ADHD: Neural Correlates of Adult Outcomes

描述（由申请人提供）：本申请基于以下假设，即至少部分不同的神经和认知机制参与了注意缺陷/多动障碍合并型（ADHD-C）的病因和康复。我们假设ADHD-C是由于后脑/中脑区域网状结构中出现的神经系统的初级缺陷，这种缺陷在个体发育早期就存在，并且在一生中保持相对静止。此外，我们假设在整个发育过程中经常看到的症状的减轻与额纹状体系统能够通过使用努力或“自上而下”的执行控制来补偿这些早期缺陷的程度有关。为了验证这一假设，我们建议在三组年轻人中使用功能磁共振成像（fMRI）和神经认知测量。两组由纵向样本的患者组成，他们都符合儿童时期ADHD-C的标准。其中，许多人可以明确地确定为ADHD持续性（ADHD- p）或ADHD缓解（ADHD- r）。此外，我们有匹配良好的对照组，他们从未达到任何亚型ADHD的标准。因此，我们将评估ADHD-C不同发育途径的神经相关因素。如果我们的假设是正确的，那么无论成年后的临床状态如何，出现网状结构的系统的行为和功能磁共振成像指数应该与患有儿童ADHD-C的对照组不同。相比之下，额纹状体功能的测量应作为成人状态的函数而变化，例如成年期ADHD症状越严重，这些测量的效率越低，而那些不再有明显ADHD症状的人的表现应与从未有过ADHD的对照组更相似。

DESCRIPTION (provided by applicant): This application is based on the hypothesis that at least partially distinct neural and cognitive mechanisms are involved in the etiology of and recovery from Attention-deficit/Hyperactivity Disorder - combined type (ADHD-C). We posit that ADHD-C is due to a primary deficit in a neural system emerging from the reticular formation within the hindbrain/midbrain region that is present early in ontogeny and remains relatively static throughout the lifetime. Further, we posit that the diminution of symptoms frequently seen throughout development is related to the degree to which frontostriatal systems are able to compensate for these early deficits through the use of effort or "top-down" executive control. To test this hypothesis, we propose to use functional magnetic resonance imaging (fMRI) along with neurocognitive measures in three groups of young adults. Two groups consist of patients from a longitudinal sample, all of whom met criteria for ADHD-C during childhood. Among these, many can be clearly identified either as ADHD persisters (ADHD-P) or ADHD remitters (ADHD-R). In addition, we have well-matched controls who never met criteria for any subtype of ADHD. Thus, we will evaluate the neural correlates of diverse developmental pathways in ADHD-C. If our hypotheses are correct, behavioral and fMRI indices of the system emerging the reticular formation should differ from controls in those who had childhood ADHD-C irrespective of adult clinical status. In contrast, measures of frontostriatal function should vary as a function of adult status such that more severe ADHD symptoms in adulthood are associated with poorer efficiency on these measures while those no longer having significant ADHD symptoms should perform more similarly to never-ADHD controls.