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Abnormal Amygdala Functional Connectivity Associated With Emotional Lability in Children With Attention-Deficit/Hyperactivity Disorder
Open accessAbstract
Objective A substantial proportion of children with attention-deficit/hyperactivity disorder (ADHD) also display emotion regulation deficits manifesting as chronic irritability, severe temper outbursts, and aggression. The amygdala is implicated in emotion regulation, but its connectivity and relation to emotion regulation in ADHD has yet to be explored. The purpose of this study was to examine the relationship between intrinsic functional connectivity (iFC) of amygdala circuits and emotion regulation deficits in youth with ADHD. Method Bilateral amygdala iFC was examined using functional magnetic resonance imaging in 63 children with ADHD, aged 6 to 13 years. First, we examined the relationship between amygdala IFC and parent ratings of emotional lability (EL) in children with ADHD. Second, we compared amygdala iFC across subgroups of children with ADHD and high EL (n = 18), ADHD and low EL (n = 20), and typically developing children (TDC), all with low EL (n = 19). Results Higher EL ratings were associated with greater positive iFC between the amygdala and rostral anterior cingulate cortex in youth with ADHD. EL scores were also negatively associated with iFC between bilateral amygdala and posterior insula/superior temporal gyrus. Patterns of amygdala-cortical iFC in ADHD participants with low EL were not different from the comparison group, and the effect sizes for these comparisons were smaller than those for the trend-level differences observed between the high-EL and TDC groups. Conclusions In children with ADHD and a range of EL, deficits in emotion regulation were associated with altered amygdala-cortical iFC. When comparing groups that differed on ADHD status but not EL, differences in amygdala iFC were small and nonsignificant, highlighting the specificity of this finding to emotional deficits, independent of other ADHD symptoms.
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“These studies have consisted of relatively small samples and require replication, but nonetheless, suggest that anomalies within frontolimbic circuits, which are not typically associated with executive functions, may underlie emotional lability in children with ADHD.”
From Using Stimulants to Treat ADHD-Related Emotional Lability (2014) · cites this paper as [23]
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“revealing an enhanced intrinsic functional connectivity patterns between the amygdala–ACC/insula/STG in the high ED group (15).”
From Abnormal functional connectivity associated with emotional dysregulation in children with attention-deficit/hyperactivity disorder (2025) · cites this paper as [15]
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“only one study has subdivided ADHD patients into groups with high and low ED to explore their unique functional connectivity characteristics, and found that the effect sizes for the patterns of amygdala-cortical FC in ADHD participants with low ED were smaller than ADHD participants with the high ED and TDC groups (15).”
From Abnormal functional connectivity associated with emotional dysregulation in children with attention-deficit/hyperactivity disorder (2025) · cites this paper as [15]
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“Instead, this might possibly be due to having difficulty to allocate attention toward the appropriate cues (Muszkat et al., 2015) which itself might be as a result of amygdala intrinsic functional connectivity (Hulvershorn et al., 2014; Maier et al., 2014; Posner et al., 2011b).”
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“In summary, the role of PE exposure in the aetiology of other common neurodevelopmental disorders is less certain than it is for ASD and ADHD.”
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InfluentialUsing Stimulants to Treat ADHD-Related Emotional Lability
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Self-citationUltra-high field (10.5 T) resting state fMRI in the macaque
Yacoub, E. S., Grier, M. D., Auerbach, E. J., Lagore, R., Harel, N., Adriany, G., Zilverstand, A., Hayden, B. Y., Heilbronner, S. R., Uǧurbil, K., et al. (2020) · NeuroImage · doi:10.1016/j.neuroimage.2020.117349 · Cited by 62
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“Altered amygdala connectivity patterns have also been identified in children and adolescents with ADHD (Bebko et al., 2015; Hulvershorn et al., 2014; Posner et al., 2011).”
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“In addition, recent studies indicated that children with ADHD showed a decreased functional connectivity between the insula and amygdala interacting with emotional regulation (27, 28).”
