Institute of Child Development, University of Minnesota, Minneapolis, MN, USA.
Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA.
Nat Rev Neurosci. 2024 Dec;25(12):759-775. doi: 10.1038/s41583-024-00869-z. Epub 2024 Oct 24.
Extensive investigations spanning multiple levels of inquiry, from genetic to behavioural studies, have sought to unravel the mechanistic foundations of attention-deficit hyperactivity disorder (ADHD), with the aspiration of developing efficacious treatments for this condition. Despite these efforts, the pathogenesis of ADHD remains elusive. In this Review, we reflect on what has been learned about ADHD while also providing a framework that may serve as a roadmap for future investigations. We emphasize that ADHD is a highly heterogeneous disorder with multiple aetiologies that necessitates a multifactorial dimensional phenotype, rather than a fixed dichotomous conceptualization. We highlight new findings that suggest a more brain-wide, 'global' view of the disorder, rather than the traditional localizationist framework, which asserts that a limited set of brain regions or networks underlie ADHD. Last, we underscore how underpowered studies that have aimed to associate neurobiology with ADHD phenotypes have long precluded the field from making progress. However, a new age of ADHD research with refined phenotypes, advanced methods, creative study designs and adequately powered investigations is beginning to put the field on a good footing. Indeed, the field is at a promising juncture to advance the neurobiological understanding of ADHD and fulfil the promise of clinical utility.
广泛的研究涵盖了从遗传学到行为学的多个层次的探究,旨在揭示注意力缺陷多动障碍(ADHD)的机制基础,以期为此病症开发出有效的治疗方法。尽管付出了这些努力,但 ADHD 的发病机制仍然难以捉摸。在这篇综述中,我们反思了在研究 ADHD 方面所学到的知识,同时也提供了一个可能作为未来研究路线图的框架。我们强调 ADHD 是一种高度异质的疾病,具有多种病因,需要采用多因素的维度表型,而不是固定的二分概念化。我们强调了一些新的发现,这些发现表明,对于这种疾病,需要采用更广泛的“全局”脑观点,而不是传统的定位主义框架,后者认为 ADHD 是由有限数量的大脑区域或网络引起的。最后,我们强调了那些旨在将神经生物学与 ADHD 表型相关联的研究往往由于研究力量不足而长期阻碍了该领域的进展。然而,一个具有精细表型、先进方法、创造性研究设计和充分研究力量的 ADHD 研究新时代正在开始为该领域奠定良好的基础。事实上,该领域正处于一个有希望的阶段,可以推进对 ADHD 的神经生物学理解,并实现临床应用的承诺。