Slow oscillating transcranial direct current stimulation during non-rapid eye movement sleep improves behavioral inhibition in attention-deficit/hyperactivity disorder Automated diagnoses of attention deficit hyperactive disorder using magnetic resonance imaging Sleep and neurobehavioral characteristics of 5- to 7-year-old children with parentally reported symptoms of attention-deficit/hyperactivity disorder. Functional magnetic resonance imaging of methylphenidate and placebo in attention-deficit/hyperactivity disorder during the multi-source interference task. Transcranial Oscillatory Direct Current Stimulation During Sleep Improves Declarative Memory Consolidation in Children With Attention-deficit/hyperactivity Disorder to a Level Comparable to Healthy Controls The impact of daytime sleepiness on the school performance of college students with attention deficit hyperactivity disorder (ADHD): a prospective longitudinal study. Systematic interindividual differences in neurobehavioral impairment from sleep loss: evidence of trait-like differential vulnerability. Real‐time fMRI neurofeedback in adolescents with attention deficit hyperactivity disorder Methylphenidate Normalizes Resting-State Brain Dysfunction in Boys With Attention Deficit Hyperactivity Disorder Methylphenidate normalises activation and functional connectivity deficits in attention and motivation networks in medication-naïve children with ADHD during a rewarded continuous performance task In a randomized case–control trial with 10-years olds suffering from attention deficit/hyperactivity disorder (ADHD) sleep and psychological functioning improved during a 12-week sleep-training program Effect of neurofeedback training on the neural substrates of selective attention in children with attention-deficit/hyperactivity disorder: A functional magnetic resonance imaging study Acute impact of immediate release methylphenidate administered three times a day on sleep in children with attention-deficit/hyperactivity disorder. Aerobic exercise and attention deficit hyperactivity disorder: brain research. Common and unique therapeutic mechanisms of stimulant and nonstimulant treatments for attention-deficit/hyperactivity disorder. fMRI Neurofeedback Training for Increasing Anterior Cingulate Cortex Activation in Adult Attention Deficit Hyperactivity Disorder. An Exploratory Randomized, Single-Blinded Study Prefrontal hypoactivation and recovery in insomnia.
Background : Behavioral inhibition , which is a later-developing executive function ( EF ) and anatomically located in prefrontal areas , is impaired in attention-deficit and hyperactivity disorder ( ADHD ) . While optimal EFs have been shown to depend on efficient sleep in healthy subjects , the impact of sleep problems , frequently reported in ADHD , remains elusive . Findings of macroscopic sleep changes in ADHD are inconsistent , but there is emerging evidence for distinct microscopic changes with a focus on prefrontal cortical regions and non-rapid eye movement ( non-REM ) slow-wave sleep . Recently , slow oscillations ( SO ) during non-REM sleep were found to be less functional and , as such , may be involved in sleep-dependent memory impairments in ADHD . Objective : By augmenting slow-wave power through bilateral , slow oscillating transcranial direct current stimulation ( so-tDCS , frequency = 0.75 Hz ) during non-REM sleep , we aim ed to improve daytime behavioral inhibition in children with ADHD . Methods : Fourteen boys ( 10–14 years ) diagnosed with ADHD were included . In a r and omized , double-blind , cross-over design , patients received so-tDCS either in the first or in the second experimental sleep night . Inhibition control was assessed with a visuomotor go/no-go task .  Intrinsic alertness was assessed with a simple stimulus response task . To control for visuomotor performance , motor memory was assessed with a finger sequence tapping task . Results : SO-power was enhanced during early non-REM sleep , accompanied by slowed reaction times and decreased st and ard deviations of reaction times , in the go/no-go task after so-tDCS . In contrast , intrinsic alertness , and motor memory performance were not improved by so-tDCS . Conclusion : Since behavioral inhibition but not intrinsic alertness or motor memory was improved by so-tDCS , our results suggest that lateral prefrontal slow oscillations during sleep might play a specific role for executive functioning in ADHD Successful automated diagnoses of attention deficit hyperactive disorder ( ADHD ) using imaging and functional biomarkers would have fundamental consequences on the public health impact of the disease . In this work , we show results on the predictability of ADHD using imaging biomarkers and discuss the scientific and diagnostic impacts of the research . We created a prediction model using the l and mark ADHD 200 data set focusing on resting state functional connectivity ( rs-fc ) and structural brain imaging . We predicted ADHD status and subtype , obtained by behavioral examination , using imaging data , intelligence quotients and other covariates . The novel contributions of this manuscript include a thorough exploration of prediction and image feature extraction methodology on this form of data , including the use of singular value decompositions ( SVDs ) , CUR decompositions , r and om forest , gradient boosting , bagging , voxel-based morphometry , and support vector machines as well as important insights into the value , and potentially lack thereof , of imaging biomarkers of disease . The key results include the CUR-based decomposition of the rs-fc-fMRI along with gradient boosting and the prediction algorithm based on a motor network parcellation and r and om forest algorithm . We conjecture that the CUR decomposition is largely diagnosing common population directions of head motion . Of note , a byproduct of this research is a potential automated method for detecting subtle in-scanner motion . The final prediction algorithm , a weighted combination of several algorithms , had an external test set specificity of 94 % with sensitivity of 21 % . The most promising imaging biomarker was a correlation graph from a motor network parcellation . In summary , we have undertaken a large-scale statistical exploratory prediction exercise on the unique ADHD 200 data set . The exercise produced several potential leads for future scientific exploration of the neurological basis of ADHD OBJECTIVES This study examined the hypothesis that domains of neurobehavioral function would be selectively affected by sleep-disordered breathing ( SDB ) . Therefore , we assessed potential relationships between objective ly measured sleep disturbances and neurobehavioral function in children with reported symptoms of attention-deficit/hyperactivity disorder ( ADHD ) and also determined the incidence of snoring and other sleep problems in 5- to 7-year-old children in the local community and potential relationships to parental snoring and passive smoking . METHODS Parents of 5- to 7-year-old children in public schools were surveyed about their child 's sleeping habits using a vali date d question naire . The question naire also asked whether they believed their child to be hyperactive or have ADHD . Children with reported symptoms of ADHD and control children were r and omly selected and invited to the Sleep Medicine Center for an overnight polysomnographic assessment and a battery of neurocognitive tests . RESULTS The question naire response rate was 47.6 % ( n = 5728 ) . Frequent and loud snoring was reported for 673 children ( 11.7 % ) . Similarly , 418 ( 7.3 % ) children were reported to have hyperactivity/ADHD , 313 ( 76.5 % ) of which were boys . Eighty-three children with parentally reported symptoms of ADHD were invited for full evaluation at the Sleep Medicine Center together with 34 control children . After assessment with the Conners ' Parent Rating Scale , 44 children were design ated as having " significant " symptoms of ADHD , 27 as " mild , " and 39 design ated as " none " ( controls ) . Overnight polysomnography indicated that obstructive sleep apnea was present in 5 % of those with significant ADHD symptoms , 26 % of those with mild symptoms , and 5 % of those with no symptoms . In the cohort , no sleep variable accounted for more than a negligible proportion of the variance in domains of neurobehavioral function . CONCLUSIONS An unusually high prevalence of snoring was identified among a group of children design ated as showing mild symptoms of ADHD based on the Conners ' ADHD index identified from a community sample . However , whereas SDB is not more likely to occur among children with significant ADHD symptoms , it is significantly highly prevalent among children with mild hyperactive behaviors . Sleep studies further revealed that rapid eye movement disturbances are more likely to occur in children with significant symptoms , and they seem to impose significant but mild effects on daytime neurobehavioral functioning . We conclude that in children with significant symptoms of ADHD , the prevalence of SDB is not different from that of the general pediatric population and that rapid eye movement sleep in these children is disturbed and may contribute to the severity of their behavioral manifestations . Furthermore , SDB can lead to mild ADHD-like behaviors that can be readily misperceived and potentially delay the diagnosis and appropriate treatment CONTEXT Previous studies have reported hypofunction , structural abnormalities , and biochemical abnormalities of the dorsal anterior midcingulate cortex ( daMCC ) in attention-deficit/hyperactivity disorder ( ADHD ) . Stimulant medications are effective treatments for ADHD , but their neural effects have not been fully characterized . OBJECTIVE To determine whether the methylpheni date hydrochloride osmotic-release oral system ( OROS ) would increase functional magnetic resonance imaging ( fMRI ) activation , compared with placebo , in the daMCC and other frontoparietal regions subserving attention