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“Hulvershorn et al. (2014) also did not detect differences in amygdala iFC between HV and youths with ADHD plus high emotional lability, a phenotype resembling SMD (Merwood et al., 2014).”
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“Based on previous research indicating the amygdala’s role in irritability-related neural mechanisms (Dougherty et al., 2018; Hulvershorn et al., 2014; Kircanski et al., 2018; Kryza-Lacombe et al., 2019), the right and left amygdala were selected as connectivity seeds for the present study.”
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“More precisely, it is thought to play a role in the perception of emotions (55), processing of punishment (56), error awareness, and related actions (55, 57).”
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Beneath the surface: hyper-connectivity between caudate and salience regions in ADHD fMRI at rest
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“Inhibition difficulties, for instance, can be seen in the amygdalar hyperactivity and greater positive functional connectivity between the amygdala and rostral ACC (i.e., social pain network) in children with attentiondeficit/hyperactivity disorder (ADHD; Hulvershorn et al., 2014).”
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“One region consistently highlighted by structural MRI (Gibbard et al., 2017) and fMRI (Guo et al., 2016; Odriozola et al., 2018; Iidaka et al., 2019) studies is the amygdala.”
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InfluentialYue, X., Liu, L., Chen, W., Preece, D. A., Liu, Q., Li, H., Wang, Y., & Qian, Q. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.03.065 · Cited by 31
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“Consistent with this conclusion, a recent study found that, in children with ADHD, emotional symptoms were associated with abnormal amygdala-cortical intrinsic functional connectivity, which was independent of the core ADHD symptoms of inattention and hyperactivity-impulsivity [28].”
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“…with alterations in the prefrontal cortex (PFC), including orbitofrontal cortex (OFC), and the anterior cingulate cortex (ACC), as well as in limbic and reward areas such as the amygdala, insula, and accumbens (Hulvershorn et al., 2014; Passarotti et al., 2010; Posner et al., 2011, 2013).”
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“Previous seed-based studies of the affective network have found mixed results of hyper-connected and hypo-connected affective network in ADHD [22,39,40].”
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“, 2015), mood problems (Hulvershorn et al., 2014; Posner et al., 2014), and temperament difficulties in childhood (Karalunas et al.”
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Developmental Resting State Functional Connectivity for Clinicians
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Mindfulness as an Intervention for ADHD
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Altered Neuronal Responses During an Affective Stroop Task in Adolescents With Conduct Disorder
Fehlbaum, L. V., Raschle, N. M., Menks, W. M., Prätzlich, M., Flemming, E., Wyss, L., Euler, F., Sheridan, M. A., Sterzer, P., & Stadler, C. (2018) · Frontiers in Psychology · doi:10.3389/fpsyg.2018.01961 · Cited by 19
“…in a variety of psychiatric disorders linked to emotion processing and regulation deficits such as attention-deficit hyperactivity disorder (Hulvershorn et al., 2014), high-functioning autism spectrum disorder (Ebisch et al., 2011), depression (Bebko et al., 2015), post-traumatic stress…”
BackgroundAgoalikum, E., Klugah‐Brown, B., Wu, H., Hu, P., Jing, J., & Biswal, B. B. (2023) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2023.1076873 · Cited by 17
“Some recent works also showed reduced functional connectivity between the amygdala and insula interaction in regulating emotion in ADHD children (Hulvershorn et al., 2014; Yu et al., 2020); these findings further show the implication of the insula in ADHD.”
ResultSukhodolsky, D. G., Ibrahim, K., Kalvin, C. B., Jordan, R. P., Eilbott, J. A., & Hampson, M. (2021) · Social Cognitive and Affective Neuroscience · doi:10.1093/scan/nsab128 · Cited by 21
“Increased functional connectivity was reported between the amygdala and vmPFC/rostral anterior cingulate in children with attention-deficit hyperactivity disorder (ADHD) complicated by high emotional liability (Hulvershorn et al., 2014).”
