Cortical Arousal and Pediatric Attention-Deficit/Hyperactivity Disorder (ADHD)

Abstract

Attention-deficit/Hyperactivity Disorder (ADHD) is a complex neurodevelopmental disorder characterized by excessive and developmentally inappropriate inattention and hyperactivity/ impulsivity levels [1]. The largest and most comprehensive randomized clinical trial in child and adolescent psychiatry, the Multimodal Treatment Study of Children with Attentiondeficit/hyperactivity disorder (MTA), documents significant and continued impairment in children with ADHD into adulthood across multiple domains of functioning after 16 years despite receiving the most effective treatments available for the [2]. Children with ADHD earn lower grades and experience higher rates of special education placements, grade retention, and school dropout. Relative to typically developing children, children with ADHD score significantly lower on standardized math, reading, and spelling achievement measures even after controlling for individual differences in intelligence [3]. Approximately 70% children with ADHD meet criteria for a specific learning disability [4] and the annual academic-related impairment cost in the US is $15-25 billion dollars [5].Although the elevated health risks, social/interpersonal problems, and above-described academic/cognitive impairments are documented well [6], the underlying physiological processes remain unknown [3]. This review will outline research linking arousal to ADHD-related cognitive impairments. Additionally, the reviews highlight etiological models that attempt to associate arousal to ADHD-related cognitive impairments and behavioral manifestations of the disorder. Finally, recommendations for future research will be explored with a particular emphasis on both research and clinical implications.Meta-analytic reviews document moderate Executive Function (EF) impairments in children with ADHD across a number of domains including behavioral inhibition, short-term memory, verbal fluency, inhibition, problem-solving, and working memory [7]. Executive Functions (EFs) refer to a "suite" of related mental processes mediated by the prefrontal cortex. EFs are needed to sustain goal-oriented problem-solving. Moreover, EF-related processes include inhibition, working memory, planning, emotional or motivational regulation, and interference control [8]. Moreover, ADHD-related EF deficits have a central and secondary role in several theoretical models of ADHD [9]. EF deficits (i.e., executive dysfunctions) are linked to learning, particularly performance in language arts, mathematics, and science [10], comprehension, reasoning, and planning [8].Research suggests that EF deficits may mediate the relationship between ADHD symptoms and grades [11]. Consistently large effects sizes are often associated with verbal and spatial working memory impairments. Working memory is a limited-capacity system for the simultaneous storage and processing of spatial and phonological (i.e., speech-based information). Rapport and colleagues conducted the first study to examine between-group AbstractWhile the continued manifestation...