Department of Psychology, Florida International University, Miami, USA.
Department of Psychology, University of Texas at Austin, Austin, USA.
Res Child Adolesc Psychopathol. 2023 Nov;51(11):1565-1579. doi: 10.1007/s10802-023-01104-6. Epub 2023 Aug 5.
Attention-deficit/hyperactivity disorder (ADHD) is the most commonly diagnosed mental health disorder in childhood, however, there is well-established heterogeneity in both the presentation of ADHD symptoms and secondary characteristics across the literature. Existing Diagnostic and Statistical Manual of Mental Disorders (DSM-5) nosology has been ineffective in explaining such heterogeneity in terms of both pathophysiology and clinical trajectories. The current study investigated ADHD heterogeneity via a biologically-based, data-driven approach (k-Means algorithm). Specifically, unique biological profiles (derived from patterns of parasympathetic and sympathetic functioning) were identified and utilized as predictors of clinical presentations. Two hundred eighty-nine participants (167 youth with ADHD), ages 5 to 13 years, completed an emotion-based task while indexes of parasympathetic (i.e., respiratory sinus arrhythmia [RSA]) and sympathetic (i.e., electrodermal activity [EDA]) activity were obtained. Overall, results suggest that three distinct biological profiles among youth with ADHD are evident, with biological profiles differing in regulation and arousal levels during emotionally evocative contexts: (Profile 1) underregulated, hyperaroused (negative contexts only), (Profile 2) typically regulated, underaroused, and (Profile 3) overregulated (positive contexts only), hyperaroused. Results are supported by several dopaminergic- and reward-based theories, integrating differing concepts across the literature, and adds biological support for existing models. Behaviorally, results may translate into differing clinical presentations, however, further work is needed. In general, youth with ADHD are heterogenous in autonomic functioning, which could have implications for synthesizing across differing theories within the literature, predicting clinical presentations, and developing targeted treatments.
注意缺陷多动障碍（ADHD）是儿童期最常见的精神健康障碍，但在文献中，ADHD 症状的表现和次要特征都存在明显的异质性。现有的《精神障碍诊断与统计手册》（DSM-5）分类学在解释病理生理学和临床轨迹方面的这种异质性方面一直效果不佳。本研究通过基于生物学的、数据驱动的方法（k-均值算法）研究 ADHD 的异质性。具体来说，从副交感神经和交感神经功能的模式中识别出独特的生物学特征，并将其用作临床表现的预测因子。289 名参与者（167 名患有 ADHD 的青少年）年龄在 5 至 13 岁之间，完成了一项基于情绪的任务，同时获得了副交感神经（即呼吸窦性心律失常[RSA]）和交感神经（即皮肤电活动[EDA]）活动的指标。总的来说，结果表明，ADHD 青少年中存在三种不同的生物学特征，这些特征在情绪唤起的环境中表现出不同的调节和唤醒水平：（特征 1）调节不足，过度唤醒（仅在负面环境中），（特征 2）通常调节，唤醒不足，和（特征 3）过度调节（仅在正面环境中），过度唤醒。这些结果得到了几种多巴胺能和奖励基础理论的支持，整合了文献中的不同概念，并为现有的模型提供了生物学支持。从行为上看，这些结果可能转化为不同的临床表现，但还需要进一步的研究。一般来说，ADHD 青少年的自主神经功能存在异质性，这可能对综合文献中的不同理论、预测临床表现和开发针对性治疗方法具有重要意义。
