Shared and disorder-specific task-positive and default mode network dysfunctions during sustained attention in paediatric Attention-Deficit/Hyperactivity Disorder and obsessive/compulsive disorder

Norman, Luke J.; Carlisi, Christina O.; Christakou, Anastasia; Cubillo, Ana; Murphy, Clodagh M.; Chantiluke, Kaylita; Simmons, Andrew; Giampietro, Vincent; Brammer, Michael; Mataix-Cols, David; Rubia, Katya · 2017 · DOAJ

DOI: 10.1016/j.nicl.2017.04.013

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Summary

This study investigates the neural mechanisms underlying sustained attention deficits in paediatric Attention-Deficit/Hyperactivity Disorder (ADHD) and Obsessive-Compulsive Disorder (OCD). While both disorders share clinical symptoms of impaired sustained attention and potential comorbidity, it remains unclear whether these deficits stem from shared or disorder-specific dysfunctions in task-positive and default mode networks (DMN). The authors hypothesized that both groups would exhibit reduced activation in task-positive regions and decreased deactivation in the DMN, but with specific patterns distinguishing the two conditions. The research involved 60 right-handed male adolescents (aged 12–18), comprising 20 boys with ADHD, 20 with OCD, and 20 healthy controls. Participants underwent functional magnetic resonance imaging (fMRI) while performing a parametrically modulated sustained attention task. This task required rapid responses to visual stimuli appearing after either short, predictable delays (0.5 s) or long, unpredictable delays (2, 5, or 8 s), thereby increasing the sustained attention load. Data were analyzed using non-parametric statistical methods to identify group differences and interactions between group and attention load. Behavioral results indicated that only the ADHD group exhibited significant performance impairments, characterized by slower reaction times compared to controls and OCD patients. Neuroimaging analysis revealed distinct patterns of brain activation. Both ADHD and OCD patients shared underactivation in the left insula/ventral inferior frontal gyrus (IFG) and increased activation in posterior DMN regions relative to controls. However, disorder-specific abnormalities were prominent. ADHD patients showed specific underactivation in the left dorsolateral prefrontal cortex/dorsal IFG and overactivation in the dorsal anterior cingulate cortex. Conversely, OCD patients exhibited specific underactivation in the middle anterior cingulate cortex and overactivation in the anterior ventromedial prefrontal cortex. The findings suggest that while ADHD and OCD share some neural dysfunctions in salience and ventral attention networks, the neural underpinnings of sustained attention deficits are largely disorder-specific. ADHD is characterized by lateral frontal deficits, whereas OCD involves middle anterior cingulate deficits. These results imply that attention performance in these disorders is driven by distinct activation patterns in task-positive and medial frontal DMN regions, supporting the view that separate neural mechanisms contribute to attentional difficulties in ADHD and OCD despite their clinical overlap.

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• sustained attention vigilance