The Effects of Methylphenidate on Neural Systems of Attention in Attention Deficit Hyperactivity Disorder

• Published in: The American journal of psychiatry Vol. 161; no. 11; pp. 1990 - 1997
• Main Authors: Shafritz, Keith M., Marchione, Karen E., Gore, John C., Shaywitz, Sally E., Shaywitz, Bennett A.
• Format: Journal Article
• Language: English
• Published: Washington, DC American Psychiatric Publishing 01.11.2004; American Psychiatric Association
• Subjects: Adolescent; Attention - drug effects; Attention Deficit Disorder with Hyperactivity - drug therapy; Attention Deficit Disorder with Hyperactivity - physiopathology; Attention deficit disorders. Hyperactivity; Attention deficit hyperactivity disorder; Basal Ganglia - drug effects; Basal Ganglia - physiopathology; Biological and medical sciences; Central Nervous System Stimulants - pharmacology; Central Nervous System Stimulants - therapeutic use; Child clinical studies; Clinical trials; Cognition & reasoning; Corpus Striatum - drug effects; Corpus Striatum - physiopathology; Double-Blind Method; Dyslexia - drug therapy; Dyslexia - physiopathology; Female; Humans; Magnetic Resonance Imaging - methods; Male; Medical sciences; Methylphenidate - pharmacology; Methylphenidate - therapeutic use; Neural networks; Neural Pathways - drug effects; Neural Pathways - physiopathology; Placebos; Prefrontal Cortex - drug effects; Prefrontal Cortex - physiopathology; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychomotor Performance - drug effects; Psychomotor Performance - physiology; Psychopathology. Psychiatry; Human; Vigilance; CNS stimulant; Healthy subject; Psychotropic; Hyperactivity; Central nervous system; Attention; Nuclear magnetic resonance imaging; Encephalon; Attentional disorder; Adolescent; Developmental stage; Comparative study; Methylphenidate
• ISSN: 0002-953X; 1535-7228
• DOI: 10.1176/appi.ajp.161.11.1990

OBJECTIVE: Recent studies have suggested that attention deficit hyperactivity disorder (ADHD) is associated with abnormalities in basal ganglia and prefrontal cortical functioning. However, these studies have primarily relied upon cognitive tasks that reflect impulse control rather than attentional mechanisms. METHOD: The authors used functional magnetic resonance imaging to investigate the neural correlates of selective and divided attention in a randomized, double-blind, placebo-controlled pharmacological challenge with methylphenidate in 15 adolescents with ADHD (ages 14-17), eight adolescents with reading disorder (ages 12-17), and four adolescents with both reading disorder and ADHD (ages 14-18) who were scanned during both a methylphenidate and a placebo session. Fourteen healthy comparison subjects (ages 12-20) who were not given methylphenidate served as the primary comparison group. RESULTS: During the divided attention task, unmedicated subjects with ADHD or reading disorder recruited the left ventral basal ganglia significantly less than the healthy comparison subjects. Methylphenidate led to an increase in activation in this region but had no effect on task performance. Subjects with ADHD also recruited the middle temporal gyrus significantly less than the comparison subjects, but methylphenidate did not have a direct effect on activation in this region. CONCLUSIONS: These results suggest that ADHD is associated with abnormal processing in attentional networks, with specific dysfunction in striatal circuitry. Methylphenidate may act to normalize activity within this network.