Identifying a consistent pattern of neural function in attention deficit hyperactivity disorder: a meta-analysis
Abstract
Background: The neurobiological underpinnings of attention deficit hyperactivity disorder (ADHD) are inconclusive. Activation abnormalities across brain regions in ADHD compared with healthy controls highlighted in task-based functional magnetic resonance imaging (fMRI) studies are heterogeneous. To identify a consistent pattern of neural dysfunction in ADHD, a meta-analysis of fMRI studies using Go/no-go, Stop and N-back tasks was undertaken. Method: Several databases were searched using the key words: ‘ADHD and fMRI’ and ‘ADHD and fMRI task’. In all, 20 studies met inclusion criteria comprising 334 patients with ADHD and 372 healthy controls and were split into N-back, Stop task and Go/no-go case–control groups. Using Signed Differential Mapping each batch was meta-analysed individually and meta-regression analyses were used to examine the effects of exposure to methylphenidate (MPH), length of MPH wash-out period, ADHD subtype, age and intelligence quotient (IQ) differences upon neural dysfunction in ADHD. Results: Across all tasks less activity in frontal lobe regions compared with controls was detected. Less exposure to treatment and lengthier wash-out times resulted in less left medial frontal cortex activation in N-back and Go/no-go studies. Higher percentage of combined-type ADHD resulted in less superior and inferior frontal gyrus activation. Different IQ scores between groups were linked to reduced right caudate activity in ADHD. Conclusions: Consistent frontal deficits imply homogeneous cognitive strategies involved in ADHD behavioural control. Our findings suggest a link between fMRI results and the potentially normalizing effect of treatment and signify a need for segregated examination and contrast of differences in sample characteristics in future studies.
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A Stop task fMRI meta-analysis based on five pediatric and one adult fMRI studies confirmed that 74 ADHD relative to 102 controls had reduced activation in bilateral IFC/insula, but showed additionally reduced activation in right superior and middle frontal cortices.
“The Stop task fMRI meta-analysis, based on five pediatric and one adult fMRI studies, confirmed the previous meta-analytical findings that 74 ADHD relative to 102 controls had reduced activation in bilateral IFC/insula, but showed additionally reduced activation in right superior and middle frontal cortices (McCarthy et al., 2014).”
From Cognitive Neuroscience of Attention Deficit Hyperactivity Disorder (ADHD) and Its Clinical Translation (2018) · cites this paper as McCarthy et al., 2014
A meta-analysis of N-back WM fMRI studies showed that 111 ADHD patients relative to 113 controls had reduced activation in bilateral middle and superior PFC and left MFC/ACC.
“A meta-analysis of N-back WM fMRI studies showed that 111 ADHD patients relative to 113 controls had reduced activation in bilateral middle and superior PFC and left MFC/ACC (McCarthy et al., 2014).”
From Cognitive Neuroscience of Attention Deficit Hyperactivity Disorder (ADHD) and Its Clinical Translation (2018) · cites this paper as McCarthy et al., 2014
For the Go/no-go task, 149 ADHD patients had reduced activation relative to 159 healthy controls in predominantly left MFC/ACC and right caudate cortices.
“For the Go/no-go task, 149 ADHD patients had reduced activation relative to 159 healthy controls in predominantly left medial frontal cortex (MFC)/ACC and right caudate cortices (McCarthy et al., 2014)”
From Cognitive Neuroscience of Attention Deficit Hyperactivity Disorder (ADHD) and Its Clinical Translation (2018) · cites this paper as McCarthy et al., 2014
Meta-analyses of fMRI studies of inhibitory control find most consistently reduced activation in right, left or bilateral IFC, MFC/ACC/SMA and striato-thalamic regions, with some studies also finding DLPFC underactivation.
“In conclusion, meta-analyses of fMRI studies of inhibitory control find most consistently reduced activation in right, left or bilateral IFC, MFC/ACC/SMA and striato-thalamic regions with some studies also finding DLPFC underactivation (Hart et al., 2013; McCarthy et al., 2014; Lei et al., 2015; Norman et al., 2016).”
From Cognitive Neuroscience of Attention Deficit Hyperactivity Disorder (ADHD) and Its Clinical Translation (2018) · cites this paper as McCarthy et al., 2014
Combined-type ADHD relative to the inattentive subtype had more severe underactivation in right superior and IFC during the Stop task, in right caudate during the Go/no-go task, and in right cerebellum during the WM task.
“combined-type ADHD relative to the inattentive subtype had more severe underactivation in right superior and IFC during the Stop task, in right caudate during the Go/no-go task and in right cerebellum during the WM task.”
From Cognitive Neuroscience of Attention Deficit Hyperactivity Disorder (ADHD) and Its Clinical Translation (2018) · cites this paper as McCarthy et al., 2014
Areas of the DMN such as medial frontal and occipital regions were more enhanced in activation in the combined-type ADHD subgroup relative to controls for all tasks.
“areas of the DMN such as medial frontal and occipital regions were more enhanced in activation in the combined type ADHD subgroup relative to controls for all tasks (McCarthy et al., 2014).”
From Cognitive Neuroscience of Attention Deficit Hyperactivity Disorder (ADHD) and Its Clinical Translation (2018) · cites this paper as McCarthy et al., 2014
Stimulants may have effects lasting longer than 48 hours.
“However, stimulants may act longer than 48h”
From Cognitive heterogeneity in adult attention deficit/hyperactivity disorder: A systematic analysis of neuropsychological measurements (2015) · cites this paper as McCarthy et al., 2014
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- Authors
- McCarthy, H., Skokauskas, N., & Frodl, T.
- Affiliations
- Trinity College Dublin (IE)
- Corresponding author
- Frodl, T.
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2013-05-13
- Volume
- 44
- Issue
- 4
- Pages
- 869-880
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W2153211018
- Semantic Scholar
- f347e114c8d58ef2f7b6c62e32685eb8c4d47ad0
- Cited by
- 156
- References
- 28
- Citations by year
- 2026: 4 · 2025: 17 · 2024: 15 · 2023: 11 · 2022: 8 · 2021: 19 · 2020: 19 · 2019: 12 · 2018: 11 · 2017: 6 · 2016: 14 · 2015: 15 · 2014: 5
- FWCI
- 1.54
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Health Research Board
- Science Foundation Ireland
- 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, neural dysfunction, frontal lobe dysfunction, medial frontal cortex, n-back task, go/no-go task, stop-signal task, methylphenidate, washout period, combined type ADHD, caudate nucleus, IQ differences, cognitive control, brain activation
- MeSH terms
- Attention Deficit Disorder with Hyperactivity, Humans, Prefrontal Cortex, Executive Function
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