Asymmetrical visual-spatial attentional performance in ADHD: evidence for a right hemispheric deficit

This study was designed to confirm the presence of a lateralizing deficit in visual-spatial attention in children with ADHD, to further characterize the nature of this deficit and to specify the likely hemispheric locus of dysfunction. Two versions of the covert orienting of attention procedure which evaluated separately endogenous and exogenous cuing effects were administered to 20 unmedicated children aged 9-12 with ADHD and 20 matched controls. Both groups also underwent thorough psychiatric assessment and testing using the TOVA and the Wisconsin Card Sorting Task (WCST). Children with ADHD showed an asymmetrical performance deficit characterized by a loss of costs on controlled (endogenous) attentional orienting to invalidly cured left visual field targets. The degree of cost asymmetry correlated negatively with the number of categories sorted on the WCST. It was concluded that unmedicated children with ADHD show an asymmetrical performance deficit on the covert orienting procedure characterized by a disruption of right hemispheric attentional mechanisms. This deficit may be related to diminished right hemispheric frontal-striatal catecholamine activity.