BackgroundInfluentialThe Neural Correlates of Emotional Lability in Children with Autism Spectrum Disorder
Bennett, R. H., Somandepalli, K., Roy, A. K., & Martino, A. D. (2017) · Brain Connectivity · doi:10.1089/brain.2016.0472 · Cited by 15
“At the individual level, we measured the iFC of the amygdala bilaterally, chosen a priori as an region-of-interest (ROI; based on Harvard Oxford Atlas 50% probability as implemented in FSL) as in earlier studies (Hulvershorn et al., 2014).”
BackgroundMethodInfluentialSelf-citationWhat do ADHD Neuroimaging Studies Reveal for Teachers, Teacher Educators and Inclusive Education?
Boon, H. J. (2020) · Child & Youth Care Forum · doi:10.1007/s10566-019-09542-4 · Cited by 16
Musella, K. E., & Weyandt, L. L. (2022) · Applied Neuropsychology Child · doi:10.1080/21622965.2022.2119142 · Cited by 15
“…that participants were asked to suspend stimulant medication at least 24 h prior to scanning but were permitted to take psychotropic medications (Hulvershorn et al., 2014; Hwang et al., 2015, Nikolaidis et al., 2022), 20% of studies ( n ¼ 2) reported participants were asked to withhold…”
InfluentialKim, S. J., Tanglay, O., Chong, E. H. N., Young, I. M., Fonseka, R. D., Taylor, H. M., Nicholas, P. J., Doyen, S., & Sughrue, M. E. (2023) · Translational Neuroscience · doi:10.1515/tnsci-2022-0299 · Cited by 16
“…literature, the core phenotype of ADHD has extended beyond just de fi cits in motor inhibition and sustained attention to include a variety of non-cognitive symptoms such as dissociated emotional regulation [59], hyper-aggressiveness [60], emotional lability [61], and depressive symptoms [62].”
Not Only Mania or Depression: Mixed States/Mixed Features in Paediatric Bipolar Disorders
Janiri, D., Conte, E., Luca, I. D., Simone, M. V., Moccia, L., Simonetti, A., Mazza, M., Marconi, E., Monti, L., Chieffo, D. P. R., et al. (2021) · Brain Sciences · doi:10.3390/brainsci11040434 · Cited by 15
“, Emotional lability may depend on changes in subcortical structures, particularly in the limbic system [34], which has been reported as biomarkers of BD [35].”
BackgroundBarrett, C. E., Jiang, M., O'Flaherty, B. G., Dias, B. G., Rainnie, D. G., Young, L. J., & Menigoz, A. (2021) · The Journal of Nutritional Biochemistry · doi:10.1016/j.jnutbio.2022.109220 · Cited by 13
Stimulation Therapies and the Relevance of Fractal Dynamics to the Treatment of Diseases
Cheng, W., Law, P. K., Kwan, H. C., & Cheng, R. S. S. (2014) · Open Journal of Regenerative Medicine · doi:10.4236/ojrm.2014.34009 · Cited by 13
“As a result, extensive research has been performed supporting this notion of dysfunctional connectivity in numerous ailments such as schizophrenia [42]-[46], major depressive disorder (MDD) [47]-[50], attention-deficit hyperactivity disorder (ADHD) [51]-[53], post-traumatic stress disorder (PTSD) [54]-[56], obsessive-…”
BackgroundNielsen, K. H., Andria-Habermann, K., Richards, T. L., Abbott, R., Mickail, T., & Berninger, V. W. (2017) · Journal of Psychoeducational Assessment · doi:10.1177/0734282917698056 · Cited by 13
“Hulvershorn et al. (2014) reported abnormal levels of amygdala activation in ADHD.”
