Jakobi Babette, Arias-Vasquez Alejandro, Hermans Erno, Vlaming Priscilla, Buitelaar Jan, Franke Barbara, Hoogman Martine, van Rooij Daan
Department of Human Genetics, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands.
Centre for Cognitive Neuroimaging, Donders Institute for Brain Cognition and Behavior, Nijmegen, Netherlands.
Front Psychiatry. 2022 May 19;13:840095. doi: 10.3389/fpsyt.2022.840095. eCollection 2022.
Despite not being part of the core diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD), emotion dysregulation is a highly prevalent and clinically important component of (adult) ADHD. Emotionally dysregulated behaviors such as reactive aggression have a significant impact on the functional outcome in ADHD. However, little is known about the mechanisms underlying reactive aggression in ADHD. In this study, we aimed to identify the neural correlates of reactive aggression as a measure of emotionally dysregulated behavior in adults with persistent ADHD during implicit emotion regulation processes. We analyzed associations of magnetic resonance imaging-based whole-brain activity during a dynamic facial expression task with levels of reactive aggression in 78 adults with and 78 adults without ADHD, and also investigated relationships of reactive aggression with symptoms and impairments. While participants with ADHD had higher reactive aggression scores than controls, the neural activation patterns of both groups to processing of emotional faces were similar. However, investigating the brain activities associated with reactive aggression in individuals with and without ADHD showed an interaction of diagnosis and reactive aggression scores. We found high levels of activity in the right insula, the hippocampus, and middle and superior frontal areas to be particularly associated with high reactive aggression scores within the ADHD group. Furthermore, the limbic activity was associated with more hyperactivity/impulsivity symptoms. These results suggest a partly differential mechanism associated with reactive aggression in ADHD as compared to controls. Emotional hyper-reactivity in the salience network as well as more effortful top-down regulation from the self-regulation network might contribute to emotionally dysregulated behavior as measured by reactive aggression.
尽管情绪失调并非注意力缺陷多动障碍（ADHD）核心诊断标准的一部分，但它却是（成人）ADHD中高度普遍且具有临床重要性的组成部分。诸如反应性攻击等情绪失调行为对ADHD的功能结局有重大影响。然而，关于ADHD中反应性攻击背后的机制却知之甚少。在本研究中，我们旨在确定反应性攻击的神经关联，以此作为持续性ADHD成人在隐性情绪调节过程中情绪失调行为的一种度量。我们分析了78名患有ADHD的成人和78名未患ADHD的成人在动态面部表情任务期间基于磁共振成像的全脑活动与反应性攻击水平之间的关联，还研究了反应性攻击与症状及功能损害之间的关系。虽然患有ADHD的参与者的反应性攻击得分高于对照组，但两组对情绪面孔加工的神经激活模式相似。然而，对患有和未患ADHD个体中与反应性攻击相关的大脑活动进行研究时发现，诊断与反应性攻击得分之间存在交互作用。我们发现，右侧脑岛、海马以及额中回和额上回区域的高水平活动与ADHD组内的高反应性攻击得分特别相关。此外，边缘系统活动与更多的多动/冲动症状相关。这些结果表明，与对照组相比，ADHD中与反应性攻击相关的机制存在部分差异。显著性网络中的情绪过度反应以及来自自我调节网络的更费力的自上而下调节可能导致以反应性攻击衡量的情绪失调行为。
