Valmiki Mrinaal, Fawzy Peter, Valmiki Surbhi, Aid Mohamed A, Chaitou Ali R, Zahid Maria, Khan Safeera
Psychiatry, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Neurological Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Cureus. 2021 Mar 5;13(3):e13718. doi: 10.7759/cureus.13718.
Attention-deficit hyperactivity disorder (ADHD) is a neuropsychological disorder that causes inattentiveness, hyperactivity, and impulsiveness in patients. Ventral striatal hypo-responsiveness, orbitofrontal cortex, and dopaminergic status in the brain are related to the pathogenesis of ADHD. Reinforcement tasks by monetary incentive delay (MID) was shown to produce more responsiveness in patients. In this study, we reviewed how reinforcement interventions and compensatory mechanisms affect the behavior of ADHD patients. This systematic review was undertaken as per the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, and PubMed database was used for literature search. The quality appraisal was completed using the Newcastle-Ottawa scale, and nine case-control studies were included in this systematic review. A total of 976 participants were included, with 493 cases and 330 controls. The studies included discuss reinforcement, attention networks, and compensatory mechanisms. Our review concludes that reinforcement improves responsiveness to gain and loss of rewards in ADHD patients. Reward processing is selectively associated with the salience network. While ADHD, predominantly the inattentive type, is insensitive to stimuli, ADHD combined type and controls showed similar responsiveness. The right visual cortex may also be related to compensatory mechanisms in ADHD. As we only included case-control studies from the last eight years, in the English language, we might have missed some relevant studies related to this research. Because the included studies have a relatively small sample size, we recommend future studies to explore larger cohorts of patients to improve the reliability of findings pertinent to this field.
注意力缺陷多动障碍（ADHD）是一种神经心理障碍，会导致患者出现注意力不集中、多动和冲动行为。大脑腹侧纹状体反应低下、眶额皮质和多巴胺能状态与ADHD的发病机制有关。货币奖励延迟（MID）强化任务显示能使患者产生更多反应。在本研究中，我们回顾了强化干预和代偿机制如何影响ADHD患者的行为。本系统评价按照系统评价和Meta分析的首选报告项目指南进行，使用PubMed数据库进行文献检索。使用纽卡斯尔-渥太华量表完成质量评估，本系统评价纳入了9项病例对照研究。总共纳入了976名参与者，其中493例病例和330例对照。纳入的研究讨论了强化、注意力网络和代偿机制。我们的综述得出结论，强化可提高ADHD患者对奖励得失的反应性。奖励处理与突显网络选择性相关。虽然ADHD，主要是注意力不集中型，对刺激不敏感，但ADHD混合型和对照组表现出相似的反应性。右侧视觉皮层也可能与ADHD的代偿机制有关。由于我们只纳入了过去八年的英文病例对照研究，我们可能遗漏了一些与本研究相关的研究。由于纳入的研究样本量相对较小，我们建议未来的研究探索更大的患者队列，以提高该领域相关研究结果的可靠性。