BackgroundShushakova, A., Wiesner, C. D., Ohrmann, P., & Pedersen, A. (2018) · Clinical Neurophysiology · doi:10.1016/j.clinph.2018.06.019 · Cited by 13
The Relationship Between Neuropsychological Deficits and Emotional Lability in Adults With ADHD
Gisbert, L., Vanesa Richarte, B., Montse Corrales, F., Ibáñez, P., Bosch, R., Bellina, M., Fadeuilhe, C., Casas, M., & Ramos‐Quiroga, J. A. (2018) · Journal of Attention Disorders · doi:10.1177/1087054718780323 · Cited by 14
“In addition, and in line with previous studies in children using a continuous approach (Banaschewski et al., 2012; Hulvershorn et al., 2014), we replicated our final model with EL scores as the outcome variable to ensure that conclusions did not vary if we used quantitative ratings for EL (supplementary material).”
BackgroundResultSegregation and integration of the functional connectome in neurodevelopmentally ‘at risk’ children
Jones, J. S., The CALM Team, & Astle, D. E. (2021) · Developmental Science · doi:10.1111/desc.13209 · Cited by 12
Lichenstein, S. D., Shaw, D. S., & Forbes, E. E. (2022) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2022.951204 · Cited by 10
“However, a variety of different patterns of aberrant white matter development may contribute to risk for psychopathology (Hulvershorn et al., 2014), and both delayed (Acheson et al.”
Neural Correlates of Reactive Aggression in Adult Attention-Deficit/Hyperactivity Disorder
Jakobi, B., Vásquez, A. A., Hermans, E. J., Vlaming, P., Buitelaar, J. K., Franke, B., Hoogman, M., & van Rooij, D. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.840095 · Cited by 14
“Our results on altered activity of limbic structures and the insula during emotion processing are in line with previous findings in medication-naive individuals with ADHD (22, 51).”
ResultLiu, Q.-R., Feng, Y., Chen, W., Zhu, Y., Preece, D. A., Gao, Y., Luo, X.-S., Dang, C., Wang, Y.-F., Sun, L., et al. (2025) · European Child and Adolescent Psychiatry · doi:10.1007/s00787-025-02643-7 · Cited by 11
Liu, L., Chen, W., Sun, L., Cheng, J., Su, Y., Rudaizky, D., Li, H., Yang, L., Qian, Q., & Wang, Y. (2017) · Journal of Attention Disorders · doi:10.1177/1087054717745594 · Cited by 11
“…ODD, and ADHD (Sobanski et al., 2010) has become a focus of ADHD research, notably in the area of their factorial validity and separation (Liu et al., 2019), and their underlying neural substrates as probed by neuroimaging studies (Hulvershorn et al., 2014; Posner et al., 2013; Yu et al., 2016).”
BackgroundConway, F. P. (2015) · Journal of Infant Child and Adolescent Psychotherapy · doi:10.1080/15289168.2015.1069235 · Cited by 10
“The neuroscientists are conducting research on ADHD also associates deficits in these regions of the brain with the ADHD symptoms of impulsivity, poor impulse control (Hulvershorn et al., 2014).”
BackgroundTsai, C., Lin, H., & Gau, S. S. (2024) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-024-01787-y · Cited by 10
“…emotion regulation (which is a part of the self-regulatory process [1]) as an example, two earlier rsfMRI studies reported that emotional dysregulation is associated with amygdalar iFC with rostral ACC and posterior insula [31] and orbito-frontal iFC with ventral striatum in youth with ADHD [21].”
