To advance our understanding of attention-deficit hyperactivity disorder and medication effects we draw upon the evidence for (1) a neurotransmitter imbalance between norepinephrine and dopamine in attention-deficit hyperactivity disorder and (2) an asymmetric neural control system that links the dopaminergic pathways to left hemispheric processing and links the noradrenergic pathways to right hemispheric processing. It appears that attention-deficit hyperactivity disorder may involve a bihemispheric dysfunction characterized by reduced dopaminergic and excessive noradrenergic functioning. In turn, favorable medication effects may be mediated by a restoration in neurotransmitter balance and by increased control over the allocation of attentional resources between hemispheres.

Effects of stimulant medication (methylphenidate) on levels (feature, name, semantic) of word processing by the left and right hemisphere were assessed in 31 attention-deficit-disordered children. In a double-blind procedure, same-different decisions were made to tachistoscopically presented word pairs under medication and placebo. Analysis of manual response times failed to show any negative effects of medication. Feature decisions were faster than name decisions, which were faster than semantic decisions. Methylphenidate induced a right visual field advantage (left hemisphere) for the name decision, which was interpreted as a normalization effect. The results suggest that (1) methylphenidate may selectively improve the phonological level of word processing and (2) methylphenidate's favorable therapeutic effect is produced through inhibition of excessive right hemisphere activity in response to task demands that engage the left hemisphere.

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