Segregating sustained attention from response inhibition in ADHD: An fMRI study

Soonjo Hwang, Harma Meffert, Ian Parsley, Patrick M Tyler, Anna K Erway, Mary L Botkin, Kayla Pope, R J R Blair, Soonjo Hwang, Harma Meffert, Ian Parsley, Patrick M Tyler, Anna K Erway, Mary L Botkin, Kayla Pope, R J R Blair

Abstract

Background: The functional significance of the impairment shown by patients with ADHD on response inhibition tasks is unclear. Dysfunctional behavioral and BOLD responses to rare no-go cues might reflect disruption of response inhibition (mediating withholding the response) or selective attention (identifying the rare cue). However, a factorial go/no-go design (involving high and low frequency go and no-go stimuli) can disentangle these possibilities.

Methods: Eighty youths [22 female, mean age = 13.70 (SD = 2.21), mean IQ = 104.65 (SD = 13.00); 49 with diagnosed ADHD] completed the factorial go/no-go task while undergoing fMRI.

Results: There was a significant response type-by-ADHD symptom severity interaction within the left anterior insula cortex; increasing ADHD symptom severity was associated with decreased recruitment of this region to no-go cues irrespective of cue frequency. There was also a significant frequency-by-ADHD symptom severity interaction within the left superior frontal gyrus. ADHD symptom severity showed a quadratic relationship with responsiveness to low frequency cues (irrespective of whether these cues were go or no-go); within this region, at lower levels of symptom severity, increasing severity was associated with increased BOLD responses but at higher levels of symptom severity, decreasing BOLD responses.

Conclusion: The current study reveals two separable forms of dysfunction that together probably contribute to the impairments shown by patients with ADHD on go/no-go tasks.

Trial registration: ClinicalTrials.gov NCT00104039.

Keywords: Anterior insula cortex; Attention-Deficit/Hyperactivity Disorder; Go/no-go test; Superior frontal cortex.

Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.

Figures

Fig. 1
Fig. 1
Experimental design. Schematic of design in which green circles represent go trials and red circles represent no-go trials. During the actual task, participants would see one of six Spiderman pictures for go trials and one of six Green Goblin pictures for no-go trials. Trials occurred in an event-related fashion within two types of blocks: (A) high go frequency blocks (25% no-go cues and 75% go cues) and (B) high no-go frequency blocks (25% go cues and 75% no-go cues). Each block contained 60 trials and each run contained two blocks, separated by 30s of fixation (2 runs in total). (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)
Fig. 2
Fig. 2
Region showing a significant response type by ADHD symptom level interaction; (A) left anterior insula (coordinates: −28.5, 19.5, −3.5); (B) negative correlation between symptom severity of ADHD measured by CBCL and BOLD response parameter estimates of no-go cues relative to go cues in this region.
Fig. 3
Fig. 3
Region showing a significant frequency by ADHD symptom level interaction; (A) left superior frontal gyrus (coordinates: −22.5, 52.5, 29.5); (B) quadratic correlation between symptom severity of ADHD measured by CBCL and BOLD response parameter estimate of low frequency trials relative to high frequency trials in this region.

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