Dysfunctional attentional networks in children with attention deficit/hyperactivity disorder: Evidence from an event-related functional magnetic resonance imaging study

Background: Although there is evidence for attentional dysfunction in children with attention deficit/hyperactivity disorder (ADHD), the neural basis of these deficits remains poorly understood. Methods: We used event-released functional magnetic resonance imaging (fMRI) to investigate brain activations related to three particular aspects of attention: alerting, reorienting, and executive control. Sixteen medication-naive boys with ADHD and 16 healthy boys, aged 8 to 12 years, were studied. Results: Behaviorally, children with ADHD showed a significant impairment only in their executive control system compared to healthy subjects. Neurally, children with ADHD (relative to controls) recruited deviant brain regions for all three attentional networks: less right-sided activation in the anterior cingulate gyrus during alerting, more fronto-striatal-insular activation during reorienting, and less fronto-striatal activation for executive control. ADHD symptom severity was associated with dysregulation of the blood oxygen level dependent (BOLD) signal within the putamen during reorienting and executive control. Conclusions: Our results demonstrated altered brain mechanism in ADHD associated with all three attentional networks investigated. For alerting and executive attention, our data indicate a deviant Mechanism of cortical control, while ADHD children may have adopted altered strategies for reorienting of attention. Our results also stress the etiological role of functional abnormalities in the putamen in medication-naive ADHD.