How ADHD symptoms can be modulated by immediate environment modifications ?: A behavioral and electrophysiological study
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A deeper understanding of how the relationships between impulsivity, reward systems and executive function deficits may be similar or different in attention-deficit/hyperactivity disorder (ADHD) and pediatric bipolar disorder (PBD) is fundamental for better defining phenotypy in these two developmental illnesses, and moving towards improved treatment and intervention. We focus our article on recent neurocognitive and neuroimaging data examining the behavioral and neural aspects of poor behavior regulation, response inhibition and reward systems in ADHD and PBD. In light of recent research evidence, we propose that the common behavioral manifestations of impulsivity in ADHD and PBD may indeed originate from different neural mechanisms mediated by altered reward systems. In order to define and differentiate these mechanisms, unlike previous approaches, our theoretical model examines the interface of the dorsal frontostriatal circuit, involved in behavior regulation, and the ventral frontostriatal circuit, which is involved in reward-related and affect processes. Preliminary evidence suggests that the neural systems involved in impulsivity, reward systems and executive function engage differently in the two illnesses. In PBD, ‘emotional impulsivity’ is predominantly ‘bottom-up’ and emotionally/motivationally driven, and stems from ventral frontostriatal circuitry dysfunction. By contrast, in ADHD ‘cognitive impulsivity’ is predominantly ‘top-down’ and more ‘cognitively driven’, and stems from dorsal frontostriatal dysfunction. We discuss this evidence in view of clinically relevant questions and implications for illness-based intervention. We conclude that the reward-related mechanisms underlying the interactions between executive function, behavior regulation and impulsivity in PBD and ADHD may be differentially compromised, and in accordance differently shape the clinical symptoms of impulsivity and goal-directed behavior.
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Although arousal mechanisms have frequently been found to be atypical in ADHD, these findings usually emerged from indirect behavioural measures which give only a limited understanding of arousal dysregulation in this condition. To assess the hypothesis that functioning of the autonomic nervous system (ANS), one component of arousal, is atypical in ADHD, we carried out a systematic review of the literature on 55 studies investigating electro-dermal, heart rate and pupillometry measures under different experimental conditions (resting-state, cognitive tasks and in response to reinforcers or socio-emotional stimuli). Our literature review identified ANS dysfunction in individuals with ADHD, more often in the direction of hypo-arousal than hyper-arousal, particularly at rest and during tasks requiring response regulation and sustained attention. Almost half of the reported findings were null. Stimulant medications increased ANS activity and, in some studies, reinforcers and rewards produced a similar effect, suggesting that ANS function can be modified in ADHD. Further research is needed to assess the influence of comorbid symptoms and to explore methodological parameters that may influence findings.
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