during the Multi- Source Interference Task ( MSIT ) . DESIGN R and omized , placebo-controlled , 6-week , before-after fMRI study . SETTING Academic medical center ambulatory clinic . PATIENTS Twenty-one adults with ADHD r and omized to 6 weeks of treatment with methylpheni date OROS ( n = 11 ) or placebo ( n = 10 ) . INTERVENTIONS Patients underwent fMRI twice while performing the MSIT ( scan 1 at baseline and scan 2 at 6 weeks ) . MAIN OUTCOME MEASURES Group-averaged , r and om-effects , repeated- measures , general linear model analyses were used to compare daMCC ( and whole-brain ) fMRI activation during the MSIT . Individual-based daMCC volume-of-interest confirmatory analyses and behavioral data are also presented . RESULTS Performance and baseline fMRI measures in the daMCC and other a priori brain regions did not differ between groups . Group comparisons showed a group x scan interaction and t test confirmation of higher activation in the daMCC at 6 weeks in the methylpheni date OROS group than in the placebo group ( P < 1 x 10(-4 ) , cluster corrected for multiple comparisons ) . Individual daMCC volume-of-interest analyses confirmed group-averaged findings and suggested that daMCC activity might be related to clinical response . Methylpheni date OROS also produced higher activation in the dorsolateral prefrontal cortex and the parietal cortex at 6 weeks . CONCLUSION Methylpheni date OROS increased daMCC activation during the MSIT and may act , in part , by normalizing daMCC hypofunction in ADHD BACKGROUND Slow oscillations ( < 1 Hz ) during slow wave sleep ( SWS ) promote the consolidation of declarative memory .  Children with attention-deficit/hyperactivity disorder ( ADHD ) have been shown to display deficits in sleep-dependent consolidation of declarative memory supposedly due to dysfunctional slow brain rhythms during SWS . OBJECTIVE Using transcranial oscillating direct current stimulation ( toDCS ) at 0.75 Hz , we investigated whether an externally triggered increase in slow oscillations during early SWS elevates memory performance in children with ADHD . METHODS 12 children with ADHD underwent a toDCS and a sham condition in a double-blind crossover study design conducted in a sleep laboratory . Memory was tested using a 2D object-location task . In addition , 12 healthy children performed the same memory task in their home environment . RESULTS Stimulation enhanced slow oscillation power in children with ADHD and boosted memory performance to the same level as in healthy children . CONCLUSION These data indicate that increasing slow oscillation power during sleep by toDCS can alleviate declarative memory deficits in children with ADHD This prospect i ve longitudinal study evaluated the impact of daytime sleepiness on the school performance of 62 college students diagnosed comprehensively with attention deficit hyperactivity disorder . The primary goal of the study was to determine if self-reported daytime sleepiness rated at the beginning of the academic year could predict academic and overall functioning at the end of the academic year while also considering potentially important covariates , including symptoms of inattention , hyperactivity and impulsivity , medication status and whether or not students lived at home or on-campus . Self-reported  daytime sleepiness predicted longitudinally school maladjustment , overall functional impairment and the number of D and F grade s ( i.e. poor and failing ) students received in courses above and beyond both self- and parent-report of symptoms , but did not predict overall grade point average . Living at home served as a protective factor and was associated with less school maladjustment and overall impairment . Gender was the only significant predictor in the overall grade point average model , with female gender associated with higher overall grade s. The implication s of these findings for monitoring and treatment of sleep disturbances in college students with attention deficit hyperactivity disorder are discussed OBJECTIVES To investigate interindividual differences in neurobehavioral deficits during  sleep deprivation  , and to establish to what extent the neurobehavioral responses to sleep loss are a function of sleep history versus trait-like differential vulnerability . DESIGN Individuals were exposed to sleep deprivation on 3 separate occasions in order to determine the stability of interindividual differences in neurobehavioral impairment . SETTING The sleep-deprivation experiments were conducted under st and ardized laboratory conditions with continuous monitoring of wakefulness . Each subject underwent a laboratory-adaptation session before entering the sleep-deprivation phase of the study . PARTICIPANTS A total of 21 healthy adults ( aged 21 - 38 years ) completed the experiment . INTERVENTIONS Subjects came to the laboratory 3 times at intervals of at least 2 weeks . During each laboratory session , they underwent neurobehavioral testing every 2 hours during 36 hours of total sleep deprivation , which was preceded by baseline sleep and followed by recovery sleep . In the week prior to each sleep-deprivation session and on the baseline night in the laboratory , subjects were required to either restrict their sleep to 6 hours per day ( prior sleep restriction condition ) or to extend their time in bed to 12 hours per day ( prior sleep extension condition ) , so as to experimentally manipulate sleep history ( in r and omized counterbalanced order ) . RESULTS There was strong evidence that interindividual differences in neurobehavioral deficits during sleep deprivation were systematic and trait-like . The magnitude of interindividual variability was substantial relative to the magnitude of the effect of prior sleep restriction ( which on average involved a reduction of 4.1 hours sleep per day , compared to prior sleep extension , for 7 days ) . Overall , interindividual differences were not explained by subjects ' baseline functioning or a variety of other potential predictors . Interindividual variability clustered on 3 distinct neurobehavioral dimensions : self-evaluation of sleepiness , fatigue , and mood ; cognitive processing capability ; and behavioral alertness as measured by sustained attention performance . CONCLUSIONS Neurobehavioral deficits from sleep loss varied significantly among individuals and were stable within individuals . Interindividual differences in neurobehavioral responses to sleep deprivation were not merely a consequence of variations in sleep history . Rather , they involved trait-like differential vulnerability to impairment from sleep loss , for which neurobiologic correlates have yet to be discovered Abstract Attention Deficit Hyperactivity Disorder ( ADHD ) is associated with poor self‐control , underpinned by inferior fronto‐striatal deficits . Real‐time functional magnetic resonance neurofeedback ( rtfMRI‐NF ) allows participants to gain self‐control over dysregulated brain regions . Despite evidence for beneficial effects of electrophysiological‐NF on ADHD symptoms , no study has applied the spatially superior rtfMRI‐NF neurotherapy to ADHD . A r and omized controlled trial tested the efficacy of rtfMRI‐NF of right inferior prefrontal cortex ( rIFG ) , a key region that is compromised in ADHD and upregulated with psychostimulants , on improvement of ADHD symptoms , cognition , and inhibitory fMRI activation . To control for region‐specificity , an active control group received rtfMRI‐NF of the left parahippocampal gyrus ( lPHG ) . Thirty‐one ADHD boys were r and omly allocated and had to learn to upregulate their target brain region in an average of 11 rtfMRI‐NF runs over 2 weeks . Feedback was provided through a video‐clip of a rocket that had to be moved up into space . A transfer session without feedback tested learning retention as a proximal measure of transfer to everyday life . Both NF groups showed significant linear activation increases with increasing number of runs in their respective target regions and significant reduction in ADHD symptoms after neurotherapy and at 11‐month follow‐up . Only the group targeting rIFG , however , showed a transfer effect , which correlated with ADHD symptom reductions , improved at trend level in sustained attention , and showed increased IFG activation during an inhibitory fMRI task . This proof‐of‐concept study demonstrates for the first time feasibility , safety , and shorter‐ and longer‐term efficacy  of rtfMRI‐NF of rIFG in adolescents with ADHD . Hum Brain Mapp 38:3190–3209 , 2017 . © 2017 The Authors Human Brain Mapping Published by Wiley Periodicals , We used resting-state functional magnetic resonance imaging ( RS-fMRI ) to investigate the acute effects of methylpheni date hydrochloride ( MPH ) on spontaneous brain activity in children with attention deficit hyperactivity disorder ( ADHD ) . In all , 23 boys with ADHD were scanned twice , under either 10 mg dose of MPH or placebo , in a r and omized , cross-over , counterbalanced placebo-controlled design . 32 Matched healthy controls were scanned once for comparison . Seven of the 23 ADHD boys participated in a follow-up 8-week MPH treatment . A regional homogeneity ( ReHo ) method was applied to characterize the local synchronization of spontaneous brain activity .  ADHD boys under placebo compared with controls showed decreased ReHo in bilateral dorsolateral prefrontal cortices and increased ReHo in bilateral sensorimotor and parieto-visual cortices . Relative to placebo , MPH upregulated ReHo in bilateral ventral prefrontal cortices and cerebellar vermis , and downregulated ReHo in right parietal and visual areas that overlapped with the abnormally enhanced activities . When under MPH , ReHo differences between patients and controls were no longer observed . The preliminary prediction analysis revealed that the decreased ReHo in right parietal cortex after the acute MPH was positively correlated with the decreased symptom scores after the 8-week MPH treatment in the seven patients . We show that an acute dose of MPH