严重早期剥夺后广泛的皮质厚度减少：注意缺陷多动障碍的神经发育途径。
Widespread reductions in cortical thickness following severe early-life deprivation: a neurodevelopmental pathway to attention-deficit/hyperactivity disorder.
作者信息
McLaughlin Katie A, Sheridan Margaret A, Winter Warren, Fox Nathan A, Zeanah Charles H, Nelson Charles A
机构信息
Boston Children's Hospital, Harvard Medical School, Boston; Harvard Center on the Developing Child, Cambridge, Massachusetts.
Boston Children's Hospital, Harvard Medical School, Boston; Harvard Center on the Developing Child, Cambridge, Massachusetts.
出版信息
Biol Psychiatry. 2014 Oct 15;76(8):629-38. doi: 10.1016/j.biopsych.2013.08.016. Epub 2013 Oct 3.
BACKGROUND
Children exposed to early-life psychosocial deprivation associated with institutional rearing are at markedly elevated risk of developing attention-deficit/hyperactivity disorder (ADHD). Neurodevelopmental mechanisms that explain the high prevalence of ADHD in children exposed to institutionalization are unknown. We examined whether abnormalities in cortical thickness and subcortical volume were mechanisms explaining elevations in ADHD among children raised in institutional settings.
METHODS
Data were drawn from the Bucharest Early Intervention Project, a cohort of children raised from early infancy in institutions in Romania (n = 58) and age-matched community control subjects (n = 22). Magnetic resonance imaging data were acquired when children were aged 8 to 10 years, and ADHD symptoms were assessed using the Health and Behavior Questionnaire.
RESULTS
Children reared in institutions exhibited widespread reductions in cortical thickness across prefrontal, parietal, and temporal regions relative to community control subjects. No group differences were found in the volume of subcortical structures. Reduced thickness across numerous cortical areas was associated with higher levels of ADHD symptoms. Cortical thickness in lateral orbitofrontal cortex, insula, inferior parietal cortex, precuneus, superior temporal cortex, and lingual gyrus mediated the association of institutionalization with inattention and impulsivity; additionally, supramarginal gyrus thickness mediated the association with inattention and fusiform gyrus thickness mediated the association with impulsivity.
CONCLUSIONS
Severe early-life deprivation disrupts cortical development resulting in reduced thickness in regions with atypical function during attention tasks in children with ADHD, including the inferior parietal cortex, precuneus, and superior temporal cortex. These reductions in thickness are a neurodevelopmental mechanism explaining elevated ADHD symptoms in children exposed to institutional rearing.
背景
早年经历与机构养育相关的心理社会剥夺的儿童患注意力缺陷多动障碍（ADHD）的风险显著升高。解释机构养育儿童中ADHD高患病率的神经发育机制尚不清楚。我们研究了皮质厚度和皮质下体积异常是否是解释机构养育儿童中ADHD患病率升高的机制。
方法
数据来自布加勒斯特早期干预项目，该队列包括在罗马尼亚机构中从婴儿早期开始养育的儿童（n = 58）和年龄匹配的社区对照受试者（n = 22）。在儿童8至10岁时获取磁共振成像数据，并使用健康与行为问卷评估ADHD症状。
结果
与社区对照受试者相比，在机构中养育的儿童前额叶、顶叶和颞叶区域的皮质厚度普遍降低。皮质下结构体积未发现组间差异。多个皮质区域厚度的降低与更高水平的ADHD症状相关。外侧眶额皮质、岛叶、顶下小叶、楔前叶、颞上皮质和舌回的皮质厚度介导了机构养育与注意力不集中和冲动之间的关联；此外，缘上回厚度介导了与注意力不集中的关联，梭状回厚度介导了与冲动的关联。
结论
严重的早年剥夺会破坏皮质发育，导致ADHD儿童在注意力任务期间功能异常区域的厚度降低，包括顶下小叶、楔前叶和颞上皮质。这些厚度的降低是一种神经发育机制，解释了机构养育儿童中ADHD症状升高的原因。
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