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Timing, space and ADHD: the dopamine theory revisited
1School of Psychiatry, University of New South Wales, Prince of Wales Hospital, Randwick, Australia. f.levy@unsw.edu.au
The dopamine theory of attention deficit hyperactivity disorder (ADHD) is supported by new research, but noradrenergic agonists may also play a key role in improving cognitive functions.
Area of Science:
- Neuroscience
- Psychiatry
- Genetics
Background:
- Attention deficit hyperactivity disorder (ADHD) is a complex neurodevelopmental disorder.
- The dopamine theory has been a leading explanation for ADHD pathophysiology.
- Advances in neuroscience necessitate a review of current ADHD theories.
Purpose of the Study:
- To review the dopamine theory of ADHD, focusing on advances in the last decade.
- To explore the roles of noradrenergic systems and neuropsychological findings in ADHD.
- To describe a model of attention systems implicated in ADHD.
Main Methods:
- Review of 'hyper' and 'hypo' dopaminergic theories.
- Discussion of noradrenergic and neuropsychological findings in ADHD.
- Description of a model integrating anterior and posterior attention systems.
- Review of neuropsychological studies on covert orienting and working memory.
Main Results:
- Neuroimaging, genetic, and stimulant medication studies support the dopamine theory, indicating an inhibitory dopaminergic effect.
- Noradrenergic systems are crucial for prefrontal regulation, with alpha(2A) noradrenergic agonists showing cognitive benefits.
- Neuropsychological studies highlight posterior parietal mechanisms in attention orienting and anterior/posterior systems in working memory.
Conclusions:
- ADHD symptoms and subtypes may stem from deficits in inhibition and working memory, reflecting involvement of anterior and posterior attention systems.
- While genetic and stimulant studies support the dopamine theory, alpha(2) noradrenergic agonists like guanfacine show therapeutic potential.
- ADHD pathophysiology is likely multifactorial, involving both dopaminergic and noradrenergic pathways.
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