normalized all fronto-parieto-cerebellar dysfunctions in boys with ADHD during the resting state . Preliminary findings furthermore suggest the potential of RS-fMRI as a prognostic imaging tool to identify response to MPH treatment BACKGROUND Children with Attention Deficit Hyperactivity Disorder ( ADHD ) have deficits in motivation and attention that can be ameliorated with the indirect dopamine agonist Methylpheni date ( MPH ) . We used functional magnetic resonance imaging ( fMRI ) to investigate the effects of MPH in medication-naïve children with ADHD on the activation and functional connectivity of " cool " attentional as well as " hot " motivation networks . METHODS 13 medication-naïve children with ADHD were scanned twice , under either an acute clinical dose of MPH or Placebo , in a r and omised , double-blind design , while they performed a rewarded continuous performance task that measured vigilant selective attention and the effects of reward . Brain activation and functional connectivity was compared to that of 13 healthy age-matched controls to test for normalisation effects of MPH . RESULTS MPH normalised performance deficits that were observed in children with ADHD compared to controls . Under placebo , children with ADHD showed reduced activation and functional inter-connectivity in bilateral fronto-striato-parieto-cerebellar networks during the attention condition , but enhanced activation in the orbitofrontal and superior temporal cortices for reward . MPH within children with ADHD enhanced the activation of fronto-striato-cerebellar and parieto-temporal regions . Compared to controls , MPH normalised differences during vigilant attention in parieto-temporal activation and fronto-striatal and fronto-cerebellar connectivity ;  MPH also normalised the enhanced orbitofrontal activation in children with ADHD in response to reward . CONCLUSIONS MPH normalised attention differences between children with ADHD and controls by both up-regulation of dysfunctional fronto-striato-thalamo-cerebellar and parieto-temporal attention networks and down-regulation of hyper-sensitive orbitofrontal activation for reward processing . MPH thus shows context -dependent dissociative modulation of both motivational and attentional neuro-functional networks in children with ADHD Abstract Objectives . We tested the hypothesis that sleep training would improve emotional , social and behavioural functioning in children with attention-deficit/hyperactivity disorder ( ADHD ) compared to children with ADHD without such intervention and to healthy controls . Methods . Forty children with ADHD were r and omly assigned to intervention and control conditions . Parents of 20 children with ADHD were instructed and thoroughly supervised in improving their children 's sleep schedules and sleep behaviour .  Parents of the other 20 children with ADHD and parents of 20 healthy children  received general information about sleep hygiene . At baseline and 12 weeks later , parents and children completed question naires related to children 's sleep and psychological functioning . Results . Relative to the control groups , children in the intervention group improved sleep quantitatively and qualitatively ( F values < 3.33 , P values < 0.05 ) . The intervention group children reported improvements in mood , emotions , and relationships ( F values < 2.99 , P values < 0.05 ) . Parents reported that their children improved in physical and psychological wellbeing , mood , emotions , relationships , and social acceptance ( F values < 3.02 , P values < 0.05 ) . Conclusions . Training and monitoring parents of children with ADHD in regulating and supervising children 's sleep schedules leads to positive changes in the emotions , behaviour and social lives of these children Attention Deficit Hyperactivity Disorder ( AD/HD ) is a neurodevelopmental disorder mainly characterized by impairments in cognitive functions . Functional neuroimaging studies carried out in individuals with AD/HD have shown abnormal functioning of the anterior cingulate cortex ( ACC ) during tasks involving selective attention . In other respects , there is mounting evidence that neurofeedback training ( NFT ) can significantly improve cognitive functioning in AD/HD children . In this context , the present functional magnetic resonance imaging ( fMRI ) study was conducted to measure the effect of NFT  on the neural substrates of selective attention in children with AD/HD . Twenty AD/HD children -- not taking any psychostimulant and without co-morbidity-participated to the study . Fifteen children were r and omly assigned to the Experimental ( EXP ) group ( NFT ) , whereas the other five children were assigned to the Control ( CON ) group ( no NFT ) . Subjects from both groups were scanned 1 week before the beginning of the NFT ( Time 1 ) and 1 week after the end of this training ( Time 2 ) , while they performed a Counting Stroop task . At Time 1 , for both groups , the Counting Stroop task was associated with significant loci of activation