactivity - diagnosis; physiopathology; radionuclide imaging
Brain - blood supply; physiology; radionuclide imaging
Brain Mapping - methods
Cerebral Cortex - blood supply; physiology; radionuclide imaging
Decision Making - physiology
Female
Frontal Lobe - blood supply; physiology; radionuclide imaging
Humans

Humans
Male
Middle Aged
Motivation
Prefrontal Cortex - blood supply; physiology; radionuclide imaging
Regional Blood Flow - physiology
Reward
Task Performance and Analysis
Tomography, Emission-Computed

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