Pathophysiology of ADHD and associated problems—starting points for NF interventions?

Abstract

Attention deficit hyperactivity disorder (ADHD) is characterized by severe and age-inappropriate levels of hyperactivity, impulsivity and inattention. ADHD is a heterogeneous disorder, and the majority of patients show comorbid or associated problems from other psychiatric disorders. Also, ADHD is associated with cognitive and motivational problems as well as resting-state abnormalities, associated with impaired brain activity in distinct neuronal networks. This needs to be considered in a multimodal treatment, of which neurofeedback (NF) may be a promising component. During NF, specific brain activity is fed-back using visual or auditory signals, allowing the participants to gain control over these otherwise unaware neuronal processes. NF may be used to directly improve underlying neuronal deficits, and/or to establish more general self-regulatory skills that may be used to compensate behavioral difficulties. The current manuscript describes pathophysiological characteristics of ADHD, heterogeneity of ADHD subtypes and gender differences, as well as frequently associated behavioral problems such as oppositional defiant/conduct or tic disorder. It is discussed how NF may be helpful as a treatment approach within these contexts.

Animal models of attention‐deficit hyperactivity disorder (ADHD)

“…The exact causes of ADHD are not known absolutely, but genetic factors are majorly involved in the prevalence of the disease. Dopamine alteration is the primary cause of ADHD pathology, which has been extensively considered as a significant factor for the progression of the disease (Albrecht et al., 2015; Bijlenga et al., 2019). The substantial clues involved are decreased release of dopamine in the specific areas of brain‐like, striatum, nucleus accumbens, and prefrontal cortex, further decreased dopamine turnover in the frontal cortex, substantia nigra, and ventral tegmental area, as well as reduced dopamine vesicular storage (Bijlenga et al., 2019; Instanes et al., 2018), and increased density of binding sites for the dopamine D1/D5 receptor family in the anterior forebrain (Mitra et al., 2017; Wu et al., 2012).…”

“…Tonic pool stimulates the D2/D3 receptor, further providing feedback inhibition upon which the net amount DA release in a tonic pool depends. The presence of DA transporter‐1 (DAT‐1) (E) on the presynaptic terminal leads to the reuptake of the DA released, which further abolishes all the actions on the postsynaptic terminal (Albrecht et al., 2015) (Figure 1).…”

Electrophysiology Echoes Brain Dynamics in Children and Adolescents With Tourette Syndrome—A Developmental Perspective

“…The importance of dysrhythmic brain oscillations in TS has already been clarified [e.g., ( 17 , 18 )] Hence, improving rhythmicity/synchronization of brain oscillations along the striatal-thalamic-cortical circuit by voluntary training could be promising, specifically, when co-existing ADHD symptoms are taken into consideration. This would also allow improvement of executive control functions via increasing attentional capacities ( 68 ). Neurofeedback (NF) seems to be a good candidate.…”

Perception in attention deficit hyperactivity disorder

“…Despite being one of the most extensively studied psychiatric disorders, the pathophysiology underlying ADHD symptoms remains only poorly understood (Albrecht et al 2015;Sharma and Couture 2014;Thapar et al 2013). A vast amount of research demonstrated that ADHD has strong biological underpinnings, including abnormalities in neurotransmitter systems in the brain.…”