Lee Ka Shu, Xiao Jingyuan, Luo Jiajun, Leibenluft Ellen, Liew Zeyan, Tseng Wan-Ling
Department of Experimental Psychology, Medical Sciences Division, University of Oxford, Oxford, United Kingdom.
Yale Child Study Center, Yale School of Medicine, New Haven, CT, United States.
Front Psychiatry. 2022 Mar 4;13:803891. doi: 10.3389/fpsyt.2022.803891. eCollection 2022.
Attention-deficit/hyperactivity disorder (ADHD), characterized by symptoms of inattention and/or hyperactivity and impulsivity, is a neurodevelopmental disorder associated with executive dysfunctions, including response inhibition and error processing. Research has documented a common co-occurrence between ADHD and pediatric irritability. The latter is more characterized by affective symptoms, specifically frequent temper outbursts and low frustration tolerance relative to typically developing peers. Shared and non-shared neural correlates of youths with varied profiles of ADHD and irritability symptoms during childhood remain largely unknown. This study first classified a large sample of youths in the Adolescent Brain Cognitive Development (ABCD) study at baseline into distinct phenotypic groups based on ADHD and irritability symptoms ( = 11,748), and then examined shared and non-shared neural correlates of response inhibition and error processing during the Stop Signal Task in a subset of sample with quality neuroimaging data ( = 5,948). Latent class analysis (LCA) revealed four phenotypic groups, i.e., high ADHD with co-occurring irritability symptoms ( = 787, 6.7%), moderate ADHD with low irritability symptoms ( = 901, 7.7%), high irritability with no ADHD symptoms ( = 279, 2.4%), and typically developing peers with low ADHD and low irritability symptoms ( = 9,781, 83.3%). Latent variable modeling revealed group differences in the neural coactivation network supporting response inhibition in the fronto-parietal regions, but limited differences in error processing across frontal and posterior regions. These neural differences were marked by decreased coactivation in the irritability only group relative to youths with ADHD and co-occurring irritability symptoms and typically developing peers during response inhibition. Together, this study provided initial evidence for differential neural mechanisms of response inhibition associated with ADHD, irritability, and their co-occurrence. Precision medicine attending to individual differences in ADHD and irritability symptoms and the underlying mechanisms are warranted when treating affected children and families.
注意力缺陷多动障碍（ADHD）以注意力不集中和/或多动及冲动症状为特征，是一种与执行功能障碍相关的神经发育障碍，包括反应抑制和错误处理。研究表明ADHD与儿童易激惹症常同时出现。后者更以情感症状为特征，特别是相对于正常发育的同龄人而言，频繁发脾气和低挫折容忍度。儿童期具有不同ADHD和易激惹症状特征的青少年的共享和非共享神经关联在很大程度上仍不为人知。本研究首先在基线时将青少年大脑认知发展（ABCD）研究中的大量青少年样本（n = 11748）根据ADHD和易激惹症状分为不同的表型组，然后在具有高质量神经影像数据的样本子集（n = 5948）中，研究在停止信号任务期间反应抑制和错误处理的共享和非共享神经关联。潜在类别分析（LCA）揭示了四个表型组，即伴有易激惹症状的高ADHD组（n = 787，6.7%）、伴有低易激惹症状的中度ADHD组（n = 901，7.7%）、无ADHD症状的高易激惹组（n = 279，2.4%）以及伴有低ADHD和低易激惹症状的正常发育同龄人组（n = 9781，83.3%）。潜在变量建模显示，在支持额顶叶区域反应抑制的神经共激活网络中存在组间差异，但在额叶和后部区域的错误处理方面差异有限。这些神经差异的标志是，在反应抑制期间，仅易激惹组相对于伴有ADHD和易激惹症状的青少年以及正常发育的同龄人，其共激活减少。总之，本研究为与ADHD、易激惹及其共现相关的反应抑制的不同神经机制提供了初步证据。在治疗受影响的儿童和家庭时，考虑ADHD和易激惹症状的个体差异及其潜在机制的精准医学是必要的。
