Brain activity in predominantly-inattentive subtype attention-deficit/hyperactivity disorder during an auditory...

Previous functional neuroimaging studies have found brain activity abnormalities in attention-deficit/hyperactivity disorder (ADHD) on numerous cognitive tasks. However, little is known about brain dysfunction unique to the predominantly-inattentive subtype of ADHD (ADHD-I), despite debate as to whether DSM-IV-defined ADHD subtypes differ in etiology. This study compared brain activity of 18 ADHD-I adolescents (ages 12-18) and 20 non-psychiatric age-matched control participants on a functional magnetic resonance image (fMRI) auditory oddball attention task. ADHD-I participants had significant activation deficits to infrequent target stimuli in bilateral superior temporal gyri, bilateral insula, several midline cingulate/medial frontal gyrus regions, right posterior parietal cortex, thalamus, cerebellum, and brainstem. To novel stimuli, ADHD-I participants had reduced activation in bilateral lateral temporal lobe structures. There were no brain regions where ADHD-I participants had greater hemodynamic activity to targets or novels than controls. Brain activity deficits in ADHD-I participants were found in several regions important to attentional orienting and working memory-related cognitive processes involved in target identification. These results differ from those in previously studied adolescents with combined-subtype ADHD, who had a lesser magnitude of activation abnormalities in frontoparietal regions and relatively more discrete regional deficits to novel stimuli. The divergent findings suggest different etiological factors might underlie attention deficits in different DSM-IV-defined ADHD subtypes, and they have important implications for the DSM-V reconceptualization of subtypes as varying clinical presentations of the same core disorder.