Leisman Gerry, Melillo Robert
Movement and Cognition Laboratory, Department of Physical Therapy, University of Haifa, Haifa, Israel.
Department of Neurology, University of Medical Sciences of Havana, Havana, Cuba.
Front Neuroanat. 2022 Aug 23;16:936025. doi: 10.3389/fnana.2022.936025. eCollection 2022.
Frontal lobe function may not universally explain all forms of attention deficit hyperactivity disorder (ADHD) but the frontal lobe hypothesis described supports an internally consistent model for integrating the numerous behaviors associated with ADHD. The paper examines the developmental trajectories of frontal and prefrontal lobe development, framing ADHD as maturational dysregulation concluding that the cognitive, motor, and behavioral abilities of the presumptive majority of ADHD children may not primarily be disordered or dysfunctional but reflect maturational dysregulation that is inconsistent with the psychomotor and cognitive expectations for the child's chronological and mental age. ADHD children demonstrate decreased activation of the right and middle prefrontal cortex. Prefrontal and frontal lobe regions have an exuberant network of shared pathways with the diencephalic region, also having a regulatory function in arousal as well as with the ascending reticular formation which has a capacity for response suppression to task-irrelevant stimuli. Prefrontal lesions oftentimes are associated with the regulatory breakdown of goal-directed activity and impulsivity. In conclusion, a presumptive majority of childhood ADHD may result from maturational dysregulation of the frontal lobes with effects on the direct, indirect and/or, hyperdirect pathways.
额叶功能可能无法普遍解释所有形式的注意力缺陷多动障碍（ADHD），但所描述的额叶假说支持了一个内部一致的模型，用于整合与ADHD相关的众多行为。本文研究了额叶和前额叶发育的轨迹，将ADHD界定为成熟失调，得出结论：大多数ADHD儿童的认知、运动和行为能力可能并非主要是紊乱或功能失调，而是反映了与儿童实际年龄和心理年龄的心理运动及认知期望不一致的成熟失调。ADHD儿童表现出右侧和前额叶中部皮质的激活减少。前额叶和额叶区域与间脑区域有丰富的共享通路网络，在唤醒方面以及与具有抑制对任务无关刺激反应能力的上行网状结构中也具有调节功能。前额叶病变常常与目标导向活动和冲动的调节障碍有关。总之，大多数儿童ADHD可能是由额叶成熟失调导致的，对直接、间接和/或超直接通路产生影响。