Wu, Z.-M., Wang, P., Liu, X., Zhou, Q.-C., Cao, X., Liu, J., Sun, L., Liu, L., Cao, Q., Wang, Y., et al. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-06500-4 · Cited by 9
Mustika, D., Nishimura, Y., Ueno, S., Tominaga, S., Shimizu, T., Tajiri, N., Jung, C., & Hida, H. (2024) · Frontiers in Nutrition · doi:10.3389/fnut.2024.1356189 · Cited by 8
Okada, N., Yahata, N., Koshiyama, D., Morita, K., Sawada, K., Kanata, S., Fujikawa, S., Sugimoto, N., Toriyama, R., Masaoka, M., et al. (2019) · NeuroImage · doi:10.1016/j.neuroimage.2019.116478 · Cited by 7
Attention-Deficit Hyperactivity Disorder Across the Lifespan
Pliszka, S. R. (2016) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/appi.focus.20150022 · Cited by 10
Liu, L., Zhao, Q., Yu, X., Xu, D., Li, H., Ji, N., Wu, Z.-M., Cheng, J., Su, Y., Cao, Q., et al. (2020) · Journal of Attention Disorders · doi:10.1177/1087054719897838 · Cited by 7
“Hulvershorn et al. (2014) found that EL in children with ADHD may be associated with functional connectivity (FC) between the amygdala and the medial PFC (mPFC).”
BackgroundKim, Y. J., Jeon, S., Choi, J., Kim, N., Goto, Y., & Lee, Y. (2021) · Behavioural Pharmacology · doi:10.1097/fbp.0000000000000620 · Cited by 6
“Studies have shown that functional coupling between the AMY and PFC is associated with regulation of negative emotions and suppression of fears in normal subjects, which is altered in ADHD subjects (Hulvershorn et al., 2014; Stujenske et al., 2014).”
BackgroundYamashita, M., Kagitani‐Shimono, K., Hirano, Y., Hamatani, S., Nishitani, S., Yao, A., Kurata, S., Kosaka, H., Jung, M., Yoshida, T., et al. (2023) · BMJ Open · doi:10.1136/bmjopen-2022-070157 · Cited by 4
Kaiser, A., Reneman, L., Lucassen, P. J., Vries, T. J. D., Schrantee, A., & Kaag, A. M. (2021) · Brain Imaging and Behavior · doi:10.1007/s11682-021-00532-6 · Cited by 4
“For example, higher emotional lability has been associated with a hyper-connectivity of the corticoamygdalar network, including the anterior cingulate cortex, both in children and adolescents (Hulvershorn et al., 2014; Hafeman et al., 2017).”
BackgroundSangoi, J. A., Kozlowski, M. B., Feeney, K. E., Karalunas, S. L., Riopelle, C., Peraza, J. A., Smith, J. N., Lobo, R. P., González, R., Laird, A. R., et al. (2025) · Clinical Psychological Science · doi:10.1177/21677026251369850 · Cited by 3
“…and ventral attention networks (e.g., right inferior frontal gyrus), default mode network (e.g., rostral anterior cingulate cortex), and salience network (e.g., caudate/putamen) compared with TD youths with no/low levels of irritability (Hulvershorn et al., 2014; Mukherjee et al., 2022).”
Won, N. R., Son, Y., Kim, S. M., Bae, S., Kim, J.-H., Kim, J., & Han, D. H. (2023) · Clinical Psychopharmacology and Neuroscience · doi:10.9758/cpn.22.1029 · Cited by 3
“Emotional lability is thought to be related to hyperconnectivity of the amygdala network, which includes the anterior cingulate cortex [32].”
BackgroundMerzon, L., Tauriainen, S., Triana, A., Nurmi, T., Huhdanpää, H., Mannerkoski, M., Aronen, E. T., Kantonistov, M., Henriksson, L., Macaluso, E., et al. (2025) · PLoS ONE · doi:10.1371/journal.pone.0319746 · Cited by 3
“…from Data Protection office Helsinki University Central Hospital (tietosuo-ja@om.fi, 029 566 6700) and Aalto University’s legal counsel Annina Harju (anniina.harju@ aalto.fi). connectivity in the amygdala was shown to be associated with emotional liability symptoms in children with ADHD [28].”
