Neural substrates of decision making in adults with attention deficit hyperactivity disorder.
OBJECTIVE
The characteristics of attention deficit hyperactivity disorder (ADHD) include abnormalities in reward responsivity that may interfere with decision making. The study examined reward responsivity in ADHD by comparing the neural correlates of decision making in adults with childhood-onset ADHD and in healthy adults.


METHODS
The neural correlates of performance on a decision-making task and a control task were compared in 10 adults with ADHD and 12 age-matched healthy volunteers by using [(15)O]H(2)O positron emission tomography. The decision-making task tested the ability to weigh short-term rewards against long-term losses. The control task matched all components of the decision-making task except for the decision-making process and related contingency.


RESULTS
The ventral and dorsolateral prefrontal cortex and the insula were activated during performance of the decision-making task in both the ADHD and healthy groups; however, activation in the ADHD group was less extended and did not involve other regions, such as anterior cingulate and hippocampus, that subserve emotion/memory processes. Direct comparison of data from the ADHD subjects and the healthy volunteers suggested that the healthy subjects engaged the hippocampal and insular regions more than did the ADHD subjects and that the ADHD subjects recruited the caudal part of the right anterior cingulate more than did the healthy subjects.


CONCLUSIONS
The findings suggest that the neural circuits engaged during decision making differ in subjects with ADHD and healthy comparison subjects. This difference may explain observed deficits in motivated behaviors in ADHD. A better understanding of the nature of these deficits could ultimately be applied to refine treatment strategies for ADHD.
Ernst
Monique
M
Intramural Research program, NIMH, Natioanl Institute on Drug Abuse, Baltimore, MD, USA. ernstm@intra.nimh.nih.gov
Kimes
Alane S
AS
London
Edythe D
ED
Matochik
John A
JA
Eldreth
Dana
D
Tata
Satya
S
Contoreggi
Carlo
C
Leff
Michelle
M
Bolla
Karen
K
D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D001921:Brain / Q000098:blood supply / Q000000981:diagnostic imaging / Q000502:physiology*; D001931:Brain Mapping / Q000379:methods*; D002540:Cerebral Cortex / Q000098:blood supply / Q000000981:diagnostic imaging / Q000502:physiology; D003657:Decision Making / Q000502:physiology*; D005260:Female; D005625:Frontal Lobe / Q000098:blood supply / Q000000981:diagnostic imaging / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D017397:Prefrontal Cortex / Q000098:blood supply / Q000000981:diagnostic imaging / Q000502:physiology; D012039:Regional Blood Flow / Q000502:physiology; D012201:Reward; D013647:Task Performance and Analysis; D014055:Tomography, Emission-Computed