Elsevier

Biological Psychiatry

Volume 62, Issue 9, 1 November 2007, Pages 999-1006
Biological Psychiatry

Original Article
Temporal Lobe Dysfunction in Medication-Naïve Boys With Attention-Deficit/Hyperactivity Disorder During Attention Allocation and Its Relation to Response Variability

https://doi.org/10.1016/j.biopsych.2007.02.024Get rights and content

Background

Patients with attention-deficit/hyperactivity disorder (ADHD) typically show fronto-striatal abnormalities during functions of cognitive control. In this study we investigate whether medication-naïve children with ADHD are impaired in temporo-parietal neural networks that mediate purely perceptual attention allocation to a behaviorally neutral oddball task. Furthermore, we explore the relationship between the neural substrates of attention allocation and response variability, typically increased in patients.

Method

Event-related functional magnetic resonance imaging was used to compare brain activation of 17 medication-naïve boys with ADHD with that of 18 handedness- and IQ-matched healthy comparison boys during a visual oddball task that required the same response to oddball and standard trials. Furthermore, to explore the relationship between behavioral dispersion and attention networks, regression analyses were conducted between response variability and brain activation networks.

Results

Patients showed significantly reduced brain activation in left and right superior temporal lobes, basal ganglia, and posterior cingulate during the oddball versus standard contrast. The activation differences in superior temporal lobes correlated inversely with response variability in control subjects but not in patients with ADHD.

Conclusions

Brain abnormalities in patients with ADHD are not confined to fronto-striatal networks mediating executive functions but are also observed in temporo-striatal and cingulate regions during perceptive visual attention processes. Furthermore, temporal lobe dysfunction in the context of perceptual attention might be related to their behavioral problems with response variability.

Section snippets

Subjects

Patients were 17 right-handed male adolescents, in the age range from 9 to 16 years, recruited from parent support groups, clinics, and advertisement. Clinical diagnosis of combined subtype of ADHD (DSM IV) (24) was established through interviews with a trained psychiatrist with the standardized Maudsley diagnostic interview (25), which includes a systematic symptom checklist excluding autism and other pervasive developmental disorders, bipolar disorder, and affective and anxiety disorders.

Task Performance

As expected, patients with ADHD compared with control adolescents showed increased variability of response to both standard and oddball trials (Table 2). This difference was more pronounced during standard trials. Consequently, the between-group ANOVAs were co-varied for the combined intra-subject–SD to standard and oddball trials. Within each group and across groups, the intra-subject variability of response was highly correlated with reaction times (r > .7, p < .004). Consequently, all

Discussion

Medication-naïve patients with ADHD had no specific deficits related to the oddball condition but, as expected, showed increased response variability during both standard and oddball conditions. During the oddball versus standard contrast, patients with ADHD compared with control subjects showed reduced brain activation in left and right superior and middle temporal cortices reaching subcortically into bilateral insula and right basal ganglia and bordering the inferior parietal lobes in the

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