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The dual pathway model of AD/HD: an elaboration of neuro-developmental characteristics
Abstract
The currently dominant neuro-cognitive model of Attention Deficit Hyperactivity Disorder (AD/HD) presents the condition as executive dysfunction (EDF) underpinned by disturbances in the fronto-dorsal striatal circuit and associated dopaminergic branches (e.g. meso-cortical). In contrast, motivationally-based accounts focus on altered reward processes and implicate fronto-ventral striatal reward circuits and those meso-limbic branches that terminate in the ventral striatum especially the nucleus accumbens. One such account, delay aversion (DEL), presents AD/HD as a motivational style-characterised by attempts to escape or avoid delay-arising from fundamental disturbances in these reward centres. While traditionally regarded as competing, EDF and DEL models have recently been presented as complimentary accounts of two psycho-patho-physiological subtypes of AD/HD with different developmental pathways, underpinned by different cortico-striatal circuits and modulated by different branches of the dopamine system. In the current paper we describe the development of this model in more detail. We elaborate on the neuro-circuitry possibly underpinning these two pathways and explore their developmental significance within a neuro-ecological framework.
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“they also show a failure to delay gratification, have impaired responses to partial schedules of reinforcement, and preference for small immediate rewards over larger delayed rewards 6 , 7 .”
From Motivation Deficit in ADHD is Associated with Dysfunction of the Dopamine Reward Pathway (2011) · cites this paper as [6]
In the citing paper
“The observation of a deficit in the DA reward pathway is further evidence that deficits in motivation may be contributing to impairment in ADHD adults 6 .”
From Motivation Deficit in ADHD is Associated with Dysfunction of the Dopamine Reward Pathway (2011) · cites this paper as [6]
In the citing paper
“Last, there is considerable heterogeneity in cognitive impairments, with some patients not showing impairments or only in some cognitive domains, which may be underpinned by different pathophysiological pathways (Sonuga-Barke, 2003; Nigg et al., 2005; Sonuga-Barke et al., 2010).”
From Cognitive Neuroscience of Attention Deficit Hyperactivity Disorder (ADHD) and Its Clinical Translation (2018) · cites this paper as Sonuga-Barke, 2003
In the citing paper
“However, this is countered by substantial heterogeneity among the identified domains, leading to variable characterizations of ADHD as a predominant disorder of inhibition (e.g. [13]), delay aversion [14] or temporal processing [15], among others (e.g. [16]).”
From Linking ADHD to the Neural Circuitry of Attention (2017) · cites this paper as [14]
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Metadata
- Authors
- Sonuga-Barke, E. J. S.
- Affiliations
- University of Southampton (GB)
- Corresponding author
- Sonuga-Barke, Edmund J.S
- Venue
- Neuroscience & Biobehavioral Reviews
- Publisher
- Elsevier BV
- Published
- 2003-11
- Volume
- 27
- Issue
- 7
- Pages
- 593-604
- ISSN
- 0149-7634 (ISSN-L)
- OpenAlex
- W2064260924
- Cited by
- 816
- References
- 105
- Citations by year
- 2026: 33 · 2025: 29 · 2024: 38 · 2023: 43 · 2022: 41 · 2021: 35 · 2020: 50 · 2019: 23 · 2018: 32 · 2017: 35 · 2016: 49 · 2015: 32 · 2014: 46 · 2013: 41 · 2012: 47
- FWCI
- 3.38
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Neuroscience & Biobehavioral Reviews (publishedVersion)
- PubMed (publishedVersion)
- ePrints Soton (University of Southampton) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
- Keywords
- attention deficit hyperactivity disorder, executive dysfunction, delay aversion, reward processing, dopaminergic system, mesocortical pathway, mesolimbic system, nucleus accumbens, ventral striatum, motivational styles
- MeSH terms
- Attention Deficit Disorder with Hyperactivity, Cognition Disorders, Humans, Mental Processes, Models, Neurological, Models, Psychological, Neural Pathways, Reinforcement, Psychology
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