Brain functional domains inform therapeutic interventions in attention-deficit/hyperactivity disorder and pediatric bipolar disorder
Open accessAbstract
A deeper understanding of how the relationships between impulsivity, reward systems and executive function deficits may be similar or different in attention-deficit/hyperactivity disorder (ADHD) and pediatric bipolar disorder (PBD) is fundamental for better defining phenotypy in these two developmental illnesses, and moving towards improved treatment and intervention. We focus our article on recent neurocognitive and neuroimaging data examining the behavioral and neural aspects of poor behavior regulation, response inhibition and reward systems in ADHD and PBD. In light of recent research evidence, we propose that the common behavioral manifestations of impulsivity in ADHD and PBD may indeed originate from different neural mechanisms mediated by altered reward systems. In order to define and differentiate these mechanisms, unlike previous approaches, our theoretical model examines the interface of the dorsal frontostriatal circuit, involved in behavior regulation, and the ventral frontostriatal circuit, which is involved in reward-related and affect processes. Preliminary evidence suggests that the neural systems involved in impulsivity, reward systems and executive function engage differently in the two illnesses. In PBD, 'emotional impulsivity' is predominantly 'bottom-up' and emotionally/motivationally driven, and stems from ventral frontostriatal circuitry dysfunction. By contrast, in ADHD 'cognitive impulsivity' is predominantly 'top-down' and more 'cognitively driven', and stems from dorsal frontostriatal dysfunction. We discuss this evidence in view of clinically relevant questions and implications for illness-based intervention. We conclude that the reward-related mechanisms underlying the interactions between executive function, behavior regulation and impulsivity in PBD and ADHD may be differentially compromised, and in accordance differently shape the clinical symptoms of impulsivity and goal-directed behavior.
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IFC underactivation during cognitive and motivation control tasks was disorder-specific to ADHD relative to borderline personality and bipolar disorder.
“IFC underactivation during cognitive and motivation control tasks was also found to be disorder-specific to ADHD relative to borderline personality (Sebastian et al., 2014) and bipolar disorder (Passarotti and Pavuluri, 2011).”
From Cognitive Neuroscience of Attention Deficit Hyperactivity Disorder (ADHD) and Its Clinical Translation (2018) · cites this paper as Passarotti and Pavuluri, 2011
The section on inhibitory functions reports that adolescents with ADHD failed to engage the VLPFC relative to adolescents with pediatric bipolar disorder during a response-inhibition task, supporting the cognitive-control comparison. The reward-sensitivity section does not establish IFC underactivation during motivational-control tasks relative to bipolar disorder. This citation is attached to the bipolar comparison, not the separate borderline-personality comparison. (LLM, conf=0.86)
Experimental — accuracy not yet measuredAffective childhood disorders appear to suffer from similar underactivations in ventromedial and/or dorsomedial prefrontal and limbic regions during cognitive control.
“These more “affective childhood disorders” appear to suffer from similar underactivations in ventromedial and/or dorsomedial prefrontal and limbic regions during cognitive control (Passarotti and Pavuluri, 2011; Sebastian et al., 2014; Alegria et al., 2016; Norman et al., 2016;”
From Cognitive Neuroscience of Attention Deficit Hyperactivity Disorder (ADHD) and Its Clinical Translation (2018) · cites this paper as Passarotti and Pavuluri, 2011
In “Inhibitory functions: common external phenotype & differential neural operations,” the paper reports prefrontal dysfunction during response inhibition in pediatric bipolar disorder and ADHD, but describes different affected regions across the two disorders rather than similar underactivation. In “Cognitive versus emotional impulsivity,” it associates pediatric bipolar disorder with reduced prefrontal regulatory function but hypothesizes amygdala and ventral-striatal overactivity, not limbic underactivation. The copy provides no page numbers for these passages. (LLM, conf=0.85)
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References 192 · Cited by 44
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- Authors
- Passarotti, A. M., & Pavuluri, M. N.
- Affiliations
- University of Illinois Chicago (US)
- Corresponding author
- Passarotti, Alessandra M
- ORCID
- Pavuluri, Mani N
- Venue
- Expert Review of Neurotherapeutics
- Publisher
- Informa UK Limited
- Published
- 2011-06
- Volume
- 11
- Issue
- 6
- Pages
- 897-914
- ISSN
- 1473-7175 (ISSN-L)
- 1744-8360
- PMC
- PMC3129632
- OpenAlex
- W2000524224
- Cited by
- 44
- References
- 192
- Citations by year
- 2026: 2 · 2024: 2 · 2023: 1 · 2022: 1 · 2021: 1 · 2020: 2 · 2019: 1 · 2018: 3 · 2017: 2 · 2016: 4 · 2015: 3 · 2014: 11 · 2013: 6 · 2012: 3
- FWCI
- 0.92
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Expert Review of Neurotherapeutics (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (RC1MH088462, R01MH081019, R01MH085639)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Keywords
- attention deficit hyperactivity disorder, pediatric bipolar disorder, impulsivity, reward systems, executive function, response inhibition, behavioral regulation, emotional impulsivity, cognitive impulsivity, goal-directed behavior, neuroimaging, neurocognitive impairment, therapeutic interventions
- MeSH terms
- Attention Deficit Disorder with Hyperactivity, Bipolar Disorder, Brain, Child, Humans, Phenotype
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