in the left superior parietal lobule . No activation was noted in the ACC . At Time 2 , for both groups , the Counting Stroop task was still associated with significant activation of the left superior parietal lobule . This time , however , for the EXP group only there was a significant activation of the right ACC . These results suggest that in AD/HD children , NFT has the capacity to normalize the functioning of the ACC , the key neural substrate of selective attention OBJECTIVE To determine the impact of immediate release Ritalin , given three times a day , on sleep quality and quantity in medication-naïve , newly diagnosed children with attention-deficit/hyperactivity disorder ( ADHD ) . METHODS Children ( aged 6 - 12 ) rigorously diagnosed with ADHD ( n = 21 ) underwent multiple measurement assessment s ( i.e. , actigraphy , sleep diary , and question naires ) during a 1-week baseline and then during a 3-week blinded r and omized medication trial . RESULTS Although the medication was effective in reducing ADHD symptoms , analyses of actigraphy and sleep diary data found statistically and clinical ly significant changes in the children 's total sleep time and sleep onset latency in the medication compared to the no medication conditions . No effects on sleep were found based on the sleep question naire . CONCLUSIONS Physicians and parents are encouraged to closely monitor children 's sleep when treating ADHD with stimulant medication PURPOSE As adjuvant therapy for enhancing the effects of stimulants and thereby minimizing medication doses , we hypothesized that aerobic exercise might be an effective adjunctive therapy for enhancing the effects of methylpheni date on the clinical symptoms , cognitive function , and brain activity of adolescents with attention deficit hyperactivity disorder ( ADHD ) . METHODS Thirty-five adolescents with ADHD were r and omly assigned to one of two groups in a 1/1 ratio ; methylpheni date treatment + 6-wk exercise ( sports-ADHD ) or methylpheni date treatment + 6-wk education ( edu-ADHD ) . At baseline and after 6 wk of treatment , symptoms of ADHD , cognitive function , and brain activity were evaluated using the Dupaul attention deficit hyperactivity disorder rating scale -- Korean version ( K-ARS ) , the Wisconsin Card Sorting Test , and 3-T functional magnetic resonance imaging , respectively . RESULTS The K-ARS total score and perseverative errors in the sports-ADHD group decreased compared with those in the edu-ADHD group . After the 6-wk treatment period , the mean β value of the right frontal lobe in the sports-ADHD group increased compared with that in the edu-ADHD group . The mean β value of the right temporal lobe in the sports-ADHD group decreased . However , the mean β value of the right temporal lobe in the edu-ADHD group did not change . The change in activity within the right prefrontal cortex in all adolescents with ADHD was negatively correlated with the change in K-ARS scores and perseverative errors . CONCLUSIONS The current results indicate that aerobic exercise increased the effectiveness of methylpheni date on clinical symptoms , perseverative errors , and brain activity within the right frontal and temporal cortices in response to the Wisconsin card sorting test stimulation CONTEXT Attention-deficit/hyperactivity disorder ( ADHD ) is a highly prevalent and impairing psychiatric disorder that affects both children and adults . There are Food and Drug Administration-approved stimulant and nonstimulant medications for treating ADHD ; however , little is known about the mechanisms by which these different treatments exert their therapeutic effects . OBJECTIVE To contrast changes in brain activation related to symptomatic improvement with use of the stimulant methylpheni date hydrochloride vs the nonstimulant atomoxetine hydrochloride . DESIGN Functional magnetic resonance imaging before and after 6 to 8 weeks of treatment with methylpheni date ( n = 18 ) or atomoxetine ( n = 18 ) using a parallel-groups design . SETTING Specialized ADHD clinical research program at Mount Sinai School of Medicine , New York , New York . PARTICIPANTS Thirty-six youth with ADHD ( mean [ SD ] age , 11.2 [ 2.7 ] years ; 27 boys ) recruited from r and omized clinical trials . MAIN OUTCOME MEASURES Changes in brain activation during a go/no-go test of response inhibition and investigator-completed ratings on the ADHD Rating Scale-IV-Parent Version . RESULTS Treatment with methylpheni date vs atomoxetine was associated with comparable improvements in both response inhibition on the go/no-go test and mean ( SD ) improvements in ratings of ADHD symptoms ( 55 % [ 30 % ] vs 57 % [ 25 % ] ) . Improvement in ADHD symptoms was associated with common reductions in bilateral motor cortex activation for both treatments . Symptomatic improvement was also differentially related to gains in task-related activation for atomoxetine and reductions in activation for methylpheni date in the right inferior frontal gyrus , left anterior cingulate/supplementary