Enteric nervous system, gut-brain connection and related neurodevelopmental disorders
Alim, E., Gülekon, N., Atalar, K., & Bahçelioğlu, M. (2020) · Anatomy (International Journal of Experimental and Clinical Anatomy) · doi:10.2399/ana.20.008 · Cited by 3
MRI Insights Into Adolescent Neurocircuitry—A Vision for the Future
Tymofiyeva, O., Zhou, V. X., Lee, C. M., Xu, D., Hess, C. P., & Yang, T. T. (2020) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2020.00237 · Cited by 6
Segregation and integration of the functional connectome in neurodevelopmentally ‘at risk’ childrenPreprint
Jones, J. S., the CALM Team, & Astle, D. E. (2021) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2021.05.11.443579 · Cited by 3
“…al., 2018) and functional connectivity in the limbic system has been associated with emotion regulation (Posner et al., 2013), emotional lability (Hulvershorn et al., 2014), temperament (Karalunas et al., 2014), aggressiveness and conduct problems (Ho et al., 2015), and depressive symptoms…”
BackgroundRepetitive Transcranial Magnetic Stimulation in ADHD
Theiner, P., Ustohal, L., Skřont, T., Bareš, M., & Kašpárek, T. (2015) · InTech eBooks · doi:10.5772/61158 · Cited by 2
Kim, Y., Kim, J., Cohen, A., Backus, M., Arnovitz, M. D., Rice, T., Luber, M. J., & Coffey, B. J. (2017) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2017.29138.bjc · Cited by 2
“As in A.’s case, children with ADHD may experience significant emotional lability and are known to have deficiencies in amygdalar connectivity (Hulvershorn et al. 2014).”
Weber, W. A., Tallman, M. J., Blom, T. J., Schurdak, J. D., Patino, L. R., & McNamara, R. K. (2018) · Journal of Nutritional Therapeutics · doi:10.6000/1929-5634.2017.06.04.3 · Cited by 2
“associated with greater positive functional connectivity between the amygdala and rostral ACC in ADHD children [12].”
BackgroundLi, S., Luo, T., Wang, M., Situ, M., Liu, P., & Huang, Y. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1700693 · Cited by 1
An investigation of the neural basis of anger attributions in irritable youth.
Benda, M. S., DeSerisy, M. L., Levitch, C. F., & Roy, A. K. (2023) · Emotion · doi:10.1037/emo0001337 · Cited by 1
Self-citation
Metadata
- Authors
- Hulvershorn, L. A., Mennes, M., Castellanos, F. X., Di Martino, A., Milham, M. P., Hummer, T. A., & Roy, A. K.
- Affiliations
- Riley Hospital for Children (US)
- Radboud University Medical Center (NL)
- Nathan Kline Institute for Psychiatric Research (US)
- Fordham University (US)
- Corresponding author
- Hulvershorn, Leslie A.
- ORCID
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2014-03
- Volume
- 53
- Issue
- 3
- Pages
- 351-361.e1
- ISSN
- 0890-8567 (ISSN-L)
- PMC
- PMC3961844
- OpenAlex
- W2127237900
- Cited by
- 138
- References
- 57
- Citations by year
- 2026: 10 · 2025: 7 · 2024: 6 · 2023: 10 · 2022: 9 · 2021: 24 · 2020: 9 · 2019: 3 · 2018: 13 · 2017: 13 · 2016: 10 · 2015: 13 · 2014: 10
- FWCI
- 7.79
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- IUScholarWorks (Indiana University) (submittedVersion)
- Funders
- National Institute of Mental Health (K23MH087770, K23MH074821, R01MH081218)
- National Institute on Drug Abuse (K12DA000357)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD065282)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Life Sciences › Neuroscience › Cognitive Neuroscience › Functional Brain Connectivity Studies
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Keywords
- attention deficit hyperactivity disorder, emotional lability, amygdala, intrinsic functional connectivity, emotion regulation, rostral anterior cingulate cortex, posterior insula, superior temporal gyrus, children, irritability, temper outbursts
- MeSH terms
- Adolescent, Affective Symptoms, Amygdala, Attention Deficit Disorder with Hyperactivity, Cerebral Cortex, Child, Female, Humans, Magnetic Resonance Imaging, Male, Nerve Net
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