注意缺陷多动障碍相关的额皮质下脑区功能连接的性别差异，及其与延迟折扣的关联。
ADHD-related sex differences in fronto-subcortical intrinsic functional connectivity and associations with delay discounting.
机构信息
Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, MD, 21205, USA.
Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, 21205, USA.
出版信息
J Neurodev Disord. 2018 Dec 13;10(1):34. doi: 10.1186/s11689-018-9254-9.
BACKGROUND
Attention-deficit/hyperactivity disorder (ADHD) is associated with atypical fronto-subcortical neural circuitry and heightened delay discounting, or a stronger preference for smaller, immediate rewards over larger, delayed rewards. Recent evidence of ADHD-related sex differences in brain structure and function suggests anomalies in fronto-subcortical circuitry may differ among girls and boys with ADHD. The current study examined whether the functional connectivity (FC) within fronto-subcortical neural circuitry differs among girls and boys with ADHD compared to same-sex typically developing (TD) controls and relates to delay discounting.
METHODS
Participants include 8-12-year-old children with ADHD (n = 72, 20 girls) and TD controls (n = 75, 21 girls). Fronto-subcortical regions of interest were functionally defined by applying independent component analysis to resting-state fMRI data. Intrinsic FC between subcortical components, including the striatum and amygdala, and prefrontal components, including ventromedial prefrontal cortex (vmPFC), anterior cingulate cortex (ACC), and anterior dorsolateral prefrontal cortex (dlPFC), was compared across diagnostic groups overall and within sex. Correlations between intrinsic FC of the six fronto-subcortical pairs and delay discounting were also examined.
RESULTS
Both girls and boys with ADHD show atypical FC between vmPFC and subcortical regions including the striatum (stronger positive FC in ADHD) and amygdala (weaker negative FC in ADHD), with the greatest diagnostic effects among girls. In addition, girls with ADHD show atypical intrinsic FC between the striatum and dlPFC components, including stronger positive FC with ACC and stronger negative FC with dlPFC. Further, girls but not boys, with ADHD, show heightened real-time delay discounting. Brain-behavior correlations suggest (1) stronger negative FC between the striatal and dlPFC components correlated with greater money delay discounting across all participants and (2) stronger FC between the amygdala with both the dlPFC and ACC components was differentially related to heightened real-time discounting among girls and boys with and without ADHD.
CONCLUSIONS
Our findings suggest fronto-subcortical functional networks are affected in children with ADHD, particularly girls, and relate to delay discounting. These results also provide preliminary evidence of greater disruptions in fronto-subcortical FC among girls with ADHD that is not due to elevated inattention symptom severity, intellectual reasoning ability, age, or head motion.
背景
注意力缺陷多动障碍（ADHD）与额皮质下神经回路的非典型性以及延迟折扣增加有关，即人们更倾向于选择较小的、即时的奖励，而不是较大的、延迟的奖励。最近关于 ADHD 相关的性别差异在大脑结构和功能上的证据表明，ADHD 患者的额皮质下神经回路异常可能在男孩和女孩之间存在差异。本研究通过比较 ADHD 儿童与同性别正常发育（TD）对照组之间额皮质下神经回路的功能连接（FC），以及与延迟折扣的关系，来探究 ADHD 儿童是否存在这种差异。
方法
参与者包括 8-12 岁的 ADHD 儿童（n=72，20 名女孩）和 TD 对照组（n=75，21 名女孩）。额皮质下的感兴趣区域通过对静息态 fMRI 数据进行独立成分分析来进行功能定义。对包括腹内侧前额叶皮层（vmPFC）、前扣带皮层（ACC）和前背外侧前额叶皮层（dlPFC）在内的皮质下成分和前额叶成分之间的内在 FC 进行比较，包括整个诊断组和性别内的比较。还检查了六个额皮质下对之间的内在 FC 与延迟折扣之间的相关性。
结果
ADHD 患儿的女孩和男孩的 vmPFC 与皮质下区域（包括纹状体和杏仁核）之间的 FC 均表现出异常，在 ADHD 中表现为更强的正相关（FC 增加），而在杏仁核中表现为更弱的负相关（FC 降低），且女孩的诊断效果最大。此外，ADHD 女孩表现出纹状体与 dlPFC 成分之间的内在 FC 异常，包括与 ACC 的正相关更强和与 dlPFC 的负相关更强。此外，ADHD 女孩但不是男孩表现出更高的实时延迟折扣。脑-行为相关性表明：1）纹状体和 dlPFC 成分之间的负相关 FC 与所有参与者的金钱延迟折扣呈正相关；2）杏仁核与 dlPFC 和 ACC 成分之间的正相关与 ADHD 患儿和无 ADHD 患儿实时折扣的增加呈负相关。
结论
我们的研究结果表明，ADHD 患儿，特别是女孩，额皮质下功能网络受到影响，并与延迟折扣有关。这些结果还提供了初步证据，表明 ADHD 女孩的额皮质下 FC 中断更为严重，而这并非由于注意力不集中症状严重程度、智力推理能力、年龄或头部运动增加所致。
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