Liu Ningning, Jia Gaoding, Li Haimei, Zhang Shiyu, Wang Yufeng, Niu Haijing, Liu Lu, Qian Qiujin
Peking University Sixth Hospital/Institute of Mental Health, Beijing, 100191, China.
NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China.
Child Adolesc Psychiatry Ment Health. 2022 Jun 27;16(1):54. doi: 10.1186/s13034-022-00486-7.
Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder. Many previous studies have shown that the comorbid status of disruptive behaviour disorders (DBD) was a predictor for ADHD persistence into adulthood. However, the brain mechanisms underlying such a relationship remain unclear. Thus, we aim to investigate whether the brain functional alteration in adults with ADHD could also be detected in children with ADHD co-occurring with disruptive behaviours from both quantitative and categorical dimensions.
A total of 172 children with ADHD (cADHD), 98 adults with ADHD (aADHD), 77 healthy control children (cHC) and 40 healthy control adults (aHC) were recruited. The whole-brain spontaneous fluctuations in brain activity of each participant were recorded using functional near-infrared spectroscopy (fNIRS), and the functional connectivities (FCs) were calculated. We first compared the FC differences between aADHD and aHC. Then, for the regions with significantly abnormal FCs in aADHD, we further compared these features between cADHD and cHC. In addition, the correlation between these FCs and the conduct disorder (CD)/oppositional defiant disorder (ODD) symptoms were analysed in cADHD. Moreover, to render the results readily interpretable, we compared the FC differences among ADHD, subthreshold ADHD and cHC groups, and among ADHD, ADHD and cHC groups. Finally, we repeated the above analysis after controlling for other comorbidities and core symptoms to diminish the potential confounding effects.
We found that compared with aHC, aADHD showed significantly increased FCs in the VN, DMN, SMN, and DAN. The aforementioned abnormal FCs were also detected in cADHD, however, in an opposite orientation. Notably, these abnormal FCs were positively correlated with CD symptoms. Finally, the subthreshold ADHD group even exhibited a tendency of adult-like increased FCs compared with the cHC. The results held after controlling for other comorbidities and core symptoms.
This study provides functional neuroimaging evidence that CD might be a risk factor for ADHD persistence into adulthood. Our work highlights the importance of differentiating ADHD from ADHD and inspiring further understanding of brain development in ADHD.
注意力缺陷多动障碍（ADHD）是一种常见的神经发育障碍。许多先前的研究表明，破坏性行为障碍（DBD）的共病状态是ADHD持续至成年期的一个预测因素。然而，这种关系背后的脑机制仍不清楚。因此，我们旨在从定量和分类维度研究患有ADHD且伴有破坏性行为的儿童中是否也能检测到成人ADHD患者的脑功能改变。
共招募了172名患有ADHD的儿童（cADHD）、98名患有ADHD的成人（aADHD）、77名健康对照儿童（cHC）和40名健康对照成人（aHC）。使用功能近红外光谱（fNIRS）记录每个参与者大脑活动的全脑自发波动，并计算功能连接（FC）。我们首先比较了aADHD和aHC之间的FC差异。然后，对于aADHD中FC显著异常的区域，我们进一步比较了cADHD和cHC之间的这些特征。此外，在cADHD中分析了这些FC与品行障碍（CD）/对立违抗障碍（ODD）症状之间的相关性。此外，为了使结果易于解释，我们比较了ADHD、亚阈值ADHD和cHC组之间以及ADHD、ADHD和cHC组之间的FC差异。最后，在控制其他共病和核心症状后重复上述分析，以减少潜在的混杂效应。
我们发现，与aHC相比，aADHD在腹侧注意网络（VN）、默认模式网络（DMN）、躯体运动网络（SMN）和背侧注意网络（DAN）中的FC显著增加。上述异常的FC在cADHD中也被检测到，然而，方向相反。值得注意的是，这些异常的FC与CD症状呈正相关。最后，与cHC相比，亚阈值ADHD组甚至表现出类似成人的FC增加趋势。在控制其他共病和核心症状后，结果仍然成立。
本研究提供了功能性神经影像学证据，表明CD可能是ADHD持续至成年期的一个危险因素。我们的工作强调了区分ADHD和亚阈值ADHD以及促进对ADHD脑发育的进一步理解的重要性。