motor area , and bilateral posterior cingulate cortex . These findings were not attributable to baseline differences in activation . CONCLUSIONS Treatment with methylpheni date and atomoxetine produces symptomatic improvement via both common and divergent neurophysiologic actions in frontoparietal regions that have been implicated in the pathophysiology of ADHD . These results represent a first step in delineating the neurobiological basis of differential response to stimulant and nonstimulant medications for ADHD Attention Deficit Hyperactivity Disorder ( ADHD ) is characterized by poor cognitive control/attention and hypofunctioning of the dorsal anterior cingulate cortex ( dACC ) . In the current study , we investigated for the first time whether real-time fMRI neurofeedback ( rt-fMRI ) training targeted at increasing activation levels within dACC in adults with ADHD leads to a reduction of clinical symptoms and improved cognitive functioning . An exploratory r and omized controlled treatment study with blinding of the participants was conducted . Participants with ADHD ( n = 7 in the neurofeedback group , and n = 6 in the control group ) attended four weekly MRI training sessions ( 60-min training time/session ) , during which they performed a mental calculation task at varying levels of difficulty , in order to learn how to up-regulate dACC activation . Only neurofeedback participants received continuous feedback information on actual brain activation levels within dACC . Before and after the training , ADHD symptoms and relevant cognitive functioning was assessed . Results showed that both groups achieved a significant increase in dACC activation levels over sessions . While there was no significant difference between the neurofeedback and control group in clinical outcome , neurofeedback participants showed stronger improvement on cognitive functioning . The current study demonstrates the general feasibility of the suggested rt-fMRI neurofeedback training approach as a potential novel treatment option for ADHD patients . Due to the study ’s small sample size , potential clinical benefits need to be further investigated in future studies . Trial Registration : IS RCT STUDY OBJECTIVES Although subjective complaints about daytime cognitive functioning are an essential symptom of chronic insomnia , abnormalities in functional brain activation have not previously been investigated . This study was design ed to investigate functional brain activation differences as a possible result of chronic insomnia , and the reversibility of these differences after nonmedicated sleep therapy . DESIGN Insomniacs and carefully matched controls underwent functional magnetic resonance imaging ( fMRI ) scanning during the performance of a category and a letter fluency task . Insomniacs were r and omly assigned to either a 6-week period of nonpharmacological sleep therapy or a wait list period , after which fMRI scanning was repeated using parallel tasks . Task-related brain activation and number of generated words were considered as outcome measures . SETTING The outpatient sleep clinic of the VU University Medical Center , Department of Clinical Neurophysiology ; fMRI was performed at the Department of Radiology . PARTICIPANTS Twenty-one patients suffering from chronic insomnia and 12 matched controls . INTERVENTIONS Nonpharmacological sleep therapy for 6 weeks , consisting of cognitive behavioral therapy , body temperature and bright light interventions , sleep hygiene , and physical activity counseling . MEASUREMENT AND RESULTS Compared to controls , insomnia patients showed hypoactivation of the medial and inferior prefrontal cortical areas ( Brodmann Area 9 , 44 - 45 ) , which recovered after sleep therapy but not after a wait list period . CONCLUSIONS Insomnia interferes in a reversible fashion with activation of the prefrontal cortical system during daytime task performance
RESULTS Conjunction analyses revealed overlapping hypoactivations between ADHD and sleep loss in executive function regions , notably the dorsal anterior cingulate cortex .
Sleep deprivation , however , was associated with significantly exaggerated hyperactivation in the thalamus .
Our study indicates that ADHD and sleep deprivation share a common neural signature : hypoactivation of executive function neuroanatomy .
In contrast , sleep loss , but not ADHD , was associated with thalamic hyperactivations , intimating a potential compensatory response in sleep loss not present in ADHD .
STUDY OBJECTIVES Sleep disruption is common in attention deficit hyperactivity disorder ( ADHD ) .
Likewise , deficits in attention are a hallmark of sleep deprivation in healthy individuals .
Whether ADHD and sleep deprivation modulate common , or disparate , neural systems is unknown .
No study has yet utilized functional magnetic resonance imaging ( fMRI ) to investigate sleep loss in ADHD .
We address this gap by performing a novel meta- analysis to compare patterns of fMRI activation during sleep deprivation and ADHD .